Pericarditis: a rare complication of methotrexate therapy

Serositis is a rare complication of methotrexate (MTX) administration. We report a 60-year-old man with rheumatoid arthritis who developed pericarditis after taking his weekly MTX dose, which recurred within hours after 2 subsequent weekly MTX doses. Pericarditis has not recurred after discontinuance of MTX over 3 years ago. We conclude that he had MTX-induced pericarditis, based on the close temporal relationship between MTX ingestion and manifestations of pericarditis on three distinct occasions because of the previous reports of MTX-induced pericarditis and because pericarditis has not recurred after MTX withdrawal.     

Autologous skeletal myoblasts transduced with a new adenoviral bicistronic vector for treatment of hind limb ischemia

OBJECTIVE: We aimed to achieve angiogenic synergism between human vascular endothelial growth factor 165 (VEGF 165 ) and angiopoietin-1 (Ang-1) using a new adenoviral bicistronic vector concurrently with cell therapy to repair an ischemically damaged hind limb in a rabbit model. METHODS: Rabbit autologous primary skeletal myoblasts were isolated and labeled with retrovirally transduced LacZreporter gene, 4,6-diamidino-2-phenylindole (DAPI), and 5-bromo-2'-deoxyuridine (BrdU). Hind limb ischemia was created in 48 female New Zealand White rabbits by means of femoral artery ligation at 8 different places, and was assessed at angiography. Animals were randomized to receive intramuscular injection of either Dulbeco's Modified Eagle Medium (DMEM;group 1, n = 8), nontransduced myoblasts (group 2, n = 10), or myoblasts transduced with Ad-Null (group 3, n = 10), Ad-VEGF (group 4, n = 10), or Ad-Bicis (group 5, n = 8). Six weeks after treatment neovascularization in the limb was assessed at angiography. The animals were euthanized, and tissue was harvested for histologic study. RESULTS: Extensive transplanted myoblast survival was observed in all cell-transplanted groups, as visualized with DAPI, BrdU, and LacZ staining. Angiographic blood vessel count revealed enhanced neovascularization in group 5 (25.14 +/- 5.14) compared with group 4 (13.62 +/- 4.52), group 3 (6.09 +/- 0.09), group 2 (4.67 +/- 3.49), and group 1 (3.18 +/- 7.76). Immunostaining for von Willebrand factor confirmed significantly increased capillary density ( P < .01) at high-power microscopic field in group 5 (19.04 +/- 1.59) compared with group 4 (15.31 +/- 1.55), group 3 (6.53 +/- 0.97), group 2 (5.69 +/- 0.51), and group 1 (3.03 +/- 0.20). CONCLUSION: Simultaneous expression of VEGF and Ang-1 from bicistronic vector transduced skeletal myoblasts potently stimulated enhanced functional neovascularization in a rabbit model of limb ischemia.     

New lysophosphatidylcholines and monoglycerides from the marine sponge Stelletta sp

Two new lysophosphatidylcholines (1, 2) and four new monoglycerides (5-8) were isolated from the marine sponge Stelletta sp. by bioactivity-guided fractionation. The planar structures of the new compounds were established on the basis of NMR and MS analyses. The stereochemistry was defined by comparison of the optical rotation. The compounds were evaluated for cytotoxicity against a small panel of five human tumor cell lines.     

Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows

Burnout among surgeons has been attributed to increased workload and decreased autonomy. Although prior studies have examined burnout among transplant surgeons, no studies have evaluated burnout in abdominal transplant surgery fellows. The objective of our study was to identify predictors of burnout and understand its impact on personal and patient care during fellowship. A survey was sent to all abdominal transplant surgery fellows in an American Society of Transplant Surgeons–accredited fellowship. The response rate was 59.2% (n = 77) and 22.7% (n = 17) of fellows met criteria for burnout. Fellows with lower grit scores were more likely to exhibit burnout compared with fellows with higher scores (3.6 vs 4.0, P = .026). Those with burnout were more likely to work >100 hours per week (58.8% vs 27.6%, P = .023), have severe work-related stress (58.8% vs 22.4%, P = .010), consider quitting fellowship (94.1% vs 20.7%, P < .001), or make a medical error (35.3% vs 5.2%, P = .003). This national analysis of abdominal transplant fellows found that burnout rates are relatively low, but few fellows engage in self-care. Personal and program-related factors attribute to burnout and it has unacceptable effects on patient care. Transplant societies and fellowship programs should develop interventions to give fellows tools to prevent and combat burnout.     

Strength‐based assessment in clinical practice

Strength‐based assessment can enhance clinical clarity, improve the range of information, and provide a more complete picture of clients and their circumstances. Deficit‐oriented assessment has improved the assessment and treatment of a number of disorders but, at the same time, has created a negative bias, considered strengths as clinical peripheries or by‐products, tended to reduce clients to diagnostic categories, and created a power differential, which could be counterproductive to clinical efficacy. Strength‐based assessment explores weaknesses as well as strengths to effectively deal with problems. We present a number of strength‐based strategies for use in clinical practice. These strategies, we hope, will help clinicians to operationalize how strengths and weaknesses reverberate and contribute to a client's psychological status, which is comprehensive and guards against negative bias. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65: 1–11, 2009.