Long-Term Health and Psychosocial Status of Youth who Received Substance Abuse Treatment in Adolescence

Alcohol and substance abuse in the adolescent population is a major health concern with a number of harms known to be associated with high levels of use. Few studies report on long-term health status of youth who have received treatment for a substance abuse problem during adolescence. This study aimed to describe the long-term status of a cohort of adolescents who received treatment in an intensive day treatment program situated in a tertiary care paediatric hospital. Youth participated in an interview that collected data using both standardized screening tools (GAIN-SS, AUDIT, CUDIT, DUI) as well as closed and open ended questions about education, employment, and physical and mental health status. Young adults in this sample continue to use alcohol and cannabis, with a proportion reporting problematic use. Their academic achievement is close to expected for their age group. They report concurrent mental health disorders; and as a cohort, access the health care system for both acute and chronic health conditions more than their contemporaries. These findings support the inclusion of academic, mental health and medical components in programs for adolescents with substance abuse, in order to address a broad range of determinants of health outcomes.     

Assessment of the distensibility of superficial arteries

Doppler signal processing cannot only be employed to detect the local blood velocity as function of time, but also to assess transcutaneously the displacement of the arterial walls during the cardiac cycle (distension waveform) and, hence, the time-dependent changes in arterial diameter relative to its initial diameter at the start of a cardiac cycle. The distension waveform normalized with respect to the local pulse pressure provides useful information about the local elasticity of the arterial wall. The displacement of the arterial wall can be obtained by processing the RF-signals within a sample volume coinciding with the arterial wall. To evaluate this method a dedicated high-speed memory system has been developed storing the RF-signal, as obtained with a conventional echo-imager in M-mode, over a number of successive sweeps covering a selected depth range. The data are transferred line after line to a personal computer (PC) and processed on the fly, thereby relieving the memory requirements of the PC. It can be concluded that a RF-signal memory in combination with a PC provides a useful tool to extract detailed diameter waveforms from the RF-signals obtained. Although the system does not process the signals in real-time the process can be considered to be on-line since the results become available within one minute after the acquisition of the data is completed.     

The TNF-derived TIP peptide activates the epithelial sodium channel and ameliorates experimental nephrotoxic serum nephritis

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Splenic Abscess Complicating Infective Endocarditis: Three Case Reports

We present three case-reports of splenic abscess in patients who were initially diagnosed with bacterial endocarditis. In all cases the diagnosis of splenic abscess was based on the findings of abdominal CT scan or MRI. All patients were treated by laparotomy and splenectomy. Two patients fully recovered and one patient, who suffered from splenic rupture and massive blood loss before surgery, died.

Splenic abscess is a well-described but rare complication of infective endocarditis. Rapid diagnosis and treatment are essential as its course can prove fatal.

Abdominal CT scan or MRI should be performed if there is clinical suspicion of splenic abscedation. Immediate splenectomy combined with appropriate antibiotics and valve replacement surgery is the treatment of choice. Splenic tissue is very fragile — especially if the abscess is located subcapsular — and a splenic rupture can result from minimal trauma. If the patient’s general state allows it, it is best to perform splenectomy prior to valve replacement surgery to prevent re-infection of the valve prosthesis. A combined one-stage procedure is also an option.     

Clinical evaluation of the Bentley Univox membrane oxygenator

This paper reports a clinical evaluation of Bentley's new Univox membrane oxygenator (Bentley Laboratories, Irvine, California). In this new device, the blood flow path is outside the fibre, the incorporated heat exchanger consists of a 22-channel stainless-steel bellows, and the polypropylene fibres are woven into fibre ribbons and wound into each of the bellows channels. In this way, heat and gas transfers take place simultaneously. The priming volume has been reduced to 220ml and the membrane has an effective surface area of 1.6m 2. A BMR 1900 collapsible reservoir (Bentley Laboratories, Irvine, California) was used as a venous reservoir. Ten consenting patients undergoing elective coronary artery bypass surgery were perfused with this new oxygenator. BSA was between 1.7 and 2.11m 2; mean BSA was 1.81. Minimum priming was 1200 ml. The blood-gas results were all within or close to the normal range used in our institution. Acid-base management was performed using alpha-stat regulation and no problems occurred in this series of patients. Average pO 2 was 155mmHG+/-53 with a mean O 2 transfer of 90.7ml and a maximum of 185ml. The heat exchange performance was very good, with a mean coefficient of heat exchange of 0.54+/-0.11 and a maximum of 0.87.     

A qualitative interview study on effects of diet on children's mental state and performance. Evaluation of perceptions, attitudes and beliefs of parents in four European countries

Nutrition is one of the many factors that influence a child's cognitive development and performance. Understanding the relationship between nutrition and mental performance in children is important in terms of their attainment and productivity both in school and later life. Since parents are seen as nutritional gatekeepers for their children's diets, their views and beliefs are of crucial importance. The present study aims to qualitatively examine parents' perceptions of the relationship between diet and mental performance of children. The study was conducted with a total of 124 parents in four European countries using a semi-structured interview schedule. Parents speak of the effects of diet at two levels; the nature of the effects of diet and the characteristics of the foods responsible for these effects. Mental outcomes are related to diet, with the effects perceived to be associated with attention and concentration, often mediated by effects on children's mood and behaviour. Parents categorise foods as 'good' or 'bad' with positive effects related generally to a healthy balanced diet while negative effects are perceived to be associated with sugary and fatty foods. Understanding parental perceptions is important for many purposes including the targeting of dietary advice and prioritising of public health issues.     

Cytotoxic effects of SMAC-mimetic compound LCL161 in head and neck cancer cell lines

Objectives

Head and neck squamous cell carcinoma (HNSCC) is one of the most common tumor entities worldwide. Unfortunately, recent drug developments in other fields of oncology have yielded no efficacy in the treatment of oral squamous cell carcinoma. As a new starting point, we investigated the impact of Fas ligand (FasL) and the SMAC-mimetic compound LCL161 in mono- and combination treatment in HNSCC cell lines.

Methods

Five different cell lines of HNSCC were treated with FasL and LCL161 in mono- and combination treatment. Cytotoxicity was measured via a crystal violet assay. The cell lines were characterized for CD95 (FasL receptor) expression via flow cytometry. The degradation of cellular inhibitor of apoptosis protein 1 (cIAP1) was detected via Western blot.

Results

Incubation with FasL led to a significant decrease in three out of five cell lines. Combination treatment with LCL161 enhanced cytotoxicity significantly. Two cell lines were FasL resistant, but one of them could be resensitized with LCL161. In all cell lines, Western blot analysis showed degradation of cIAP1 after LCL161 application. However, one cell line showed only minor vulnerability to the FasL and LCL161 combination.

Conclusion

This is the first study investigating combination treatment of FasL and LCL161 in head and neck cancer cell lines. Pro-apoptotic effects of the combination were detected in the majority of the cell lines. Interestingly, one of two FasL-resistant cell lines was sensitive to the combination therapy with FasL and LCL161.

Clinical relevance

SMAC-mimetic compounds show promising results in the treatment of other tumor entities in vitro and might be useful drugs to improve HNSCC therapy.

     

Beneficial effects of alkaline phosphatase in septic shock

OBJECTIVE: Alkaline phosphatase may decrease the harmful effects of lipopolysaccharide by detoxifying lipid A. The aim of this study was to investigate whether administration of alkaline phosphatase is beneficial in a clinically relevant septic shock model. DESIGN: Interventional laboratory study. SETTING: University hospital animal research laboratory. SUBJECTS: Fourteen fasted, anesthetized, invasively monitored, mechanically ventilated, female sheep (27.6 +/- 3.9 kg). INTERVENTIONS: Each animal received 1.5 g/kg body weight of feces intraperitoneally to induce sepsis. Ringer's lactate and a 6% hydroxyethyl starch solution were infused throughout the experiment to prevent hypovolemia. Two hours after feces injection, animals were randomized to alkaline phosphatase (60 units/kg intravenous bolus followed by a continuous infusion of 20 units/kg/hr for a total of 15 hrs) or no alkaline phosphatase (control group). MEASUREMENTS AND MAIN RESULTS: All animals were studied until their spontaneous death or for a maximum of 30 hrs. Plasma alkaline phosphatase concentrations decreased in the control group but increased in the treatment group following alkaline phosphatase administration. In the treatment group, the Pao2/Fio2 ratio was higher (p < .05), blood interleukin-6 concentrations were lower (p < .05), and the survival time was longer (median time 23.8 vs. 17 .0 hrs, p < 0.05) than in the control group. There were no significant differences in systemic hemodynamics or diuresis. CONCLUSIONS: In this clinically relevant septic shock model, alkaline phosphatase administration improved gas exchange, decreased interleukin-6 concentrations, and prolonged survival time.