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Isavuconazole is a new azole approved for adults with invasive aspergillosis and mucormycosis, with a favorable hepatic tolerability reported in Phase III trials. Here, we report on a case of drug-induced liver failure related to isavuconazole in a pediatric patient treated for invasive aspergillosis after bone marrow transplant.

Background: Invasive mold infections in children with hematological malignancies are associated with high mortality rates. The use of combination antifungal therapy in cases with a severe clinical course is increasing, although information on the efficacy and safety of this approach is limited., Methods: We present a case series of 13 children affected by hemato-oncological disorders who received combination antifungal therapy for invasive mold infections at our center (Pediatric Hematology, San Gerardo Hospital, Monza, Italy) from 2011 to 2016, with the aim of describing their clinical characteristics, types of infections, treatment regimens, clinical outcomes, and treatment safety. Medical records were retrospectively reviewed in order to describe patients' characteristics., Results: Combination antifungal therapy included liposomal amphotericin associated with caspofungin (5/13, 38.4%), voriconazole (5/13, 38.4%), or posaconazole (3/13, 23.1%). The 12-week treatment response rate was 69.2% (6/13 patients showed complete response, 3/13 partial response). The crude mortality was 30.7% (4/13): half was related to invasive mold infections (2/13, 15.38%) and half to disease progression (2/13, 15.38%). Overall, treatment was well tolerated, and we did not observe any permanent discontinuation of antifungals due to related side effects., Conclusions: In our experience, combination antifungal therapy seems to be a safe option in immunocompromised children with invasive mold infections. Well-designed studies are needed to confirm the safety of this approach and to better understand its efficacy in the pediatric setting., Competing Interests: The authors declare that they have no competing interests.

Introduction: Literature posits that discrimination can be a barrier to racial and ethnic minorities' healthcare use. This study examines the relationship between perceived discrimination in the form of racial microaggressions and delayed prenatal care in African American women. It also investigates whether this relationship is modified by women's shade of skin color owing to societal attitudes and beliefs tied to colorism (also known as skin-tone bias)., Methods: Data were collected from a cohort of 1,410 black, African American women in metropolitan Detroit, Michigan, enrolled in 2009-2011 (analyzed between August 2017 and July 2018). Perceived racial microaggressions were assessed using the 20-item Daily Life Experiences of Racism and Bother scale. Logistic regression modeled the relationship between the Daily Life Experiences of Racism and Bother scale and delayed prenatal care, defined as third trimester or no prenatal care entry., Results: Nearly a quarter (24.8%) of women had delayed prenatal care. Logistic regression models showed that a Daily Life Experiences of Racism and Bother score above the median was associated with delayed prenatal care (AOR=1.31, 95% CI=1.00, 1.71). This association was moderated by self-reported maternal skin tone (interaction p=0.03). A higher Daily Life Experiences of Racism and Bother score was associated with delayed prenatal care among African-American women at either end of the color continuum (light brown: AOR=1.64, 95% CI=1.02, 2.65; dark brown: AOR=2.30, 95% CI=1.20, 4.41) but not in the middle (medium brown women)., Conclusions: Skin tone-based mistreatment in tandem with racial discrimination in the form of racial microaggressions may influence African American women's use of prenatal care. These findings have implications related to the engagement of women of color, particularly African American women, in healthcare systems and maternal and child health programs., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

The classical nonhomologous end-joining (cNHEJ) pathway is a major DNA double-strand break repair pathway in mammalian cells and is required for lymphocyte development and maturation. The DNA-dependent protein kinase (DNA-PK) is a cNHEJ factor that encompasses the Ku70-Ku80 (KU) heterodimer and the large DNA-PK catalytic subunit (DNA-PKcs). In mouse models, loss of DNA-PKcs ( DNA-PKcs -/- ) abrogates end processing (e.g., hairpin opening), but not end-ligation, whereas expression of the kinase-dead DNA-PKcs protein ( DNA-PKcs KD/KD ) abrogates end-ligation, suggesting a kinase-dependent structural function of DNA-PKcs during cNHEJ. Lymphocyte development is abolished in DNA-PKcs -/- and DNA-PKcs KD/KD mice because of the requirement for both hairpin opening and end-ligation during V(D)J recombination. DNA-PKcs itself is the best-characterized substrate of DNA-PK. The S2056 cluster is the best-characterized autophosphorylation site in human DNA-PKcs. In this study, we show that radiation can induce phosphorylation of murine DNA-PKcs at the corresponding S2053. We also generated knockin mouse models with alanine- (DNA-PKcs PQR ) or phospho-mimetic aspartate (DNA-PKcs SD ) substitutions at the S2053 cluster. Despite moderate radiation sensitivity in the DNA-PKcs PQR/PQR fibroblasts and lymphocytes, both DNA-PKcs PQR/PQR and DNA-PKcs SD/SD mice retained normal kinase activity and underwent efficient V(D)J recombination and class switch recombination, indicating that phosphorylation at the S2053 cluster of murine DNA-PKcs (corresponding to S2056 of human DNA-PKcs), although important for radiation resistance, is dispensable for the end-ligation and hairpin-opening function of DNA-PK essential for lymphocyte development., (Copyright © 2019 by The American Association of Immunologists, Inc.)

B cell development requires efficient proliferation and successful assembly and modifications of the immunoglobulin gene products. CtIP is an essential gene implicated in end resection and DNA repair. Here, we show that CtIP is essential for early B cell development but dispensable in naive B cells. CtIP loss is well tolerated in G1-arrested B cells and during V(D)J recombination, but in proliferating B cells, CtIP loss leads to a progressive cell death characterized by ATM hyperactivation, G2/M arrest, genomic instability, and 53BP1 nuclear body formation, indicating that the essential role of CtIP during proliferation underscores its stage-specific requirement in B cells. B cell proliferation requires phosphorylation of CtIP at T847 presumably by CDK, but not its interaction with CtBP or Rb or its nuclease activity. CtIP phosphorylation by ATM/ATR at T859 (T855 in mice) promotes end resection in G1-arrested cells but is dispensable for B cell development and class switch recombination, suggesting distinct roles for T859 and T847 phosphorylation in B cell development., (© 2019 Liu et al.)

Objectives: Black Caribbeans in the United States have been the victims of major discrimination (e.g. unfairly fired, denied a promotion, denied housing). What is not known is the degree to which they also experience more routine forms of everyday discrimination such as receiving poor restaurant service, being perceived as dishonest, and being followed in stores. This paper investigates the distribution and correlates of everyday discrimination among a national sample of black Caribbeans in the U.S., Design: This analysis used the black Caribbean sub-sample (n = 1,621) of the National Survey of American Life. Demographic and immigration status correlates of ten items from the Everyday Discrimination Scale were investigated: being treated with less courtesy, treated with less respect, receiving poor restaurant service, being perceived as not smart, being perceived as dishonest, being perceived as not as good as others, and being feared, insulted, harassed, or followed in stores., Results: Roughly one out of ten black Caribbeans reported that, on a weekly basis, they were treated with less courtesy and other people acted as if they were better than them, were afraid of them, and as if they were not as smart. Everyday discrimination was more frequent for black Caribbeans who were male, never married, divorced/separated, earned higher incomes, and who were second or third generation immigrants. Black Caribbeans attributed the majority of the discrimination they experienced to their race., Conclusion: To our knowledge, this is the first study to provide an in-depth investigation of everyday discrimination among the black Caribbean population. It provides the frequency, types and correlates of everyday discrimination reported by black Caribbeans in the United States. Understanding the frequency and types of discrimination is important because of the documented negative impacts of everyday discrimination on physical and mental health.

Rationale: Research assessing the health-related consequences of perceived discrimination depends upon high quality measures of perceived discrimination. The Everyday Discrimination Scale (EDS) is among the most frequently used instruments to assess perceptions of discrimination in general, as well as specific types of discrimination (e.g., based on race/ethnicity or age). While numerous studies attest to its validity and reliability for racial/ethnic minority groups, no existing study has examined its psychometric equivalence across gender, age, or socio-economic groups. This study fills this gap., Hypothesis: We hypothesize that because social hierarchies of race/ethnicity, age, gender and class have different histories and are differently organized and institutionalized in contemporary United States, racial/ethnic, age, gender, and education-based groups differ in the types of discrimination they experience and perceive. As a result, the EDS may not be equivalent across these social groups., Method: We test this hypothesis by analyzing data from the 2015 US Texas Diversity Study (N=1,049), a telephone survey of English- and Spanish-speaking adults. We examine two forms of the EDS - one focusing on discrimination regardless of attribution and one focusing specifically on discrimination attributed to respondents' race/ethnicity., Results: Multi-group confirmatory factor analyses revealed that neither version of the scale generates estimates of discrimination that can be meaningfully compared across all racial/ethnic, age, gender, and education-based groups., Conclusions: Our results urge caution when drawing comparisons of perceived discrimination across diverse social groups based on the EDS and point to avenues for future scale development., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Adenovirus (AdV) infections are potentially life-threatening for allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. The AdVance study aimed to evaluate the incidence, management, and outcomes of AdV infections in European allo-HCT recipients., Methods: As part of the study, physician surveys were conducted to determine current AdV screening and treatment practices at their center., Results: All of the 28 respondents who treat pediatric patients reported routine AdV screening practices, with 93% screening all allo-HCT recipients and others screening those with transplant-related risk factors. Nearly all centers take a pre-emptive approach to AdV treatment in both high- (89%) and low-risk patients (75%). Among the 14 respondents who treat adult patients, 5 (36%) reported routine screening practices and few (21%) screen all allo-HCT recipients unless risk factors are present. In adults, pre-emptive AdV treatment is uncommon and quantitative AdV thresholds are rare. Typical treatment for all patients with symptomatic AdV infection is off-label intravenous cidofovir., Conclusions: Our findings confirm that screening for AdV is more common in pediatric patients. Antiviral treatment is employed in both pediatric and adult patients, although adults are generally treated when AdV disease is diagnosed. The approach to AdV screening and treatment is risk-based and consistent with clinical guidelines., (© 2018 The Authors. European Journal of Haematology Published by John Wiley & Sons Ltd.)

The possibility of using the first stage of the French System (FS) of vertical wetlands composed of only two units in parallel requires hydraulic investigations to allow a better understanding of its operation under tropical climatic environments. This study evaluated the pattern of the outflow hydrograph along an extended cycle of operation (seven days of feeding) and the influence of the sludge deposit, rainfall occurrence and duration of pulse application on the outflow hydrograph in a modified full-scale FS in Brazil. The results indicated that, as the feeding cycle days increased, there was an increase in the time of filtration and the internal storage of the liquid volume, probably due to a reduction in the filter permeability. Greater hydraulic gradient favoured the infiltration velocity, decreased the amount of liquid stored within the system, and delayed the loss of permeability. The sludge layer contributed to a momentary liquid retention, and also allowed greater evapotranspiration, reducing the liquid volume to be treated. The sludge deposit seemed to hinder the liquid percolation, especially at the end of the cycle, modifying the hydraulic conductivity of the filter as a whole. Intense rainfall events demonstrated that precipitation could modify the flow dynamics within the system.

This case demonstrates a novel preoxygenation technique in a patient with difficult access to the airway after a traumatic facial injury. To find a solution, a fusion of oxygenation equipment was trialed by altering and combining a tracheostomy mask and the tubing of an Optiflow circuit from which the nasal cannula component had been removed. This novel combination delivered high-flow humidified oxygen (60 L/min) orally, avoided further facial injury, and was well tolerated by the patient. Effective preoxygenation was confirmed by arterial gas measurements. This study supports the use of this novel Optiflow-tracheostomy mask fusion device in appropriately selected cases.

Introduction: At Hiwa Cancer Hospital (Sulaymaniyah, Iraqi Kurdistan) after the center was started by a cooperative project in June 2016, autologous transplantation was developed., Patients and Methods: To develop the project, the capacity-building approach was adopted, with on-site training and coaching of personnel, educational meetings, lectures, on-the-job training, and the implementation of quality management planning., Results: Here, we report initial results of peripheral-blood stem-cell mobilization and collection of the first 27 patients (age 12 to 61 years; 19 males and 8 females; multiple myeloma, n = 10; plasma cell leukemia, n = 1; Hodgkin lymphoma, n = 12; non-Hodgkin lymphoma, n = 3; and acute myeloid leukemia, n = 1). Only three (11.5%) of 26 patients experienced a failure of mobilization. A median of 6.1 × 10 6 /kg CD34-positive cells per patient were collected (range, 2.4 to 20.8), with two apheretic runs. Twenty-four patients underwent autologous transplantation. All but one transplantation engrafted fully and steadily, with 0.5 and 1.0 × 10 9 /L polymorphonucleates on day 10.5 (range, 8 to 12) and day 11 (range, 9 to 15), respectively, and with 20 and 50 × 10 9 /L platelets on day 13 (range, 10 to 17) and day 17 (range, 2 to 44), respectively. More than 95% of patients are projected to survive 1 year after autograft., Conclusion: These data are the result of an Italian effort to establish in Iraqi Kurdistan a leading center for hemopoietic stem-cell transplantation. The capacity building approach was used, with on-site training and coaching as instruments for the development of provider ability and problem solving. With future limitations for immigration, this method will be helpful, especially in the field of high-technology medicine.

The catalytic subunit of DNA-dependent protein kinase (DNA-PKcs) is a classical nonhomologous end-joining (cNHEJ) factor. Loss of DNA-PKcs diminished mature B cell class switch recombination (CSR) to other isotypes, but not IgG1. Here, we show that expression of the kinase-dead DNA-PKcs ( DNA-PKcs KD / KD ) severely compromises CSR to IgG1. High-throughput sequencing analyses of CSR junctions reveal frequent accumulation of nonproductive interchromosomal translocations, inversions, and extensive end resection in DNA-PKcs KD / KD , but not DNA-PKcs -/- , B cells. Meanwhile, the residual joints from DNA-PKcs KD/KD cells and the efficient Sµ-Sγ1 junctions from DNA-PKcs -/- B cells both display similar preferences for small (2-6 nt) microhomologies (MH). In DNA-PKcs -/- cells, Sµ-Sγ1 joints are more resistant to inversions and extensive resection than Sµ-Sε and Sµ-Sµ joints, providing a mechanism for the isotype-specific CSR defects. Together, our findings identify a kinase-dependent role of DNA-PKcs in suppressing MH-mediated end joining and a structural role of DNA-PKcs protein in the orientation of CSR., Competing Interests: The authors declare no conflict of interest.

The present study examined the impact of criminal justice contact on experiences of everyday discrimination among a national sample of African American men. African American men have a high likelihood of being targets of major discrimination, as well as experiencing disproportionate contact with the criminal justice system. Few studies, however, examine everyday discrimination (e.g., commonplace social encounters of unfair treatment) among this group. Using data from the National Survey of American Life, we provide a descriptive assessment of different types of everyday discrimination among African American men. Specifically, we examined differences in everyday discrimination among men who have never been arrested, those who have been arrested but not incarcerated, and men who have a previous history of criminal justice intervention categorized by type of incarceration experienced (i.e., reform school, detention, jail, or prison). Study findings indicated overall high levels of reported everyday discrimination, with increased likelihood and a greater number of experiences associated with more serious forms of criminal justice contact. However, in many instances, there were no or few differences in reported everyday discrimination for African American men with and without criminal justice contact, indicating comparable levels of exposure to experiences with unfair treatment.

Data from the 2001-2003National Survey of American Life are used to investigate the effects of phenotype on everyday experiences with discrimination among African Americans (N=3343). Latent class analysis is used to identify four classes of discriminatory treatment: 1) low levels of discrimination, 2) disrespect and condescension, 3) character-based discrimination, and 4) high levels of discrimination. We then employ latent class multinomial logistic regression to evaluate the association between skin tone and body weight and these four classes of discrimination. Designating the low level discrimination class as the reference group, findings revealed that respondents with darker skin were more likely to be classified into the disrespect/condescension and the high level microaggression types. BMI was unrelated to the discrimination type, although there was a significant interaction effect between gender and BMI. BMI was strongly and positively associated with membership in the disrespect and condescension type among men but not among women. These findings indicate that skin tone and body weight are two phenotypic characteristics that influence the type and frequency of discrimination experienced by African Americans.

We describe the entire process leading to the start-up of a hematopoietic stem cell transplantation center at the Hiwa Cancer Hospital, in the city of Sulaymaniyah, Kurdistan Iraqi Region. This capacity building project was funded by the Italian Development Cooperation Agency and implemented with the support of the volunteer work of Italian professionals, either physicians, nurses, biologists and technicians. The intervention started in April 2016, was based exclusively on training and coaching on site, that represent a significant innovative approach, and led to a first autologous transplant in June 2016 and to the first allogeneic transplant in October. At the time of reporting, 9 months from the initiation of the project, 18 patients have been transplanted, 15 with an autologous and 3 with an allogeneic graft. The center at the HCH represents the first transplantation center in Kurdistan and the second in wide Iraq. We conclude that international development cooperation may play an important role also in the field of high-technology medicine, and contribute to improved local centers capabilities through country to country scientific exchanges. The methodology to realize this project is innovative, since HSCT experts are brought as volunteers to the center(s) to be started, while traditionally it is the opposite, i.e. the local professionals to be trained are brought to the specialized center(s)., Competing Interests: Competing interests: The authors have declared that no competing interests exist.

African American female students' elevated suspension risk has received national attention. Despite a number of studies documenting racial/ethnic disparities in African American females' school suspension risk, few investigations have attempted to explain why these disparities occur. The purpose of this study was to examine the role of colorism in explaining suspension risk using a nationally representative sample of adolescent females. Controlling for individual- and school-level characteristics associated with school discipline such as student-teacher relationships, prior discipline history, school size and type, the results indicate that colorism was a significant predictor of school suspension risk. African American female adolescents with darker complexions were almost twice as likely to receive an out-of-school suspension as their White female peers. This finding was not found for African American female students with lighter skin complexions. Implications for adopting a colorist framework for understanding school discipline outcomes and future research for advancing the field in this area are discussed. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Objectives: This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans., Methods: This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6)., Results: Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination., Conclusions: This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John Wiley & Sons, Ltd., Competing Interests: Authors have no conflicts of interest., (Copyright © 2016 John Wiley & Sons, Ltd.)

Catheter-related bacteremias carry high mortality rates in hematological patients. When a multidrug-resistant microorganism is involved, the catheter should ideally be removed; however, this approach is not always possible. Tigecycline lock therapy was used in two pediatric oncohematological patients with intravascular catheter-related infection due to KPC-producing Klebsiella pneumoniae. The catheter was salvaged in both cases, and the patients were later discharged. Our experience suggests the usefulness of this approach in treating this type of infection., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)

We tested the possibility to prepare a hyperproteic and hyperenergetic supplementary food for malnutrition rehabilitation in children starting from available ingredients in popular markets in Sierra Leone. Twelve residents in Paediatrics from University of Parma, Italy, prepared in a hospital near the capital Freetown with modest technology a mixture of peanut flour, palm oil, milk powder, sugar and vitamins to which they gave the name of "Parma pap". Three hundred and thirty-two malnourished children (mean age 14±6.3 months) who were receiving Feeding Program Supplementations (FPS), were enrolled in the study: 177 participants received randomly FSP portions only (Group 1), and 159 participants were treated with FSP regimen plus a supplement of "Parma pap" (Group 2). Outcomes of the study were computed as WHZ-score increment (Δ value) by subtracting the discharge WHZ-score from the admission WHZ-score. The best Δ-WHZ-scores (>+4) were recorded among participants of Group 2 (64%) rather than in Group 1 (21%; p=0.040). The children receiving FSP portions plus "Parma pap" recovered faster (5.54 week on average) than those treated with FSP regimen only (8.16 on average). The percentage of children who did not recover was higher in Group 1 (25.3%) than in Group 2 (; 13%; p=0.05). A slight positive correlation has been found between WHZ-scores at admission and at the end of the study (r=0.19; p=0.045). During the experience in Sierra Leone we have had the chance to give "Parma pap" to twenty one malnourished children admitted to Xaverian Mission in Makeni, northern Sierra Leone, not taking other supplementary food. Sixteen of these children recovered in 4.9 week on average and five in 6 to 8 weeks. Mean Δ-WHZ-scores ranged between + 1 and + 5. The data from the present study suggest that "Parma pap" could be an effective additional food to FPS regimen in malnutrition recovering. Further researches are needed on the contrary to prove if "Parma pap" could be defined as a veritable ready to use therapeutic food, although this characteristic seems already to result from the experience in Makeni Mission.

Background: Human ascending thoracic aortic aneurysms (ATAAs) are life threatening and constitute a leading cause of mortality in the United States. Previously, we demonstrated that collagens α2(V) and α1(XI) mRNA and protein expression levels are significantly increased in ATAAs., Methods and Results: In this report, the authors extended these preliminary studies using high-throughput proteomic analysis to identify additional biomarkers for use in whole blood real-time RT-PCR analysis to allow for the identification of ATAAs before dissection or rupture. Human ATAA samples were obtained from male and female patients aged 65 ± 14 years. Both bicuspid and tricuspid aortic valve patients were included and compared with nonaneurysmal aortas (mean diameter 2.3 cm). Five biomarkers were identified as being suitable for detection and identification of ATAAs using qRT-PCR analysis of whole blood. Analysis of 41 samples (19 small, 13 medium-sized, and 9 large ATAAs) demonstrated the overexpression of 3 of these transcript biomarkers correctly identified 79.4% of patients with ATAA of ≥4.0 cm (P<0.001, sensitivity 0.79, CI=0.62 to 0.91; specificity 1.00, 95% CI=0.42 to 1.00)., Conclusion: A preliminary transcript biomarker panel for the identification of ATAAs using whole blood qRT-PCR analysis in men and women is presented.

Research demonstrates that the mental health of African Americans is negatively affected by discrimination, but few studies have investigated the effects of racial discrimination specifically and whether these effects vary by poverty and education levels. Using a sample of 3,372 African Americans from the National Survey of American Life (NSAL), we find a positive relationship between racial discrimination and depressive symptoms, with both lifetime and daily racial discrimination being more salient for depressive symptoms among impoverished African Americans than those living above 200% of the poverty line. Evaluating mediated moderation models, we also find that the conditional effects of socioeconomic status are mediated by poor African Americans' having fewer psychosocial resources. Namely, lower levels of mastery are influential in accounting for poor African Americans' greater vulnerability to both daily and lifetime discrimination. The findings highlight the importance of examining specific reasons for discrimination as well as mediated moderation in future research.

Background: Large-scale epidemiological studies support an important role for susceptibility genes in the pathogenesis of ischemic stroke, with phosphodiesterase 4D identified as the first gene predisposing to ischemic stroke. Several single nucleotide polymorphisms within the phosphodiesterase 4D gene have been implicated in the pathogenesis of stroke. Aim Undertake a multivariate analysis of six single nucleotide polymorphisms within the phosphodiesterase 4D gene in a previously defined Australian stroke cohort, to determine whether these single nucleotide polymorphisms have an association with ischemic stroke., Methods: This case-control study was performed using an existing genetic database of 180 ischemic stroke patients and 301 community controls, evaluated previously for cerebrovascular risk factors (hypertension, hypercholesterolemia, diabetes, paroxysmal atrial fibrillation, smoking and history of stroke in a first-degree relative). Based on previously reported associations with large vessel disease, ischemic stroke, cardioembolic stroke or a mixture of these, six single nucleotide polymorphisms in the phosphodiesterase 4D gene were selected for study, these being single nucleotide polymorphisms 13, 19, rs152312, 45, 83 and 87, based on previously utilized DeCODE nomenclature. Single nucleotide polymorphisms were genotyped using a sequence-specific polymerase chain reaction method and gel electrophoresis. Logistic regression was undertaken to determine the relevance of each polymorphism to stroke. Further analysis was undertaken to determine the risk of stroke following stratification for stroke sub-type and etiology., Results: Significant odds ratios were found to be associated with cardioembolic strokes in two single nucleotide polymorphisms: rs152312 and SNP 45 (P < 0 · 05)., Conclusions: Our findings demonstrated an association between cardioembolic stroke and phosphodiesterase 4D single nucleotide polymorphisms rs152312 and 45. No significant association was found for the other four single nucleotide polymorphisms investigated within the phosphodiesterase 4D gene. We propose that the results from this Australian population support the concept that a large prospective international study is required to investigate the role of phosphodiesterase 4D in the cardiogenic cause of ischemic stroke., (© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.)

CHOICES is a consumer driven program for addressing tobacco in people with mental illness that employs mental health peer counselors. Since 2005, CHOICES has conducted over 298 community visits reaching more than 10,000 smokers with mental illness (about 2500/year). A telephone based outcome study was conducted in 102 outpatient smokers who received a CHOICES peer-to-peer session. At 1-month follow up participants (N = 86; 84%) reported smoking an average of 13 cigarettes per day which was significantly reduced from a baseline of 19 (P < 0.001). Twenty-five individuals (29%) tried to quit smoking in the month after the peer session and another 47 (55%) reduced their smoking. Feedback from smokers about the program was positive. Most (N = 59, 71%) said it was a lot easier to talk with a consumer about smoking compared to their psychiatrist or staff. Peer-to-peer communication about tobacco use can be effective to increase awareness and change smoking behaviors.

Kawasaki disease is an acute febrile disease of unknown etiology, characterized by systemic vascular inflammation involving the small and medium sized arteries, with a predilection for the coronary arteries. It represents the leading cause of acquired heart diseases in children in developed countries. Diagnosis, difficult because of the clinical characteristics of the disease with typical signs and symptoms appearing sequentially and not simultaneously, may be even more complicated in case of unusual presentation, leading to delay in recognition, particularly in infant in whom a higher incidence of coronary arteries aneurysms has been reported. A high index of suspicion of Kawasaki disease must be maintained in case of prolonged fever in these patients. Timely appropriate treatment is essential to avoid severe sequels. We report the case of a 2 months old male infant with persistent febrile episode, transferred to us from another institution, who presented on echocardiography giant aneurysms on both coronary arteries.

We apply structural equation modeling techniques to data from the National Survey of American Life to investigate the relationship between perceived discrimination and depressive symptoms among African American women ages 18-98 years (N=2,299). In addition, we evaluate whether or not personal mastery accounts for the intensity of African American women's psychological response to discrimination and whether or not exposure to discrimination varies by skin complexion. Findings reveal that discrimination is a major threat to African American women's mental health. They are vulnerable to discrimination, in part, because discrimination undermines their beliefs in mastery making them less psychologically resilient. Experiences of discrimination do not differ by complexion. We conclude that complexion does not matter, but mastery does.

The aim of the present study was to evaluate the effect of a prolonged administration of phytoestrogens on sheep growth rate, female reproductive response, lamb carcass conformation and meat quality. To investigate these effects, two groups of Comisana sheep (24 females and 20 males, initial average live weights of 25.0 and 29.9kg, respectively) were fed on subterranean clover (SC, phytoestrogen content=0.8mg/g of DM) and Italian ryegrass (C, non-oestrogenic control diet) for about one year. Feedstuffs were offered ad libitum and supplemented with maize grain and sunflower meal to maintain an adequate and similar energy and protein intake. The results demonstrated that the prolonged administration of the selected subterranean clover cultivars, with low formononetin content (lower than 10% of total isoflavones on dry basis), did not affect ewe reproduction but induced a significant improvement in animal weigh gain and, in males, good carcass and meat characteristics.

Leishmaniasis is a parasitic disease that is transmitted through a bite of some species of sandflies. It is caused by obliged intra-cellular protozoa of the genus Leishmania and is responsible for a broad spectrum of clinical syndromes: cutaneous leishmaniasis (CL), visceral leishmaniasis (VL) and mucocutaneous leishmaniasis (ML). The visceral disease (classically known as "kala azar") is the most aggressive form and if undervalued is fatal. Here we describe the first case of visceral leishmaniasis in the Tharaka District reported in literature.

Context: GnRH analogs (GnRHa) are considered the treatment of choice for central precocious puberty (CPP). During GnRHa administration, the suppression of the pituitary-gonadal axis results in decreased rates of linear growth and skeletal maturation and in improved adult height. However, in some patients, the growth deceleration is so marked that the expected improvement in predicted adult height is not achieved., Objective: The objective of this study was to assess whether the addition of oxandrolone (Ox) may affect the height outcome of patients with CPP and growth deceleration during GnRHa treatment., Design: This was an open-label, clinical study., Setting: The study was performed at a pediatric endocrinology referral clinic., Patients: Twenty patients with CPP and marked growth deceleration during GnRHa treatment were studied., Interventions: Treatment consisted of GnRHa (Leuprorelina, 3.75 mg im every 28 d) alone (10 patients) or in combination with Ox (0.06 mg/kg.d by mouth) (10 patients)., Main Outcome Measure: The main outcome measure was the patients' adult height., Results: The adult height of the patients treated with GnRHa plus Ox was significantly higher than pretreatment predicted adult height (162.6 +/- 2.3 vs. 154.8 +/- 1.7 cm, mean +/- sem; P < 0.05) and target height (162.6 +/- 2.3 vs. 158.0 +/- 1.9; P > 0.05). Patients treated with GnRHa alone reached an adult height similar to the pretreatment predicted adult height (151.9 +/- 1.2 vs. 155.4 +/- 2.1 cm) but significantly lower than target height (151.9 +/- 1.2 vs. 156.6 +/- 1.4 cm; P < 0.005). No side effects were recorded in either group of patients., Conclusions: Combined GnRHa and Ox therapy is a viable treatment option for children with CPP and marked growth deceleration during treatment with GnRHa alone.

Nonfocused extracorporeal shock wave therapy (ESWT) treatment protocol is commonly used in veterinary practice. This study investigated the effects of four nonfocused ESWT treatments, given 2 weeks apart, on bone radiopharmaceutical uptake and radiographic and thermographic appearance in the metacarpal and metatarsal regions in six adult untrained horses. There were no measurable treatment effects determined by thermography (daily), scintigraphy (at 2-week intervals), and radiography (before study initiation and at study completion) between treated and control limbs. It was concluded that no gross evidence of bone remodeling is detectable by conventional clinical assessment when nonfocused ESWT is applied to healthy equine metacarpal or metatarsal bone.

Objective: To investigate the use of alternative therapies among different racial/ethnic groups in the USA. Specifically, we examined whether alternative medicine use differs for working aged whites, Asian Americans, African Americans, and Hispanics., Design: Using the 1996 Medical Expenditure Panel Survey, racial differences in utilization were investigated at two levels: (1) the bivariate level with no controls for other factors and (2) at the multivariate level with controls for age, sex, region, marital status, education, income, health status, satisfaction with conventional healthcare, and access measures., Results: Americans in this sample population used alternative and complementary therapies at a fairly low rate (6.5%). This 6.5%, however, was not consistent across all groups. African Americans and Hispanics were less likely than whites to utilize alternative therapies, whereas Asian Americans did not differ significantly from whites., Conclusions: The use of alternative and complementary therapies varied across racial/ ethnic groups. Evidence showed that individuals who were dissatisfied with the availability of conventional healthcare, who were in poor health, but very satisfied with their conventional provider were more likely to use complementary and alternative medicine (CAM) therapies. The addition of these variables to a logistic regression model did not change the findings for differential use by ethnicity, the relative ranking of groups, or the overall strength of the relationship.

This study explored body image as measured by perceptions of weight and appearance and its impact on adolescent drug use among predominately Mexican American middle school students in the southwest. Outcomes analyzed included lifetime and recent alcohol, cigarette, and marijuana use and antidrug norms. Disliking one's looks was more of a risk factor for boys, whereas negative weight perceptions were more of a risk factor for girls. Relative to more acculturated (English-dominant) Latinos (N=903), non-Latino Whites (N=121), and other non-Latino youth (N=107), less acculturated (Spanish-dominant) Latino youth (N=212) reported the poorest body image. However, more acculturated Latino youth with poor body image had the greatest risk of substance use. More acculturated Latino boys who disliked their looks reported relatively greater amounts of recent alcohol use, and those who rated their bodies as too thin reported higher lifetime cigarette use, a greater amount and frequency of recent cigarette use, and weaker antidrug norms. More acculturated Latina girls who thought they were too fat reported a greater amount and frequency of recent cigarette use. These findings suggest that low levels of acculturation may protect some Latino youth with poor body image from coping via substance use. In addition, they suggest that poor body image among some Latinos may result less from adoption of American thinness ideals but rather from attitudes and behaviors that devalue the characteristics of Latino appearance.

Background: The objective of the current study was to evaluate the adequacy and detection rates of SurePath after its implementation in Ontario., Methods: The detection and adequacy rates of the SurePath liquid-based cytology system (SP-LBC) were calculated for manually reviewed slides of the year 2002. The adequacy and detection rates from this study group were compared with a historical conventional smear (CS) group from the same laboratories during the same period of the previous year., Results: The SP-LBC study group consisted of 352,680 specimens with cytodiagnoses and the CS group included 378,990 specimens. The unsatisfactory rate for SP-LBC (0.24%) was less than that of the CS group (0.58%). The detection rate of atypical squamous cells (ASC+) by the SP-LBC group (4.69%) was greater than that of the CS group (3.81%), as was the detection rate of low-grade squamous intraepithelial lesions (LSIL+; 2.13% vs. 1.50% in the CS group). There was only a trend toward increased detection of high-grade squamous intraepithelial lesions (HSIL+) in the SP-LBC group (0.34%) relative to the CS group (0.31%), because the detection rate for carcinoma by SP-LBC declined., Conclusions: The implementation of SP-LBC has been followed by better specimen adequacy and detection rates for ASC+, LSIL+, and a trend of increased detection of HSIL+ relative to CS practice. To determine sensitivity rates, a histopathologic database for cervical carcinoma and precancer needs to be established.

Neurocutaneous syndromes are progressive multisystem disorders in which the dermatological findings may be apparent before the neurological signs and symptoms appear. Timely diagnosis is important for early detection of serious complications such as malignancies, for prompt interventions for learning or developmental problems, and for genetic counseling.

Using the American Changing Lives Survey, a nationally representative sample of adults residing in the United States, this research examines housewives' subjective evaluations of their housework and the subjective evaluations of paid employment among three groups of married women--professionals, sales-clerical, and service-blue collar wives. A major goal was to assess the usefulness of disaggregating employed women by occupational status. Depressive symptoms were regressed on five work conditions--autonomy, physical and time demands, boredom, and feeling appreciated--along with sociodemographic characteristics. The results indicate professional wives report fewer symptoms than homemakers, sales-clerical, and service-blue collar wives. Differences between professionals and homemakers are largely accounted for by professional women's more advantaged economic position. Nonprofessional employed women are more depressed than professionals even when their disadvantaged working conditions are controlled. We discuss the findings in view of research on the stress of combining full-time employment with homemaking and argue that balancing these two roles may be more difficult for some employed women than for others.

Purpose: We investigated whether health status (i.e., need characteristics) and financial resources (i.e., enabling characteristics) were important predictors of two types of functional adaptations among elderly adults: home modifications such as putting nonslip tape on rugs or installing more telephones and use of equipment for mobility or activities of daily living (ADLs) such as canes or walkers., Design and Methods: Participants were identified from the National Survey of Self-Care and Aging (n = 3,485), a nationally representative sample of noninstitutionalized U.S. adults aged 65 and older. Need and enabling characteristics were used to predict home modifications and equipment use in multinomial logistic analysis, controlling for predisposing characteristics., Results: Although several health-status (need) variables had significant, direct effects on functional adaptations, the effects of ADL limitations were diminished at higher levels of impairment. Among the financial (enabling) variables, subjective income measures and supplemental insurance had significant, direct effects on functional adaptations., Implications: Promotion of functional adaptations among elderly people may benefit from both a proactive approach that targets elders with few limitations and a consideration of financial factors in addition to health status.