Decompression only versus fusion in octogenarians with spinal epidural abscesses: early complications,clinical and radiological outcome with 2-year follow-up

Despite increased life expectancy due to health care quality improvements globally, pyogenic vertebral osteomyelitis (PVO) treatment with a spinal epidural abscess (SEA) remains challenging in patients older than 80 years. We aimed to assess octogenarians for PVO prevalence with SEA and compare after-surgery clinical outcomes of decompression and decompression and instrumentation. A retrospective review of electronic medical records at a single institution was conducted between September 2005 and December 2020. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Comorbidities were assessed using the age-adjusted Charlson comorbidity index (CCI). Over 16 years, 35 patients aged ≥80 years with PVO and SEA were identified. Eighteen patients underwent surgical decompression (“decompression group”), and 17 underwent surgical decompression with instrumentation (“instrumentation group”). Both groups had a CCI >6 (mean±SD, 8.9±2.1 vs. 9.6±2.7, respectively; p=0.065). Instrumentation group patients had a significantly longer hospital stay but no ICU stay. In-hospital and 90-days mortality rates were similar in both groups. The mean follow-up was 26.6±12.4 months. No further surgeries were performed. Infection levels and neurological status were improved in both groups at discharge. At the second-stage analysis, significant improvements in the blood infection parameters and the neurological status were detected in the decompression group. Octogenarians with PVO and SEA have a high adverse events risk after surgical procedures. Surgical decompression might contribute to earlier clinical recovery in older patients. Thus, the surgical approach should be discussed with patients and their relatives and be carefully weighed.

     

Endothelin-1 induces CXCL1 and CXCL8 secretion in human melanoma cells

The endothelin pathway plays a critical role in melanoma tumor progression by a variety of mechanisms that enhance tumor cell growth, invasion, and metastasis. Here, we investigate the effect of this pathway on CXC chemokine expression in human melanoma cells and melanocytes. As determined by ELISA, endothelin-1 (ET-1) induces CXCL1 and CXCL8 secretion in three human melanoma cell lines in a concentration-dependent fashion. These responses are mediated by the endothelin-B receptor and are sustained over a 40 h time course. ET-1 does not induce CXCL1 secretion in primary human melanocytes but ET-3, an endothelin isoform, induces a low level of CXCL1 secretion in certain cultures. Neither ET-1 nor ET-3 induces secretion of CXCL8 in primary human melanocytes; thus, this response may be specific for melanocytic cells that have undergone malignant transformation. We have previously demonstrated that ET-1 induces changes in the expression of adhesion molecules in melanoma cells such that invasion and metastasis are favored. This study demonstrates that ET-1 additionally induces secretion of CXC chemokines critical for melanoma metastasis and tumor progression.     

Hypnobehavioral and Hypnoenergetic Therapy in the Treatment of Obese Women: A Pragmatic Randomized Clinical Trial

This study compared the effectiveness of hypnobehavioral therapy (HypBe) and HypBe enhanced by elements of energetic psychotherapy (hypnoenergetic therapy, HypEn) for obese women. Sixty clients were randomized to either HypBe or HypEn. Body weight, BMI, eating behavior, and body concept were assessed at baseline, posttreatment, and at a follow-up. Mixed ANOVA models and effect sizes were used for statistics. Both treatments improved weight, BMI, eating behavior, and some aspects of body concept. Improvements in eating behavior and body concept were higher for those who also lost weight (responders). Weight and BMI reductions were not significantly different for the HypEn versus HypBe groups at follow-up.     

Unconventional metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy

This study investigates the relationship between unconventional (i.e., creative) metaphors and emotional-cognitive regulation in a metacognitive interpersonal therapy (MIT). The occurrence of unconventional metaphor was identified using the Metaphor Analysis in Psychotherapy (MAP) model, and emotional-cognitive regulation was assessed by the Therapeutic Cycles Model (TCM). The results showed that the dyad's frequency of unconventional metaphors is significantly related to emotional-cognitive integration, reflective processes and moments of therapeutic engagement based on the quality of such regulation. More specifically, client metaphors were associated with emotional-cognitive integration and moments of therapeutic engagement, while therapist metaphors were associated with reflective processes. The results suggest that unconventional metaphors may be considered markers for different cognitive-emotional regulatory processes and moments of heightened therapeutic work and change in MIT.     

The impact of experience of a transplantation center on the outcomes of orthotopic liver transplantation

The so-called learning factor has been disregarded for many years in analyzing the causes of surgical complications and post-operative mortality; it is also the case for OLT. In our center until April 2003, 209 OLT were performed in 196 patients. We evaluated the impact of experience of the transplantation team on the outcomes of liver transplantation. Thirty-four patients died (mortality rate, 16%) and 1-year survival rate, 64%. Mortality rates varied during different periods of observation due to increasing experience of the transplantation team. The causes of mortality were assessed for a series of 34 patients: it was 75% at the beginning of transplantation procedures while recent deaths have not recently exceeded 10% of cases.     

Trainees' self‐evaluation of their development as psychotherapists: An Italian contribution to an international collaborative study on psychotherapy training

This study presents a pilot contribution to the new collaborative, multinational study of psychotherapy trainee development that was undertaken by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (see Orlinsky, Strauss, Rønnestad, et al., 2015 ). Although the main project is longitudinal in design, this preliminary study investigated cross‐sectional differences between trainees in different years of training and explored the influence of core training experiences—including supervision and personal therapy—on their perceived development as therapists. Using the trainee current‐progress report that was designed for the Society for Psychotherapy Research Interest Section on Therapist Training and Development project, 90 trainees at 4 different 4‐year training programs in Italy provided self‐evaluations of their development and of their therapeutic work experiences. Perceived development included overall change, progress, deterioration, overcoming past limitations, and realization of potential as a therapist. Therapeutic work experiences were assessed using scales of healing and stressful involvement (Orlinsky & Rønnestad, 2005 ). Year in training and support in supervision predicted perceived development and healing involvement, whereas experiencing criticism in supervision was associated with stressful involvement. Having had personal therapy, and especially ratings of benefit from personal therapy, was also associated with perceived development and healing involvement. Results are discussed with regard of their implications for psychotherapy training.