Primary central nervous system posttransplantation lymphoproliferative disorder after heart and lung transplantation

Primary central nervous system posttransplantation lymphoproliferative disorder (PCNS-PTLD) is uncommon, especially after heart or lung transplantation. Database analysis from a single heart and lung transplantation centre and a literature review pertaining to PCNS-PTLD was performed. In this study, the prevalence of PCNS-PTLD was 0.18% after heart and/or lung transplants. Of 1674 transplants, three cases of PCNS-PTLD developed 14 months, 9 years and 17 years posttransplant, and all were Epstein-Barr virus driven malignancies. Literature review of the topic revealed predominantly retrospective studies, with most reported cases after renal transplantation. The overall survival is poor, and it may be improved by early diagnosis and treatment. There are no published guidelines on the management of PCNS-PTLD; immune-chemotherapy in conjunction with reduction of immune suppression is preferred based on available evidence.

Hepatosplenic T-cell lymphoma, immunosuppressive agents and biologicals: what are the risks?

We present three cases of the rare hepatosplenic T-cell lymphoma (HSTCL); two patients suffering from Crohn disease who developed HSTCL on azathioprine without exposure to biologicals, and a third patient who had psoriasis treated using etanercept, cyclosporine and methotrexate. The evidence for an association between HSTCL and immunosuppressive drugs and biologicals is reviewed. We argue for improved pharmacovigilance processes to help determine the benefit to risk ratios for the use of these and other new agents.

Weighing in on the issue: a longitudinal analysis of the influence of selected individual factors and the sports context on the developmental trajectories of eating pathology among adolescents

Eating disorders, and related issues (e.g., body dissatisfaction, weight control behaviors), represent pressing and prevalent health problems that affect American adolescents with alarming frequency and potentially chronic consequences. However, more longitudinal research is needed to elucidate the developmental processes that increase or maintain risk for, and that protect against, eating- and weight-related problems among adolescents. Accordingly, the current study used longitudinal data from 1,050 male and female (68.0 %) adolescents (Grades 9-11)-the majority of whom were European Americans (72.2 %)-who participated in the 4-H Study of Positive Youth Development to (a) describe trajectories of adolescents' eating pathology and body dissatisfaction, (b) identify individual and contextual correlates of these pathways, (c) examine whether trajectories of eating pathology and body dissatisfaction related to adolescents' depressive symptoms, and (d) elucidate whether sports participation moderated associations between specific trajectories of eating pathology and body dissatisfaction and adolescents' depressive symptoms. Results suggest that the diverse pathways of eating pathology and body dissatisfaction that exist across middle adolescence, in combination with adolescents' sports participation, have important implications for the positive and problematic development of our youth. In addition, the findings underscore the need to evaluate the interindividual differences that exist in regard to how sports participation may relate positively and negatively to developmental outcomes.

Acute effects of prostaglandin E1 and E2 on vascular reactivity and blood flow in situ in the chick chorioallantoic membrane

The chick chorioallantoic membrane (CAM) subserves gas exchange in the developing embryo and shell-less culture affords a unique opportunity for direct observations over time of individual blood vessels to pharmacologic interventions. We tested a number of lipids including prostaglandins PGE(1&2) for vascular effects and signaling in the CAM. Application of PGE(1&2) induced a decrease in the diameter of large blood vessels and a concentration-dependent, localized, reversible loss of blood flow through small vessels. The loss of flow was also mimicked by misoprostol, an agonist for 3 of 4 known PGE receptors, EP(2-4), and by U46619, a thromboxane mimetic. Selective receptor antagonists for EP(3) and thromboxane each partially blocked the response. This is a first report of the effects of prostaglandins on vasoreactivity in the CAM. Our model allows the unique ability to examine simultaneous responses of large and small vessels in real time and in vivo.

The association between sports participation and athletic identity with eating pathology among college-aged males and females

The current study examined associations among sports participation (SP), athletic identity (AI), weight status, and eating pathology, and whether these relations differed by gender. Data come from male and female first-year college students who participated in the Tufts Longitudinal Health Study (TLHS) between 1999-2007 (N=712). Relations among SP, AI, actual and perceived weight statuses, Eating Disorders Inventory (EDI) subscale scores, and indices of body shape concern and restrictive eating were examined with hierarchical ordinary least squares (OLS) regression. Associations between SP and eating pathology among females were moderated by perceived weight status. By contrast, relations between males' EDI subscales scores and SP were moderated by ethnicity, as well as by actual weight status. Our findings support that sports participation alone neither promotes nor protects against eating pathology among males and females.

A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers

OBJECTIVE

The study aim was to identify and describe health consumer perspectives on social barriers to care for eating disorders in an ethnically diverse sample.

METHOD

We conducted an exploratory secondary analysis of qualitative data comprising transcripts from semi-structured interviews with past and prospective consumers of eating disorder treatment (n = 32). Transcripts were inputted into NVivo 8 for coding, sorting, and quantifying thematic content of interest within strata defined by ethnic minority and non-minority participants. We then examined the influence of key social barriers-including stigma and social stereotypes-on perceived impact on care.

RESULTS

The majority of respondents (78%) endorsed at least one social barrier to care for an eating or weight concern. Perceived stigma (or shame) and social stereotyping-identified both within social networks and among clinicians-had adversely impacted care for 59% and 19% of respondents, respectively.

DISCUSSION

Social barriers to care for eating and weight related concerns may be prevalent in the U.S. and impact both ethnic minority and non-minority health care consumers.

Development of a measure of "acculturation" for ethnic Fijians: methodologic and conceptual considerations for application to eating disorders research

Acculturation has been examined as a risk factor for eating disorders, but interpretation of findings has been limited by inconsistent operationalization of this construct across studies. The study aim was to develop and evaluate a population-specific measure of acculturation for ethnic Fijian adolescent schoolgirls, to use in future analyses related to eating disorders. Our findings suggest that acculturation is a multidimensional construct characterized by distinct, though related, dimensions of orientation to ethnic Fijian and/or western/global culture with respect to a range of behaviors and attitudes. In contrast to theoretical models positing uni-dimensional, orthogonal, or oblique relations between cultural identities in individuals undergoing acculturation, our study findings support a heterogeneous pattern among correlations of dimensions across contrasting cultural identities. We suggest multidimensional measures of acculturation are optimal--and socio-demographic proxies inadequate--for characterization of this complex process for health research.

Allogeneic hematopoietic SCT as treatment option for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): a consensus conference proposal for a standardized approach

Allogeneic hematopoietic SCT (HSCT) has been proposed as a treatment for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). HSCT has been performed in nine patients using different protocols with varying success. Based on this preliminary experience, participants of the first consensus conference propose a common approach to allogeneic HSCT in MNGIE. Standardization of the transplant protocol and the clinical and biochemical assessments will allow evaluation of the safety and efficacy of HSCT as well as optimization of therapy for patients with MNGIE.

Trajectories of positive and negative behaviors from early- to middle-adolescence

Although the positive youth development (PYD) model initially assumed inverse links between indicators of PYD and of risk/problem behaviors, empirical work in adolescence has suggested that more complex associations exist between trajectories of the two domains of functioning. To clarify the PYD model, this study assessed intraindividual change in positive and problematic indicators across Grades 5-10, and the links between these trajectories of development, among 2,516 participants from the 4-H Study of PYD (58.1% females; 64.9% European American, 7.0% African American, 12.3% Latino/a American, 2.6% Asian American or Pacific Islander, 1.8% Native American, 3.0% multiethnic-racial, and 8.4% with inconsistent race/ethnicity across waves). Results from person-centered analyses indicated that most youth clustered in the high trajectories of positive indicators and in the low trajectories of the negative ones. Consistent with past research, overlap between trajectories of positive and negative behaviors was found. These results suggest that theory and application need to accommodate to variation in the links between positive and problematic developmental trajectories.

More than child's play: variable- and pattern-centered approaches for examining effects of sports participation on youth development

The authors used data from Grades 5 through 7 of the longitudinal 4-H Study of Positive Youth Development to assess relations among sports participation, other out-of-school-time (OST) activities, and indicators of youth development. They used a mixture of variable- and pattern-centered analyses aimed at disentangling different features of participation (i.e., intensity, breadth). The benefits of sports participation were found to depend, in part, on specific combinations of multiple activities in which youths participated along with sports. In particular, participation in a combination of sports and youth development programs was related to positive youth development and youth contribution, even after controlling for the total time youths spent in OST activities and their sports participation duration. Adolescents' total time spent participating in OST activities, duration of participation in sports, and activity participation pattern each explained a unique part of the variance in some of the indicators of youth functioning. These findings suggest the need for future research to simultaneously assess multiple indices of OST activity participation.

Sports and Youth Development Programs: Theoretical and Practical Implication of Early Adolescent Participation in Multiple Instances of Structured Out-of-School (OST) Activity

Among today’s youth, the most ubiquitous OST activity is sports. However, many of these youth are also participating in at least one other OST activity along with their participation in sports. Using longitudinal data from 1,622 youth (56.8% female) from the first three waves (Grades 5, 6, and 7) of the 4-H Study of Positive Youth Development (PYD), we employed a pattern-centered approach to assess differences in adolescent functioning depending on what types of OST activities youth were participating in along with their sports participation. Our findings suggest that youth benefit from their sports participation differently depending on what other types of additional activities they participate in during their out-of-school time. In particular, a participation pattern characterized by high participation in sports and Youth Development Programs was found to be the most effective activity profile for promoting PYD and preventing youth problems. Implications of these findings in research and practice are discussed.

Nuances in early adolescent developmental trajectories of positive and problematic/risk behaviors: findings from the 4-H study of positive youth development

Using data from the first three waves of data (Grades 5, 6, and 7) from the 4-H Study of Positive Youth Development (PYD), the authors assessed among 1,184 youth (58.5% female) the patterns of change associated with indicators of PYD and of risks/problem behaviors. Results indicated that five PYD trajectories represent change across grades, four trajectories were associated with indicators of internalizing problems, and three trajectories were associated with indicators of externalizing problems. Although theoretical expectations associated with the study of both child and adolescent resilience and PYD led to the expectation that most youth across the early adolescent period would show change marked by the coupling of increases in PYD and decreases in risk/problem behaviors, only about one-sixth of all youth in the sample manifested this particular pattern of change. Other youth remained stable over time, showed increases in PYD and risk, and declined in PYD. The multiplicity of patterns of conjoint trajectories for PYD and risks/problem behaviors constitutes a challenge for both developmental theory and applications aimed at enhancing resilience and positive development among adolescents.

Facets of acculturation and their diverse relations to body shape concern in Fiji

OBJECTIVE

The present study examines the relation between acculturation and body shape concern in Fiji--a society undergoing rapid social change.

METHOD

Data were from two cohorts of ethnic Fijian girls and women collected in 1998 (n = 115). A factor analysis was performed to identify dimensions of acculturation. The association of these with body shape concern was examined with linear regression.

RESULTS

Three dimensions of acculturation were identified. Multiple linear regression models demonstrated that each of these dimensions of acculturation had a unique relation to body shape concern. The adjusted R(2) for the fully adjusted model relating acculturation to body concern was 0.63, indicating a substantial degree of shared variation between measures of body shape concern and measures of acculturation.

CONCLUSION

Acculturation may have a strong impact on body shape concern in Fiji. However, acculturation is a multidimensional construct and does not likely have a monolithic relation to body shape concern.

Upregulation of calcium-sensing receptor and mitogen-activated protein kinase signalling in the regulation of growth and differentiation in colon carcinoma

In the present study, we demonstrate that Ca²⁺-induced growth inhibition and induction of differentiation in a line of human colon carcinoma cells (CBS) is dependent on mitogen-activated protein (MAP) kinase signaling and is associated with upregulation of extracellular calcium-sensing receptor (CaSR) expression. When CBS cells were grown in Ca²⁺-free medium and then switched to medium supplemented with 1.4 mM Ca²⁺, proliferation was reduced and morphologic features of differentiation were expressed. E-cadherin, which was minimally expressed in nonsupplemented medium, was rapidly induced in response to Ca²⁺ stimulation. Sustained activation of the extracellular signal-regulated kinase (ERK) occured in Ca²⁺-supplemented medium. When an inhibitor of ERK activation (10 μM U0126) was included in the Ca²⁺-supplemented culture medium, ERK-activation did not occur. Concomitantly, E-cadherin was not induced, cell proliferation remained high and differentiation was not observed. The same level of Ca²⁺ supplementation that induced MAP kinase activation also stimulated CaSR upregulation in CBS cells. A clonal isolate of the CBS line that did not upregulate CaSR expression in response to extracellular Ca²⁺ was isolated from the parent cells. This isolate failed to produce E-cadherin or undergo growth inhibition/induction of differentiation when exposed to Ca²⁺ in the culture medium. However, ERK-activation occurred as efficiently in this isolate as in parent CBS cells or in a cloned isolate that underwent growth reduction and differentiation in response to Ca²⁺ stimulation. Together, these data indicate that CaSR upregulation and MAP kinase signalling are both intermediates in the control of colon carcinoma cell growth and differentiation. They appear to function, at least in part, independently of one another.

Antagonism of Epidermal Growth Factor Receptor Tyrosine Kinase Ameliorates the Psoriatic Phenotype in Organ-Cultured Skin

Psoriatic plaque skin incubated for eight days in organ culture in the presence of a potent epidermal growth factor (EGF) receptor tyrosine kinase (RTK) antagonist reverted to a more normal histological appearance, while untreated psoriatic plaque skin retained histological features associated with the psoriatic phenotype. In concomitant studies it was shown that the EGF-RTK antagonist had no significant effect on histological features of non-psoriatic skin and no effect on dermal function, i.e. elaboration of both type I procollagen and matrix metalloproteinase-1 (MMP-1; interstitial collagenase). When human epidermal keratinocytes were treated with the EGF-RTK antagonist in monolayer culture, growth inhibition was seen (ED(50) = approximately 0.06 microM). When dermal fibroblasts were exposed to the EGF-RTK antagonist in monolayer culture, proliferation, MMP-1 and type I procollagen production were essentially unaffected at concentrations which interfered with keratinocyte growth (up to 1 microM). The capacity of the EGF-RTK antagonist to modulate the histological features of psoriatic skin in organ culture under conditions in which normal skin architecture and dermal function are largely unaffected suggests a potential for anti-psoriatic therapy.

Statistical parameters in behavioral tasks and implications for sample size of C57BL/6J:129S6/SvEvTac mixed strain mice

Most mixed strain progeny from gene-knockout experiments typically originate from C57BL/6J and one of the 129 substrains, frequently 129S6/SvEvTac. The results of this behavioral survey suggest that C57BL/6J:129S6/SvEvTac mixed strain mice are amenable to behavioral testing. The variability in behavioral tasks for subjects arising from this mixed strain genetic background does not preclude screening with a battery of behavioral tests. With clues provided by a screen of mixed strain subjects, follow-up analyses with isogenic, congenic, or F1 hybrid animals may be targeted to specific behavioral themes.

Prenatal diagnosis of congenital myotonic dystrophy and counseling of the pregnant mother: case report and literature review

The molecular basis of the myotonic dystrophy (MD) kinase gene is expansion of the CTG repeat at the 3'-untranslated region of the MD gene. Variability of the CTG repeat size in different tissues of affected individuals has been demonstrated. The objective of this report was to examine and review the feasibility of prenatal diagnosis of congenital myotonic dystrophy (CMD) in pregnant women with MD using CTG repeat sizes in amniocytes or villi. We present a case of a pregnant woman with MD who underwent prenatal diagnosis of MD using amniocytes. The repeat size in the amniocytes was smaller than the repeat size in the maternal leukocytes and smaller than the repeat size in the infant blood. The infant had CMD. We also reviewed the literature for reports on MD cases that were prenatally tested for CTG repeat size using amniocytes or chorionic villi. Data were tabulated based on the number of maternal CTG repeats, prenatal procedure [amniocentesis or chorionic villus sampling (CVS)], CTG repeat size in fetal tissue, fetal/infant blood, and pregnancy outcome. Twenty-seven pregnancies at risk for MD that underwent prenatal diagnosis were reported. Eleven (40.7%) of the 27 pregnancies underwent amniocentesis, and 16 (59.3%) underwent CVS. Fourteen patients (61%) demonstrated an increase in CTG repeat size in the amniocytes or villi compared with the maternal repeat size. Nine (33%) of the 27 pregnancies were terminated because of CMD risk. The outcomes of 11 (40.7%) pregnancies were consistent with diagnosis of CMD. CMD was diagnosed in fetuses demonstrating expansion or contraction of the CTG mutation in the amniocytes. Prenatal diagnosis of MD is possible by using mutation analysis on maternal and fetal DNA and detection of the CTG repeat expansion. Prenatal diagnosis of CMD is more complex. The possible lack of correlation between CTG repeat size in amniocytes, villi, and other fetal tissues is a potential limitation in prenatal diagnosis and counseling of CMD using CTG repeat size. Thus, prenatal diagnosis of CMD should be based on a combination of factors, including maternal pregnancy history, clinical findings, and cautious interpretation of maternal and fetal DNA analysis.

Lenograstim administration to HLA-identical donor-recipient pairs to accelerate marrow recovery post-transplant

In an attempt to accelerate marrow recovery after HLA-identical sibling bone marrow transplantation, the donors of 12 patients with haematological malignancy were given recombinant human granulocyte colony-stimulating factor (rHuG-CSF; lenograstim; Granocyte) 5 micrograms/kg/day for seven doses prior to marrow harvest. All 12 recipients also received lenograstim 5 micrograms/kg/day from the day of transplant until their neutrophil count was 1.0 x 10(9)/1. In addition to lenograstim post-transplant and lenograstim-stimulated donor bone marrow the first six recipients also received donor peripheral blood stem cells that had been enriched for CD34+ stem/progenitor cells and T cell depleted on an immune absorption column (cohort 1). The second six patients (cohort 2) received lenograstim post-transplant and lenograstim-stimulated donor marrow only. All 12 patients showed a marked elevation of their circulating white blood cell count (predominantly neutrophils) on day 1 post-transplant. Compared to carefully matched historical control patients the rate of neutrophil engraftment was significantly accelerated in both patient cohorts and platelet engraftment was accelerated in cohort 2.

[What can family physicians contribute to health promotion in schools?]

Although several German schools have developed and tested concepts of a goal-directed health education, a stable and continuous implementation is missing. In this field free-practising physicians can support public health efforts. In the area Bruchsal/Ostringen it is demonstrated, that especially those primary care physicians, who work according to the "Three-Level-Concept of Free-Practising Physicians", can successfully use their geographical and social proximity to schools in their neighbourhood for a log-lasting implementation of recurring health-related activities. Within ten years 1389 students in schools, further ca. 500 outside schools, were directly included in interactive learning in the framework of preventive measures, e.g. during school health days. 10 physicians (4 of them continuously) cooperated in these activities, which had been planned in close collaboration with teachers and parents, considering the different age groups. From the very beginning--although sometimes limited in scale--each activity was evaluated. Pupils in the age group 10-12 years generally showed the highest interest in health-related diet, 17-26% were physically more active. Promising are the results with respect to smoking: one fifth of the smoking students intended to quit as a consequence of the health activities in their schools.

Autologous blood stem cell transplantation for haematological malignancy: treatment-related mortality of 2%

BACKGROUND

Lengthy remission or cure has remained elusive for patients with many of the common haematological malignancies. Thus high dose chemotherapy followed by autologous haemopoietic stem cell transplantation is being increasingly utilised in these diseases.

AIM

To assess the safety of high dose chemotherapy and autologous stem cell transplantation in haematological malignancy.

METHODS

Forty-eight patients with haematological malignancy were given high dose chemotherapy followed by an infusion of previously cryopreserved autologous peripheral blood stem cells with (patients with acute myeloid leukaemia [AML]) or without (patients with acute lymphoblastic leukaemia [ALL], chronic myeloid leukaemia, non-Hodgkin's lymphoma, Hodgkin's disease and myeloma) autologous bone marrow.

RESULTS

All patients except one had sustained engraftment. The median (range) number of days to attain a neutrophil count of 0.5 x 10(9)/L was 12 (10-42) and a platelet count of 20 x 10(9)/L unsupported by platelet transfusions was 15 (eight to 155). Other than oropharyngeal mucositis and febrile neutropenia, morbidity was low. Two patients had haemorrhagic cystitis, one hepatic veno-occlusive disease and one interstitial pneumonitis; all resolved. The treatment-related mortality was 2%--a single patient with AML died of failure of sustained engraftment.

CONCLUSIONS

Autologous blood stem cell transplantation to support high dose chemotherapy is a relatively safe procedure and its efficacy is currently being explored in a wide range of haematological malignancies.