High-risk pregnancy and hospitalization: the women's voices

The study is a phenomenological analysis of 10 focus groups with Israeli women who were hospitalized because of high-risk pregnancy. The goal of this study was to understand the lived experience of hospitalization due to high-risk pregnancy. Five themes were recognized: (1) the desire to nurture and the social pressure to do so; (2) the personal and social meaning of a family; (3) loss of normal experiences of life and childbearing; (4) the woman's needs versus the fetus's well-being; and (5) sources of strength and stress. Conflicting relationships recognized within and between the themes pointed to ambivalence as the core characteristic of the experience. Practical implications and further research are recommended to better inform health care personnel and social workers assisting these women.     

Integration of Health Systems Management Bachelors Program graduates into the Israeli healthcare market

Ben-Gurion University (BGU) in Beer-Sheva, opened a special program (B.A. degree) for training junior academic administrative personnel who can improve the quality of service in health care organizations through suitable and high-quality administration. The program the first of its kind in Israel, has been in operation since 1994, providing 50 candidates for administrative positions within the health system per year. The research goals of the project described in this paper were to examine integration of 224 graduates of the undergraduate program in Health Systems Management (HSM) within the private and public health system in Israel, including employment trends and evaluation of the program in retrospect. Questionnaires were sent to all graduates of the program. Participants were requested to answer questions regarding their present place of employment and their satisfaction with their academic degree. The findings showed that the graduates of the undergraduate program in HSM have integrated well into the health system, butnotas well as they could have. The graduates encountered difficulties in their absorption into management roles in the public health system and feel that the extent of their abilities has yet to be fully recognized and utilized by the system.     

Social stress and the regulation of tumor necrosis factor-alpha secretion

Social disruption (SDR), a murine model of social stress, altered the phenotype and function of spleen immune cells. Previous reports indicated that following SDR spleens contained higher numbers of CD11b+ monocytes, and these cells were less sensitive to the inhibitory effects of glucocorticoids on cell viability. Additionally, lipopolysaccharide (LPS)-stimulated splenocytes from SDR mice secreted higher levels of the proinflammatory cytokines tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 compared to splenocytes from controls. The present study sought to further examine the effects of SDR on TNFalpha secretion from splenocytes. We report that SDR increased TNFalpha secretion from an enriched fraction of CD11b+ monocytes stimulated with LPS. Additionally, SDR altered the kinetics of TNFalpha release from LPS-stimulated splenocytes and induced minor changes in the suppressive effects of corticosterone and norepinephrine on LPS-induced TNFalpha secretion. These results are in agreement with the notion that complex interactions mediate the response to social stress.     

Primed peripheral polymorphonuclear leukocyte: a culprit underlying chronic low-grade inflammation and systemic oxidative stress in chronic kidney disease

This study characterizes the causal relationship between peripheral polymorphonuclear leukocyte (PMNL) priming, systemic oxidative stress (OS), and inflammation in patients with varying degrees of renal insufficiency (chronic kidney disease [CKD] not on renal replacement therapy [RRT]: continuous ambulatory peritoneal dialysis or hemodialysis [HD]) and healthy control subjects. Rate of superoxide release was measured after stimulation of PMNL with phorbol 12-myristate 13-acetate or zymosan. Priming was estimated by the rate of superoxide release after phorbol 12-myristate 13-acetate stimulation. Systemic OS was related to PMNL priming and intracellular myeloperoxidase activity. Inflammation was linked to peripheral white blood cells and PMNL counts, PMNL apoptosis, and PMNL ex vivo survival in autologous and heterologous sera. PMNL priming and counts were related to the severity of renal failure in CKD not on RRT. Compared with control subjects, PMNL from all CKD patients showed increased priming, highest in HD, with a significant decrease in their response to zymosan. PMNL myeloperoxidase activity and apoptosis were increased in all renal failure patients. Decreased ex vivo cell survival and elevated leukocyte counts were found in all patients, highest in HD. Both PMNL priming and counts correlated negatively with the GFR. A positive significant correlation was shown between PMNL counts and their priming in all groups, suggesting that the increased PMNL count in peripheral blood is an adaptive response to PMNL priming. Hence, PMNL priming is a key mediator of low-grade inflammation and OS associated with renal failure, occurring before the onset of RRT and further augmented in chronic HD.     

The effect of betahistine, a histamine H1 receptor agonist/H3 antagonist, on olanzapine-induced weight gain in first-episode schizophrenia patients

Histamine antagonism has been implicated in antipsychotic drug-induced weight gain. Betahistine, a histamine enhancer with H1 agonistic/H3 antagonistic properties (48 mg t.i.d.), was coadministered with olanzapine (10 mg/day) in three first-episode schizophrenia patients for 6 weeks. Body weight was measured at baseline and weekly thereafter. Clinical rating scales were completed at baseline and at week 6. All participants gained weight (mean weight gain 3.1+/-0.9 kg) and a similar pattern of weight gain was observed: an increase during the first 2 weeks and no additional weight gain (two patients) or minor weight loss (one patient) from weeks 3 to 6. None gained 7% of baseline weight, which is the cut-off for clinically significant weight gain. Betahistine was safe and well tolerated and did not interfere with the antipsychotic effect of olanzapine. Our findings justify a placebo-controlled evaluation of the putative weight-attenuating effect of betahistine in olanzapine-induced weight gain.     

Jasmonates induce nonapoptotic death in high-resistance mutant p53-expressing B-lymphoma cells

Mutations in p53, a tumor suppressor gene, occur in more than half of human cancers. Therefore, we tested the hypothesis that jasmonates (novel anticancer agents) can induce death in mutated p53-expressing cells. Two clones of B-lymphoma cells were studied, one expressing wild-type (wt) p53 and the other expressing mutated p53. Jasmonic acid and methyl jasmonate (0.25-3 mM) were each equally cytotoxic to both clones, whereas mutant p53-expressing cells were resistant to treatment with the radiomimetic agent neocarzinostatin and the chemotherapeutic agent bleomycin. Neocarzinostatin and bleomycin induced an elevation in the p53 levels in wt p53-expressing cells, whereas methyl jasmonate did not. Methyl jasmonate induced mostly apoptotic death in the wt p53-expressing cells, while no signs of early apoptosis were detected in mutant p53-expressing cells. In contrast, neocarzinostatin and bleomycin induced death only in wt p53-expressing cells, in an apoptotic mode. Methyl jasmonate induced a rapid depletion of ATP in both clones. In both clones, oligomycin (a mitochondrial ATP synthase inhibitor) did not increase ATP depletion induced by methyl jasmonate, whereas inhibition of glycolysis with 2-deoxyglucose did. High glucose levels protected both clones from methyl jasmonate-induced ATP depletion (and reduced methyl jasmonate-induced cytotoxicity), whereas high levels of pyruvate did not. These results suggest that methyl jasmonate induces ATP depletion mostly by compromising oxidative phosphorylation in the mitochondria. In conclusion, jasmonates can circumvent the resistance of mutant p53-expressing cells towards chemotherapy by inducing a nonapoptotic cell death.     

Image-guided cutting-edge-needle biopsy of peripheral lymph nodes and superficial masses for the diagnosis of lymphoma

OBJECTIVE: To evaluate the diagnostic efficacy of image-guided cutting-edge-needle biopsy of peripheral lymph nodes and superficial masses for the diagnosis of lymphoma, for which many still advocate open surgical resection. METHODS: A retrospective analysis was performed of the medical records of 114 lymphoma patients who presented with peripheral lymphadenopathy and superficial masses and who underwent diagnostic image-guided biopsy. There were 69 non-Hodgkin lymphoma patients, 38 Hodgkin lymphoma patients, and 7 patients who were evaluated for histologic transformation of CLL or high grade lymphoma. RESULTS: Image-guided needle biopsy was diagnostic in 96/114 (84.2%) patients. The procedure was diagnostic in 59/69 (85.5%) of NHL patients and in 30/38 of Hodgkin disease patients (79%). Diagnoses were achieved for all 7 cases where histologic transformation was suspected. CONCLUSION: Percutaneous image-guided needle biopsy is a safe and reliable procedure with a high diagnostic yield. It can be used as a first step in patients suspected of having lymphoma presenting with enlarged peripheral lymph nodes and superficial masses.     

Familial clustering of classic Kaposi sarcoma

It is widely accepted that there is a causal association between Kaposi sarcoma-associated herpesvirus (KSHV) and Kaposi sarcoma (KS). However, the majority of individuals infected with KSHV never develop KS. Here, we present a unique familial case of classic KS, in which the disease occurs in 4 siblings who have no recognized underlying immunodeficiency. We examine risk factors that could play a role in this condition, including KSHV infection, KSHV DNA load, genetic variants of KSHV, infection with additional viruses, interleukin-6-promoter polymorphism, and HLA genotype. We hypothesize that a genetic susceptibility to KS, in combination with KSHV infection, may play an important role in the presented familial case.