Dynamic models for the maintenance of smoking cessation: Event history analysis of late relapse

This paper presents event history analysis as an approach to examining the dynamic nature of the maintenance of smoking cessation. Data from a 1-year follow-up of 172 adult male and 209 adult female ex-smokers is used to estimate the rate at which individuals relapse and return to abstinence. Results indicate that the rate of relapse in both males and females (3.9 and 3.6% per month, respectively) is roughly half that of the rate of return to abstinence (7.5 and 6.3% per month, respectively). No evidence was found for a safe point during the observation interval. Individual characteristics that affect the rate at which ex-smokers relapse and return to abstinence are identified. Characteristics that influenced the rate of return to abstinence were completely different from those affecting the rate of relapse, a finding that suggests covariate asymmetry. Implications of dynamic analysis for conceptualizations of maintenance are discussed.This research was supported by Contract N01-HR-2918 from the Division of Lung Disease, the National Heart, Lung, and Blood Institute.     

Limitations of behavioral treatment of obesity: Review and analysis

Over 200 articles have been published describing behavior modification programs for weight reduction. We reviewed the group studies that reported weight data at least 1 year posttreatment. Evaluating these studies, we concluded that although changes in weight do occur, these changes are almost always clinically small, variability among patients is large, and further weight losses do not occur following the end of formal treatment. The weight lost during treatment may be explained by changes in specific eating behaviors caused by therapist contact rather than the effect of self-applied behavioral techniques on eating. Support for the effectiveness of each of the specific techniques to produce lasting weight loss or behavioral change was also lacking. Suggestions for future research in this area are given.This work was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, Grants HL 17269 and IT32 HL07258-01A1.     

Asthma and obesity in children: current evidence and potential systems biology approaches

Both obesity and asthma are highly prevalent, complex diseases modified by multiple factors. Genetic, developmental, lung mechanical, immunological and behavioural factors have all been suggested as playing a causal role between the two entities; however, their complex mechanistic interactions are still poorly understood and evidence of causality in children remains scant. Equally lacking is evidence of effective treatment strategies, despite the fact that imbalances at vulnerable phases in childhood can impact long‐term health. This review is targeted at both clinicians frequently faced with the dilemma of how to investigate and treat the obese asthmatic child and researchers interested in the topic. Highlighting the breadth of the spectrum of factors involved, this review collates evidence regarding the investigation and treatment of asthma in obese children, particularly in comparison with current approaches in ‘difficult‐to‐treat’ childhood asthma. Finally, the authors propose hypotheses for future research from a systems‐based perspective.     

Maintenance of Treatment Effects: Introduction to the Special Series

This article introduces the special series on maintenance of gains following psychosocial interventions. The special series covers specific, prevalent disorders— unipolar depression, substance abuse, obesity, and conduct disorders—and treatments that have shown positive outcomes for follow-up periods as long as 1 year. The focus is on longer term maintenance, where much less is known. Promising strategies proposed in this series to extend treatment effects are highlighted, as are research strategies that have broad application across disorders.     

Prevalence of overweight,obesity and physical activity levels in children from Azores Islands

Abstract

Background: Childhood overweight and obesity are increasing all over the world and have been associated with low levels of physical activity (PA).

Aims: To determine the prevalence of overweight, obesity and PA levels in Azorean children according to age and sex; and to determine the association between levels of PA and prevalence of overweight and obesity.

Subjects and methods: Weight, height and PA levels were measured in 3699 children aged 6–10 years, from the Azores Islands, Portugal. Overweight and obesity were classified according to the cut-offs of .

Results: In girls, prevalences of overweight and obesity were 22.8% and 13.2%, and in boys 17.6% and 12.3%, respectively. No age trends were found in the prevalence of overweight or obesity; however, girls had a higher risk of being overweight (OR = 1.4, 95% CI = 1.2–1.7) than boys. Levels of PA were higher in boys compared to girls (F(1) = 52.8, p < 0.001). A protective effect of PA practice (very active versus less active) was observed for obesity (OR = 0.7; 95% CI = 0.5–0.9).

Conclusion: The results demonstrate the existence of high prevalence of overweight and obesity in children from the Azores Islands, which is associated with low levels of PA.     

Fetuin-A levels in obesity: differences in relation to metabolic syndrome and correlation with clinical and laboratory variables

Introduction

Fetuin-A is an important player in the enhancement of insulin resistance. There are very limited data available concerning the relationships between fetuin-A, weight status and features of the metabolic syndrome (Met S) in obese Egyptian subjects, and especially in children. The aim of the study was to evaluate fetuin-A serum level in subjects with obesity and its possible association with other laboratory and clinical variables.

Material and methods

A total of 140 obese subjects and 50 controls aged 10-40 years were recruited. Demographic, anthropometric and biochemical features were collected according to a standard protocol. Serum fetuin-A levels were measured using ELISA and the modified Third Report of the National Cholesterol Education Program (NCEP-ATP III) criteria were adopted to diagnose Met S.

Results

A higher level of serum fetuin-A was detected in obese subjects. Met S cases were also significantly associated with higher serum fetuin-A. Fetuin-A correlated significantly with BMI (r = 0.437), systolic (r = 0.228) and diastolic blood pressure (r = 0.295), waist circumference (r = 0.332), insulin resistance calculated by the homeostasis model (HOMA-IR) (r = 0.295) and high-density lipoprotein (HDL) (r = 0.362).

Conclusions

Fetuin-A levels were higher in adults and children with obesity and Met S. They were related to insulin resistance and to features of the Met S in cross-sectional analyses. Our study demonstrates a novel association between human fetuin-A and the Met S among obese subject. Therefore, fetuin-A might be a new promising link between obesity and its comorbidities.     

Keratinocytes in the pathogenesis,phenotypic switch,and relapse of psoriasis

Although biologics have achieved tremendous success in the treatment of psoriasis and revolutionized the clinical management of the disease, certain issues arise during treatments, including the phenotypic switch from psoriasis to other skin disorders and the recurrence of psoriasis after the cessation of biologic treatment. Here we provide a concise overview of the roles of keratinocytes in the pathogenesis of psoriasis, elucidate the involvement of keratinocytes in the phenotypic switch and relapse of psoriasis, and address the challenges encountered in both basic and clinical research on psoriasis.     

Primary relapse of acute lymphoblastic leukemia in a cervical smear: a case report

Uterine cervix and corpus are rarely the initial site of relapse in leukemia or lymphoma. We report herein a case of uterine cervical relapse with B-cell acute lymphoblastic leukemia (ALL). The patient, a 60-yr-old woman, had a history of ALL that had been in remission for 2 yr after chemotherapy. She presented with a chief complaint of genital bleeding. In a routine cervico-vaginal Papanicolau smear, abundant atypical lymphoid cells with round-to-oval nuclei, scant cytoplasm, and high nuclear to cytoplasmic ratios was observed. The nuclei of these cells had fine and dark chromatin and thickened nuclear membranes, with one or several nucleoli being visible. Biopsy under colposcope was performed, and a diagnosis of relapse of ALL was confirmed. The ongoing genital bleeding presented a problem with clinical management of the patient. It was decided to proceed with hysterectomy to end that problem and thereafter proceed with therapy directed against the leukemia. Our results suggest that in patients with known extrauterine cancer, the presence of malignancy in uterine cellular samples provides information regarding the extent of the neoplasm.     

应用德尔菲法筛选美沙酮治疗者脱失风险评估量表条目

目的为研制美沙酮维持治疗（MMT）者脱失风险评估量表,筛选、优化条目。方法在文献研究基础上编制专家咨询问卷,应用德尔菲（Delphi）法,向22位在艾滋病防治和MMT工作领域的专家发送3次问卷并对咨询结果进行分析。结果专家权威系数均值为0．93,三轮咨询后,量表条目的重要性和可行性评分的协调系数分别为0．33和0．29（P〈0．01）,研制的《美沙酮维持治疗者脱失风险评估量表》包含6个维度,共32个条目;量表的内容效度比（CVR）为0．91,内部一致性信度测量显示Cronbach’a系数为0．83,相隔7d的重测信度达到可接受的水平（组内相关系数为0。96）。结论应用Delphi法对《美沙酮维持治疗者脱失风险评估量表》条目筛选的结果可取,量表具有良好的信度和效度。     

White matter impairment in heroin addicts undergoing methadone maintenance treatment and prolonged abstinence: a preliminary DTI study

Methadone maintenance treatment (MMT) might cause the impairments of neuropsychological and neurotransmitter function in opioid addicts. Whether long-term MMT could lead to the impairment of white matter (WM) in heroin addiction brain is unclear. This study compared the WM integrity in the bilateral frontal lobe, temporal lobe, splenium and genu of corpus collasum (CC) between MMT patients (n=13), former heroin addicts (n=11) in prolonged abstinence (PA), and healthy control subjects (n=15) using diffusion tensor imaging (DTI). Fractional anisotropy (FA), apparent diffusion coefficient (ADC) and eigenvalues (λ(⊥), λ(||)) were measured. The correlation between DTI measures and accumulated former heroin dose, total methadone consumption, and PA duration were determined. Although the PA subjects showed no difference in DTI measures relative to the controls, the extensive correlations between the former heroin consumption and the DTI measures were noted. The MMT subjects showed a decreased FA values in the left genu, as well as the increased ADC and λ(⊥) values in the left splenium of CC in comparison to the controls. Compared with the PA, the MMT subjects had a significantly increased ADC value in the bilateral splenium of CC. Importantly, the methadone dosage used in the MMT group was correlated with the FA value in the left splenium of CC and in the right frontal lobe. Our preliminary results suggest that methadone plays a role in the impairment of WM integrity in heroin users on long-term MMT and the normalization of WM injury may occur during abstinence.     

Untangling the alliance-outcome correlation: exploring the relative importance of therapist and patient variability in the alliance

Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients seen by 80 therapists (therapist average caseload was 4.1). Patients rated both the alliance and outcome and all models adjusted for baseline psychological functioning. The results indicated that therapist variability in the alliance predicted outcome, whereas patient variability in the alliance was unrelated to outcome. Reasons why therapist variability as opposed to patient variability predicted outcome are discussed. Clinical implications include therapists monitoring their contribution to the alliance, clinics providing feedback to therapists about their alliances, and therapists receiving training to develop and maintain strong alliances.     

Clinicopathological features of acute promyelocytic leukemia: an experience in one institute emphasizing the morphological and immunophenotypic changes at the time of relapse

Acute promyelocytic leukemia (APL) has two morphological variants, namely macrogranular (M3) and microgranular (M3v). M3v, characterized by the presence of neoplastic promyelocytes with only sparse fine azurophilic granules, accounts for 10-25% of all APL and has unique biological characteristics. Relapse occurs in approximately 20% of patients with APL. The morphological type of the leukemic cells at relapse is usually identical with the primary disease, and only one case of morphological change at relapse has been reported. Here, we analyzed the clinicopathological features of APL, including 4 relapsed cases emphasizing morphological changes at the time of relapse. The unique finding of the present study is that 2 of 4 relapsed cases changed from M3 to M3v at relapse. The morphological features of these were different in each case (one had blastic features and the other resembled monocytoid leukemic cells). Cytogenetic analyses revealed the continued presence of t(15;17)(q22;q12) at the time of relapse and morphological change. Moreover, the immune phenotype of the leukemic cells changed from CD2^-/CD34^- to CD2⁺/CD34⁺ at that time. These findings suggest that morphological change at relapse in APL may not be a rare event, and that the leukemic cells can show variable morphological features at the time of relapse, which could result in misdiagnosis as a different type of acute myeloid leukemia. Therefore, a comprehensive approach with emphasis on combined morphological, immunophenotypic, and cytogenetic analyses is important for diagnosis and appropriate treatment of relapsed APL.     

微RNA-374b与前列腺癌恶性程度及生化复发的分析

目的检测前列腺癌组织及良性前列腺组织中微RNA-374b表达,探讨其与前列腺癌恶性程度及生化复发的关系。方法收集广州医科大学附属广州市第一人民医院、中山大学附属第二医院、广州市红十字会医院2000年至2010年泌尿外科103例前列腺癌手术后的样本和25例前列腺增生手术获取的前列腺良性组织样本。采用原位杂交技术检测微RNA．374b在前列腺癌组织及良性前列腺组织中表达,并对微RNA．374b表达与前列腺癌患者年龄、术前PSA、临床分期、病理分期、Gleason评分、是否生化复发、是否转移及是否死亡的关系进行统计分析。根据微RNA．374b的相对表达量,以中位数（M=4．50）将其分为低表达组及高表达组,运用Kaplan．meier方法及Log．rank检验进行总体生存率和无生化复发生存率分析。结果微RNA．374b在前列腺癌的表达低于良性组织（3．97±1．17比4．70±0．71,P〈0．05）。微RNA．374b的表达量同Gleason评分、病理分期、转移、是否生存及生化复发有关（均P〈0．05）,同年龄、PSA水平及临床分期无关（均P〉0．05）。微RNA．374b低表达组无生化复发生存率低于高表达组（P〈0．05）,高表达组的生化复发时间高于低表达组（P〈0．05）。微RNA．374b表达与总体生存率无关。结论微RNA．374b的低表达与前列腺癌恶性程度有关,有望成为评价前列腺癌恶性程度及生化复发的指标。     

Primary mucosa-associated lymphoid tissue lymphoma of the prostate: tumor relapse 7 years after local therapy

Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the prostate is rare, and only five cases have been reported. Reported herein is a new case that has involved a 9 year follow up. A 79-year-old man was treated with transurethral resection (TUR) for a mass of the right prostatic lobe, and followed up under a diagnosis of benign prostatic hyperplasia with atypical lymphoid infiltration. Seven years later TUR was again performed for a right lobe mass. The lesion was diagnosed as a relapsed MALT lymphoma after detailed histological and immunoglobulin heavy chain gene analyses of the initial and relapsed lesions. Interestingly, lymphoepithelial lesions were observed only infrequently in this tumor. The API2-MALT1 fusion, a gene alteration specific to MALT lymphoma, was absent. The patient had stage IA disease at the time of tumor relapse, and has been alive and well for the 2 years after the second TUR. The present case suggests that despite tumor recurrence, prostatic MALT lymphoma is indolent, and function-preserving therapy is warranted.     

Pre-hospital trauma care: A comparison of two healthcare systems

Introduction:

The management of trauma patients differs depending upon the healthcare system available.

Aim:

To compare the pre-hospital management and outcome of polytrauma patients between two countries with differing approaches to pre-hospital management.

Materials and Methods:

The Scottish trauma and audit group (STAG) and the German trauma registry (GTR) databases were used to compare the management and outcome of trauma patients in Scotland and Germany. Severely injured patients (injury severity score (ISS) > 16) were analyzed for a 3 year period (2000 to 2002). Patient demographics, pre-hospital interventions, ISS, revised trauma score (RTS), time from scene of injury to arrival to the emergency department (ED), 120 day mortality and standardized mortality ratios using TRISS methodology were compared.

Results:

There were 227 patients identified from the STAG registry and 6878 patients from the GTR registry. There was a significant difference in ISS (24.9 vs. 29.8, P = 0.001, respectively). No significant difference was observed for the RTS (P = 0.2). There was a significantly higher rate of pre-hospital interventions in the German group (P < 0.001). The mean time from an injury to arrival to the ED (73 vs. 247 minutes, P = 0.001) was longer for the Scottish patients. There was no difference for an unadjusted mortality rate between the groups, but the standardized mortality ratio was significantly greater for the Scottish population (3.8 vs. 2.2, P = 0.036).

Conclusion:

Despite variation in pre-hospital transfer times and interventions, no significant difference was demonstrated in RTS upon arrival, or for the unadjusted mortality rates.     

Testicular infection in brucellosis: Report of 34 cases

Background/Purpose

To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement.