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The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29, p

In collaboration with the American College of Veterinary Radiology

The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29, p .001, η

Resume La transplantation pulmonaire (TP) est le seul traitement qui puisse etre propose pour permettre la survie des patients en insuffisance respiratoire terminale. L’objectif de notre etude est d’explorer les progres realises au cours des deux dernieres decennies pour demontrer l’efficacite et la securite de ce traitement. Methodes Analyse retrospective d’une cohorte monocentrique des 600 premiers patients ayant eu consecutivement une TP a l’hopital Foch (Suresnes, France) entre 1988 et 2014. Cette cohorte a ete divisee en 3 groupes chronologiques de 200 patients (1988–2004, 2004–2011, 2011–2014) Resultats La duree d’attente, la mortalite perioperatoire, l’incidence des rejets aigus cellulaires de la premiere annee et du rejet chronique (RC) a 5 ans ont toutes diminue. La survie actuarielle globale a 1 et 5 ans, de 78 % et 57 % pour les 600 patients, est passee a 86 % et 75 % pour les 200 derniers (> 2011). Elle est meilleure a 5 ans pour la mucoviscidose (68 %) que pour l’emphyseme (54 %) et la fibrose pulmonaire (37 %). Pour les 200 derniers patients, elle est a 5 ans de 81 % pour la mucoviscidose, de 78 % pour l’emphyseme et de 47 % pour les fibroses. Elle est de 60 % a 5 ans en cas de transplantation dite de super-urgence. Une surveillance attentive et prolongee doit detecter les complications proliferatives et gerer l’hypertension et la toxicite renale medicamenteuse. Conclusion En 25 ans, des progres considerables en TP ont hisse cette procedure au rang de therapeutique reconnue de l’insuffisance respiratoire chronique terminale.

Objective We conducted a controlled randomized preliminary trial of an expanded online version of the Body Project (n = 46) compared to an assessment-only control condition (n = 36) via a longitudinal design (baseline, postintervention, 2-month follow-up) in a community sample of women (N = 82) with clinical (n = 53) and subclinical (n = 29) eating disorder symptoms. Method The traditional content of the Body Project was modified to include verbal, written, and behavioral exercises designed to dissuade objectification and maladaptive social comparison and adapted to an online format. Body dissatisfaction, self-esteem, self-objectification, thin-ideal internalization, maladaptive social comparison, trait anxiety, positive affect, negative affect, and eating disorder symptomatology were evaluated in the control and the online expanded Body Project condition at baseline, postintervention, and 2-month follow-up. Results A 2 (condition: online expanded Body Project, control) × 3 (time: baseline, postintervention, 2-month follow-up) mixed factorial multivariate analysis of variance (MANOVA) was conducted to examine statistically significant group differences. As predicted, results indicated a statistically significant condition × time interaction. Conclusions Participants in the expanded online Body Project condition showed significant reductions in eating disorder symptoms and several associated psychological risk correlates from baseline to postintervention and follow-up; contrary to predictions, eating disorder symptoms and risk correlates were not significantly lower in the online expanded Body Project condition compared to the waitlist control condition at postintervention or 2-month follow-up.

Objective The purpose of this study was to identify cardiac biomarkers of disordered eating as a function of diagnostic subtype as assessed via self-report inventory. Method Mean heart rate (HR), systolic and diastolic blood pressure, mean R wave amplitude (mV), mean T wave amplitude (mV), QTc interval (sec), Tpeak-Tend interval prolongation (sec), QTc interval prolongation (sec), QRS prolongation (sec), and spectral indicators of cardiac dysfunction (LF/HF spectral ratio, HF spectral power) were assessed via electrocardiography among women with no eating disorder symptoms (n = 32), subclinical eating disorder symptoms (n = 92), anorexia nervosa (n = 7), bulimia nervosa (n = 89), binge eating disorder (BED: n = 20), and other specified feeding and eating disorders (OSFED: n = 19). Results MANOVA results showed statistically significant group differences. Follow-up tests revealed significantly decreased mean R wave amplitude among participants with self-indicated clinical (bulimia nervosa, binge eating disorder) and subclinical forms of disordered eating compared to asymptomatic controls. Discussion Results suggest decreased mean R wave amplitude is a promising cardiac biomarker of disordered eating.

Made available in DSpace on 2020-12-12T01:17:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Background and aims Fecal microbial transplantation (FMT), a treatment for certain gastrointestinal conditions associated with dysbiosis in people, is also empirically employed in horses with colitis. This study used microbiota high-throughput sequencing to compare the fecal microbial profile of healthy horses to that of geriatric microbial transplant recipients experiencing diarrhea and tested whether FMT restores microbiota diversity. Methods To evaluate the effect of environment and donor characteristics on the intestinal microbiota, fecal samples were collected per rectum from 15 healthy young-adult (2–12 years) and 15 geriatric (≥20 years) horses. Additionally, FMT was performed for 3 consecutive days in 5 geriatric horses with diarrhea using feces from the same healthy donor. Fecal samples were collected from both donor and recipient prior to each FMT and from recipients 24 hours following the last FMT. The profile of the fecal bacterial microbiota was compared using 16S amplicon sequencing. Results and conclusions In contrast to diet and farm location, age did not significantly affect the healthy equine fecal microbiota, indicating that both healthy geriatric and young-adult horses may serve as FMT donors. The fecal microbiota of horses with diarrhea was significantly more variable in terms of β-diversity than that of healthy horses. An inverse correlation between diarrhea score and relative abundance of Verrucomicrobia was identified in surviving FMT recipients. At study completion, the fecal microbiota of horses which responded to FMT had a higher α-diversity than prior to treatment and was phylogenetically more similar to that of the donor. Department of Clinical Sciences Cummings School of Veterinary Medicine Tufts University Department of Infectious Diseases and Global Health Cummings School of Veterinary Medicine Tufts University Faculdade de Medicina Veterinária Universidade Estadual Paulista (Unesp) Equine Field Service Auburn University Faculdade de Medicina Veterinária Universidade Estadual Paulista (Unesp)

OBJECTIVES To determine the impact of age on survival in horses with colitis and to elucidate whether a lower type-1/type-2 cytokine ratio or an exaggerated inflammatory state contribute to reduced survival in aged horses. DESIGN Part 1: Retrospective cohort analysis. Part 2: Analytic observational study. ANIMALS Part 1: One hundred twenty-four adult horses with colitis. Part 2: Twenty-nine adult horses with new diarrhea onset while hospitalized. MEASUREMENTS AND MAIN RESULTS Part 1: Patient signalment, select clinicopathological data, diagnoses, treatment, hospitalization length, and invoice were compared between survivors (n = 101) and nonsurvivors (n = 23). Only age and plasma transfusion retained statistical significance in the final multivariate outcome model, with 8.5 times lower odds of survival in transfused horses (95% confidence interval [CI], 2.6-27.2%). Additionally, the likelihood of nonsurvival increased by 11.8% (95% CI, 4-20.2%) for every year the horse aged (P = 0.002). Similarly, geriatric horses (≥20 years) were 15.2 times more likely to die than young-adults (2-12 years, P = 0.03), independent of financial investment, documented comorbidities, and duration of hospitalization. Part 2: Select cytokine analyses were performed on serum collected from hospitalized horses within 1 hour of diarrhea onset (T0) and 6 hours later. At T0, all recorded clinicopathological variables were comparable between geriatric and young-adult horses, suggesting a similar degree of systemic illness. The median concentration of type-2 cytokines interleukin-4 and interleukin-10, and type-1 cytokine interferon-γ did not differ between age groups. Inflammatory cytokines interleukin-6 and tumor necrosis factor-α were significantly higher in geriatric compared to young-adult horses at both sampling time points. CONCLUSIONS Outcome of colitis was less favorable in aging horses and patients receiving a plasma transfusion. Although an exaggerated inflammatory state, based on increased interleukin-6 and tumor necrosis factor-α concentrations, in geriatric horses may contribute to reduced survival, a lower type-1/type-2 cytokines ratio was not identified in our geriatric population.

MRI has the unique ability to detect abnormal fluid content, and is therefore unparalleled in its role of detection, diagnosis, prognosis, treatment planning and follow-up evaluation of musculoskeletal disease. MRI in companion animals should be considered in the following circumstances: a definitive diagnosis cannot be made on radiographs; a patient is nonresponsive to medical or surgical therapy; prognostic information is desired; assessing surgical margins and traumatic and/or infectious joint and bone disease; ruling out subtle developmental or early aggressive bone lesions. The MRI features of common disorders affecting the shoulder, elbow, stifle, carpal, and tarsal joints are included in this chapter.

Background Homeostatic turnover of the extracellular matrix conditions the structure and function of the healthy lung. In lung transplantation, long-term management remains limited by chronic lung allograft dysfunction, an umbrella term used for a heterogeneous entity ultimately associated with pathological airway and/or parenchyma remodeling. Objective This study assessed whether the local cross-talk between the pulmonary microbiota and host cells is a key determinant in the control of lower airway remodeling posttransplantation. Methods Microbiota DNA and host total RNA were isolated from 189 bronchoalveolar lavages obtained from 116 patients post lung transplantation. Expression of a set of 11 genes encoding either matrix components or factors involved in matrix synthesis or degradation (anabolic and catabolic remodeling, respectively) was quantified by real-time quantitative PCR. Microbiota composition was characterized using 16S ribosomal RNA gene sequencing and culture. Results We identified 4 host gene expression profiles, among which catabolic remodeling, associated with high expression of metallopeptidase-7, -9, and -12, diverged from anabolic remodeling linked to maximal thrombospondin and platelet-derived growth factor D expression. While catabolic remodeling aligned with a microbiota dominated by proinflammatory bacteria (eg, Staphylococcus, Pseudomonas, and Corynebacterium), anabolic remodeling was linked to typical members of the healthy steady state (eg, Prevotella, Streptococcus, and Veillonella). Mechanistic assays provided direct evidence that these bacteria can impact host macrophage-fibroblast activation and matrix deposition. Conclusions Host-microbes interplay potentially determines remodeling activities in the transplanted lung, highlighting new therapeutic opportunities to ultimately improve long-term lung transplant outcome., Graphical abstract

We describe the results of adding a new biological agent HEMO

Lung transplantation is deemed to be the only effective therapy that improves survival for patients with end stage lung disease. The aim of our study was to examine the progress achieved over the last two decades and to demonstrate the effectiveness and safety of this treatment.A retrospective analysis of a cohort of 600 consecutive lung transplant patients treated at the hospital Foch (Suresnes, France) between 1988 and 2014. They were split into three groups of 200 patients each: 1988-2004, 2004-2011, 2011-2014.Time and mortality on waiting list, perioperative mortality, the incidence of acute rejection in the first year and chronic lung allograft dysfunction (CLAD) at 5 years posttransplantation, have all decreased. Global survival at 1 and 5 years for the 600 patients increased from 78% and 57% to 86% and 75% respectively for the 200 last patients. Patients with cystic fibrosis have a better 5 year survival than those with emphysema or pulmonary fibrosis (68% vs. 54 % for emphysema and 37% for fibrosis). For the last 200 patients, 5 year survival is 81% for CF patients, 78 % for emphysema and 47% for fibrosis. Emergency transplantation had a 60% 5 years survival. Proliferative complications, arterial hypertension and renal function impairment are being monitored long term.The twenty-five years experience shows a consistent improvement in the results of lung transplantation which is now accepted as the only effective curative treatment for end stage lung disease.

OBJECTIVES Only 15% of brain death donors are considered suitable for lung transplantation (LTx). The normothermic ex vivo lung perfusion technique is used to potentially increase the availability of high-risk lung donors. We report our experience of LTx with initially rejected donors after ex vivo lung reconditioning (EVLR). METHODS From April 2011 to May 2013, we performed EVLR for 32 pairs of donor lungs deemed unsuitable for transplantation and rejected by the 11 French lung transplant teams. After EVLR, lungs with acceptable function were transplanted. During the same period, 81 double-lung transplantations (DLTx) were used as controls. RESULTS During EVLR, 31 of 32 donor lungs recovered physiological function with a median PO2/FiO2 ratio increasing from 274 (range 162-404) mmHg to 511 (378-668) mmHg at the end of EVLR (P < 0.0001). Thirty-one DLTx were performed. The incidence of primary graft dysfunction 72 h after LTx was 9.5% in the EVLR group and 8.5% in the control group (P = 1). The median time of extubation, intensive care unit and hospital lengths of stay were 1, 9 and 37 days in the EVLR group and 1 (P = 0.17), 6 (P = 0.06) and 28 days (P = 0.09) in the control group, respectively. Thirty-day mortality rates were 3.3% (n = 1) in the EVLR group and 3.7% (n = 3) in the control group (P = 0.69). One-year survival rates were 93% in the EVLR group and 91% in the control group. CONCLUSIONS EVLR is a reliable and repeatable technique that offers a significant increase of available donors. The results of LTx with EVLR lungs are similar to those obtained with conventional donors.

BACKGROUND AND PURPOSE Lung macrophages are critically involved in respiratory diseases. This study assessed the effects of the PDE4 inhibitor roflumilast and its active metabolite, roflumilast N-oxide on the release of a range of chemokines (CCL2, 3, 4, CXCL1, 8, 10) and of TNF-α, from human lung macrophages, stimulated with bacterial lipopolysaccharide LPS. EXPERIMENTAL APPROACH Lung macrophages isolated from resected human lungs were incubated with roflumilast, roflumilast N-oxide, PGE2, the COX inhibitor indomethacin, the COX-2 inhibitor NS-398 or vehicle and stimulated with LPS (24 h). Chemokines, TNF-α, PGE2 and 6-keto PGF1α were measured in culture supernatants by immunoassay. COX-2 mRNA expression was assessed with RT-qPCR. PDE activities were determined in macrophage homogenates. KEY RESULTS Expression of PDE4 in lung macrophages was increased after incubation with LPS. Roflumilast and roflumilast N-oxide concentration-dependently reduced the LPS-stimulated release of CCL2, CCL3, CCL4, CXCL10 and TNF-α from human lung macrophages, whereas that of CXCL1 or CXCL8 was not altered. This reduction by the PDE4 inhibitors was further accentuated by exogenous PGE2 (10 nM) but abolished in the presence of indomethacin or NS-398. Conversely, addition of PGE2 (10 nM), in the presence of indomethacin restored inhibition by roflumilast. LPS also increased PGE2 and 6-keto PGF1α release from lung macrophages which was associated with an up-regulation of COX-2 mRNA. CONCLUSIONS AND IMPLICATIONS Roflumilast and roflumilast N-oxide reduced LPS-induced release of CCL2, 3, 4, CXCL10 and TNF-α in human lung macrophages.

Thirty one peripheral blood stem cell mobilizations using cyclophosphamide, followed by leucapheresis, were performed in 25 patients with a variety of haematological malignancies. Cyclophosphamide at doses ranging from 0.25 g/M2/day x 4 days to 4 g/M2 on one day were given. Total doses of cyclophosphamide less than 4 g/M2 failed to induce a significant mobilization of stem cells into the peripheral blood. This compares to cyclophosphamide doses of 4 g/M2 given over one or two days where 70%-75% of patients yielded adequate stem cells for transplantation (greater than 20 x 10(4) CFU-GM/kg). Both the presence of tumour cells in the bone marrow and previous chemotherapy within 12 months of cyclophosphamide infusion significantly diminished the patients stem cell mobilizations. The rate of recovery of the patient's leucocyte count following cyclophosphamide was highly correlated to the peak level of PB CFU-GM and is a good indicator of the total stem cell yield. Fever in 50% of patients during the period of cytopaenia was the only complication seen in our patients and thus high dose cyclophosphamide is a suitable and safe agent for mobilizing haemopoietic stem cells.

This preliminary study attempts (1) to examine differences in posttraumatic symptomatology in predominately minority, sheltered battered women (n= 55) as a function of childhood trauma histories; and (2) to disentangle the impact of two often confounded forms of childhood trauma: exposure to family violence and direct childhood maltreatment. Controlling for current domestic violence (DV), hierarchical regression analyses showed childhood emotional abuse mediated the adverse effects of childhood exposure to family violence on PTSD symptomatology (i.e., hyperarousal, intrusion). Avoidant symptoms were most strongly predicted by current domestic violence, with psychological abuse adding significantly to the variance explained above and beyond physical abuse.

Studies have demonstrated that women with a history of childhood sexual abuse (CSA) are at increased risk of revictimization, but research has not yet examined whether a history of CSA may affect patterns of remaining in or returning to abusive relationships in adulthood. This study examines the impact of a CSA history on decisions to return to abusive relationships in a sample of 104 adult domestic violence survivors. Participants were interviewed about the number of times that they had previously separated from and returned to their abusive partner, the factors that influenced their decision to return (both psychological/internal and environmental/external factors), and their perceived likelihood of returning in the future. As predicted, CSA survivors (n = 34) reported a significantly greater number of past separations than non-CSA survivors (n = 70). CSA survivors were also significantly more likely to report that their decisions to return were influenced by emotional attachment to the batterer. CSA survivors did not perceive themselves to be at greater risk of returning in the future, suggesting that they may be more likely to underestimate their vulnerability to returning to the battering relationship. Clinical implications of the findings are discussed.

We report the preliminary result of the application of the collisional Ne-like soft x-ray laser as radiation source to induce DNA damage. The goal of this experiment was a test bed study of the damage yields induced by soft x-ray radiation in dried plasmid DNA sample. The saturated Ne-like soft x-ray laser available at the PALS facility, delivering several millijoules in a single 100 ps pulse at 21.2 nm was used to irradiate two different plasmids: pSPl 89 and pBS. The study is centered on the dose effect leading to single and double strand break in DNA.

While past experiments on animals, birds, fish, and insects have shown changes in stable isotope ratios due to nutritional stress, there has been little research on this topic in humans. To address this issue, a small pilot study was conducted. Hair samples from eight pregnant women who experienced nutritional stress associated with the nausea and vomiting of morning sickness (hyperemesis gravidarum) were measured for carbon (delta13C) and nitrogen (delta15N) stable isotope ratios. The delta13C results showed no change during morning sickness or pregnancy when compared with pre-pregnancy values. In contrast, the delta15N values generally increased during periods of weight loss and/or restricted weight gain associated with morning sickness. With weight gain and recovery from nutritional stress, the hair delta15N values displayed a decreasing trend over the course of gestation towards birth. This study illustrates how delta15N values are not only affected by diet, but also by the nitrogen balance of an individual. Potential applications of this research include the development of diagnostic techniques for tracking eating disorders, disease states, and nitrogen balance in archaeological, medical, and forensic cases.

RESUME L’Academie nationale de medecine avait consacre, en 1997, un rapport aux effets du soleil sur l’organisme humain. Depuis cette date, la prevention a fait relativement peu de progres tandis que les connaissances biologiques se sont considerablement accrues : — Alors que l’on croyait que seuls les rayons ultraviolets tres energetiques (UVB) provoquaient des cancers, on sait aujourd’hui que les ultraviolets moins energetiques (UVA) y contribuent autant et dans certaines conditions davantage. Les produits antisolaires devraient filtrer avec la meme efficacite les UVA et les UVB. Les produits ne filtrant que les UVB doivent etre vigoureusement deconseilles. — Il n’y a pas de parallelisme entre les effets aigus notamment l’erytheme et les coups de soleil et les effets chroniques car les mecanismes biologiques sont differents. La disparition des coups de soleil grâce a l’utilisation des cremes antisolaires n’assure donc pas une reduction equivalente du vieillissement de la peau et du risque de cancer. — Les rayons UV peuvent leser l’œil (cristallin et retine). Seules des lunettes contre le soleil filtrant les UVA et B assurent une protection efficace. — Les campagnes de prevention et de depistage ont contribue a l’information du public, mais l’effet est insuffisant et un effort complementaire est indispensable pour obtenir une meilleure prevention et notamment reduire l’exposition des enfants. Les patients souffrant d’un melanome mouraient une fois sur quatre il y a 10 ans, ils meurent maintenant une fois sur cinq : c’est le resultat des campagnes de diagnostics precoces repetees chaque annee. Ce progres est reel mais tres insuffisant d’autant que la frequence de ces cancers continue a augmenter de 10 % chaque annee. Par ailleurs, les carcinomes basocellulaires, egalement lies a l’exposition au soleil, sont les plus frequents des cancers humains et, meme si leur mortalite est tres faible, leur morbidite est importante et couteuse. Dans les deux cas, ces resultats sont decevants car, parmi les agressions de notre environnement, les consequences des expositions excessives aux ultraviolets sont particulierement bien connues et constituent meme un modele des interactions entre sante et environnement. S’il est helas clair que l’information ne suffit pas a changer les comportements, elle est neanmoins necessaire et doit etre dirigee a la fois vers les medecins praticiens, les professions de sante et le grand public Il faut en suivre les resultats et rechercher comment ameliorer leur efficacite. La protection des enfants : un enjeu prioritaire * 70 % de l’exposition totale au soleil, pendant une vie humaine, se fait avant 17 ans. * Le systeme pigmentaire est immature chez l’enfant et l’adolescent et sa sensibilite au soleil est particuliere comme le prouve la correlation entre l’augmentation du nombre des « grains de beaute » et l’exposition au soleil. D’autre part le risque de voir se developper un melanome augmente avec le nombre de grains de beaute. * L’education a la bonne utilisation de l’environnement est d’autant plus efficace, en terme de comportement, qu’elle est commencee tot, a l’ecole, des la petite enfance et, en tout cas, avant l’adolescence. Il est essentiel de rappeler chaque annee les regles de prudence : eviter les jeux en plein air entre midi et 16 heures, favoriser la protection vestimentaire, renouveler regulierement les produits de photo protection et utiliser des produits donnant une protection forte (indice 40). Une attention particuliere doit etre apportee a la protection des yeux car le soleil a une forte responsabilite dans la survenue des cataractes et peut-etre des lesions retiniennes. Les lunettes de soleil de mauvaise qualite, filtrant mal les ultraviolets, trop souvent proposees aux enfants, aggravent les dommages provoques par les ultraviolets car en diminuant l’eblouissement et la contraction reflexe de la pupille elles augmentent l’exposition du cristallin aux ultraviolets. Seules les lunettes de soleil comportant un marquage CE indiquant l’efficacite de protection, devraient etre autorisees.

Carbon (13C/12C) and nitrogen (15N/14N) stable isotope ratios were longitudinally measured in human hair that reflected the period from pre-conception to delivery in 10 pregnant women. There was no significant change in the delta13C results, but all subjects showed a decrease in delta15N values (-0.3 to -1.1 per thousand) during gestation. The mechanisms causing this decrease in hair delta15N have not been fully elucidated. However, since the delta15N values of dietary nitrogen and urea nitrogen are significantly lower compared to maternal tissues, it is hypothesized that the increased utilization of dietary and urea nitrogen for tissue synthesis during pregnancy resulted in a reduction of the steady state diet to a body trophic level effect by approximately 0.5-1 per thousand. An inverse correlation (R2 = 0.67) between hair delta15N and weight gain was also found, suggesting that positive nitrogen balance results in a reduction of delta15N values independent of diet. These results indicate that delta15N measurements have the ability to monitor not only dietary inputs, but also the nitrogen balance of an organism. A potential application of this technique is the detection of fertility patterns in modern and ancient species that have tissues that linearly record stable isotope ratios through time.

New technologies have become available to minimize the adverse events of extracorporeal devices. Link to these technological improvements ECMO in lung transplantation is currently essential. Bridging to lung transplantation changes to concepts avoiding the sequels mechanical ventilation and thereby offers improvement of lung recipients prior to the transplant procedure. Its use as hemodynamic and respiratory support during the lung transplant surgery can replace conventional Cardiopulmonary bypass. And finally, ECMO is sometimes the only alternative in the most severe forms of primary graft failure.

This study examines the impact of two factors, intergenerational substance abuse and exposureto domestic violence, on the lifetime attempted suicide histories of adult, minority, batteredwomen residing in a domestic violence shelter. A total of 122 women, mostly African Americanand Latina, were interviewed to obtain their retrospective reports of the frequency and use ofsubstances and on the incidences of domestic violence among their immediate (first-degree) andextended (second-degree) family members. Results revealed that battered women with a historyof suicide attempts (n = 45) were more likely to report substance abuse among both first-degree(specifically fathers) and second-degree relatives than were women without such suicide attempthistories (n = 77). Attempters were also more likely to report witnessing the physical abuse oftheir mothers. The multiple impacts of the extended family are discussed in light of thesefindings.

The present study examines self-identified reasons for returning to abusive relationships. Ninety female residents of an urban domestic violence shelter completed structured interviews that included questions about their previous attempts to separate from the batterer and their perceived likelihood of returning in the future. The results indicated that participants appeared to underestimate their likelihood of returning to the relationship. A particularly intriguing pattern of findings emerged with respect to emotional attachment. Compared to those leaving for the first time, participants with a history of past separations were significantly more likely to indicate that they might return to the batterer because of their continued attachment. Emotional attachment also had a high rate of repeat endorsement, indicating that those who considered returning because of their attachment to the batterer were significantly more likely to have done so for this reason in the past. Clinical implications of the findings will be discussed.

The large RBE (approximately 7) measured for the killing of Chinese hamster V79 cells by 340 eV ultrasoft X rays, which preferentially ionize the K shell of carbon atoms (Hervé du Penhoat et al., Radiat. Res. 151, 649-658, 1999), was used to investigate the location of sensitive sites for cell inactivation and the physical modes of action of radiation. The enhancement of the RBE above the carbon K-shell edge either may indicate a high intrinsic efficiency of carbon K-shell ionizations (due, for example, to a specific physical or chemical effect) or may be related to the preferential localization of these ionizations on the DNA. The second interpretation would indicate a strong local (within 3 nm) action of K-shell ionizations and consequently the importance of a direct mechanism for radiation lethality (without excluding an action in conjunction with an indirect component). To distinguish between these two hypotheses, the efficiencies of core ionizations in DNA atoms (phosphorus L-shell, carbon K-shell, and oxygen K-shell ionizations) to induce damages were investigated by measuring their capacities to produce DNA double-strand breaks (DSBs). The effect of photoionizations in isolated DNA was studied using pBS plasmids in a partially hydrated state. No enhancement of the efficiency of DSB induction by carbon K-shell ionizations compared to oxygen K-shell ionizations was found, supporting the hypothesis that it is the localization of these carbon K-shell events on DNA which gives to the 340 eV photons their high killing efficiency. In agreement with this interpretation, cell inactivation and DSB induction, which do not appear to be correlated when expressed in terms of yields per unit dose in the sample, exhibit a rather good correlation when expressed in terms of efficiencies per core event in the DNA. These results suggest that core ionizations in DNA, through core-hole relaxation in conjunction with localized effects of spatially correlated secondary and Auger electrons, may be the major critical events for cell inactivation, and that the resulting DSBs (or a constant fraction of these DSBs) may be a major class of unrepairable lesions.

Obstructive sleep apnoea (OSA) is a disorder that severely disrupts sleep and may lead to severe long- and short-term health consequences. Continuous positive airway pressure (CPAP) is an effective treatment for OSA, but compliance with CPAP is often poor. Forty participants diagnosed with OSA completed a questionnaire based on the health belief model after a one-night first-time trial of CPAP treatment. After a subsequent 1-month period of CPAP use, electronic usage records were downloaded and analysed. Perceived benefits of CPAP use and perceived barriers to use showed multivariate associations with the mean number of hours of daily CPAP use, and perceived benefits of CPAP use was inversely associated with the percentage of days that CPAP was not used. Participants' confidence in their ability to use CPAP showed significant univariate, but not multivariate, relationships with both variables. Findings suggest that patients may benefit from greater levels of information and instruction in CPAP use.

Loss of A, B, and H antigens from the surface of red blood cells has been a recurrent observation in patients with hematologic malignancy, particularly those malignancies in which the myeloid lineage is involved. To better understand this phenomenon, a 2-color flow cytometric method was developed to determine quantitative and qualitative alterations of A, B, and H antigens in patients with myeloid malignancies. Characteristic patterns, dependent on the genotype, were seen for healthy individuals from each of the blood groups. Fifty-five percent (16/29) of patients of blood group A, B, or AB had a proportion of red cells with decreased expression of A or B antigens compared with no changes in 127 healthy A, B, and AB individuals. In most cases, the changes were not detected by routine serologic typing. The loss of A or B antigens was the primary change in 28% (8/29) of patients. In 17% (5/29) of patients, loss of A or B antigens was an indirect consequence of loss of the precursor H antigen. Alterations involving both the H and the A or B antigens were seen in 10% (3/29) of patients. Loss of H was also detected in 21% (6/28) of group O patients whereas none of 51 healthy O individuals showed changes. Alterations of ABO antigens can now be considered a common event in myeloid malignancy. (Blood. 2001;97:3633-3639)

Right colonic diverticulitis is not a frequent disease and its management is still controversial. In this study we describe our experience.We retrospectively reviewed all patients operated on because of a right colonic diverticulitis in our surgical unit. All patients were treated laparoscopically. Demographics, diagnostic and surgical results were recorded.Between January 1994 and January 2007, 11 patients (7 males and 4 females) mean age 53 +/- 9 years (range 39-68), ASA 1: 6 patients, ASA 2: 4 patients, ASA 3: one patient, and BMI 27.8 (range 25-31), had right colonic diverticulitis. Four patients underwent emergency operations: one for peritonitis and three with an erroneous diagnosis of acute appendicitis; seven were operated on electively. There were no deaths or complications. The mean postoperative hospital stay was 5.6 days (range, 3-9). After a mean follow-up of 6.3 years (range 1-13) all patients of this series are symptom-free.Right colon diverticulitis diagnosis remains difficult. A pre-operative imaging screening is necessary to successfully face this challenging disease. Laparoscopy is a safe and effective method to treat these patients. Colectomy should be considered a good therapeutic option for right colonic diverticulitis, although a conservative approach could be proposed in selected cases.

Usage of nicotine-only formulations, such as transdermal patches, nicotine gum, or electronic nicotine delivery systems is increasing, as they are perceived as healthier alternatives to traditional cigarettes. Unfortunately, there is little data available on the effect of isolated nicotine on myocardial and aortic remodeling, especially in the setting of cardiovascular disease risk factors, such as hypertension. We hypothesized that nicotine would exacerbate cardiovascular remodeling induced by angiotensin-II (Ang II) treatment. Subcutaneous osmotic minipumps were implanted to administer Ang II, Nic, nicotine plus ANG II or saline to C57Bl/6 mice for 4 weeks. Heart weights were increased by all treatments, with control < nicotine < Ang II < nicotine + Ang II. Activity levels of matrix metalloproteinase (MMP-2) mirrored these changes and demonstrated clear additivity between nicotine and Ang II. Histopathological analysis of aortas revealed that mice receiving combined nicotine and Ang II treatment induced significant hypertrophy compared to all other groups. This study reveals possible cardiotoxic interactions between nicotine and a common model of systemic hypertension. Safety testing of novel nicotine delivery devices should consider that hypertension is a common impetus to begin smoking cessation therapy, and potential interactions should be more thoroughly studied.

In colorectal cancer (CRC), a proportion of patients with early stage disease still die of metastatic or recurrent disease within 5 years of "curative" resection. Detection of carcinoma cells in the peripheral circulation at presentation may identify a subgroup of patients with micro-metastatic disease who may benefit from adjuvant chemotherapy or radiotherapy. Our aim was to determine the presence and clinical significance of colon carcinoma cells in peripheral blood at the time of surgery. Preoperative peripheral blood samples were collected from 94 patients with CRC and 64 patients undergoing bowel resection for benign conditions (adenoma, diverticular disease or Crohn's colitis). Blood was also obtained from 20 normal donors not undergoing bowel surgery. Immunomagnetic beads were used to isolate epithelial cells followed by reverse transcription-polymerase chain reaction (RT-PCR) analysis of expression of cytokeratin (CK) 19, CK 20, mucin (MUC) 1 and MUC 2. Nineteen of 94 (20%) CRC patients were positive for epithelial cells in preoperative blood, including 6 with early stage disease. Kaplan-Meier survival analysis showed that detection of epithelial cells in preoperative blood was associated with reduced disease-free and overall survival (log-rank test, p = 0.0001). Surprisingly, circulating epithelial cells were detected in 3/30 (10%) patients resected for adenoma, and in 4/34 (12%) patients resected for benign inflammatory conditions, suggesting that cells from nonmalignant colonic epithelium may also gain entry into the bloodstream in the presence of bowel pathology. All 20 normal control bloods were negative for epithelial cells.

Seventy female residents of an urban domestic violence shelter were interviewed to examine a series of hypotheses concerning two factors relevant to the process of leaving an abusive relationship: risk assessments and decision-certainty. Participants' subjective estimates of their own risk of returning to the batterer were examined relative to their perceptions of the likelihood that most battered women will return to the batterer, their certainty regarding the decision to leave the batterer, and their status on known risk factors for returning to an abusive relationship. As hypothesized, battered women's perceptions of personal risk for returning to the batterer were biased by unrealistic optimism; specifically, personal risk was estimated as significantly lower than the risk of most battered women and was not correlated with actual risk factors. Further, the magnitude of the optimistic bias was significantly greater among women expressing high certainty about their decision to leave than among women who expressed less certainty. The clinical implications of these findings are discussed.