Eden Medical Center

Abstract The aim of the study was to determine the effectiveness of the recently developed Eye Movement Desensitization (EMD) procedure on traumatic memory symptomatology. Twenty‐two subjects suffering from symptoms related to traumatic memories were used in the study. All had been victims of traumatic incidents concerning the Vietnam War, childhood sexual molestation, sexual or physical assault, or emotional abuse. Memories of the traumatic incident were pivotal to the presenting complaints which included intrusive thoughts, flashbacks, sleep disturbances, low self‐esteem, and relationship problems. Dependent variables were (1) anxiety level, (2) validity of a positive self‐statement/assessment of the traumatic incident, and (3) presenting complaints. These measures were obtained at the initial session and at 1‐ and 3‐month follow‐up sessions. The results of the study indicated that a single session of the EMD procedure successfully desensitized the subjects' traumatic memories and dramatically altered their cognitive assessments of the situation, effects that were maintained through the 3‐month follow‐up check. This therapeutic benefit was accompanied by behavioral shifts which included the alleviation of the subjects' primary presenting complaints.

PURPOSE Radiation dose to the neuroregenerative zone of the hippocampus has been found to be associated with cognitive toxicity. Hippocampal avoidance (HA) using intensity-modulated radiotherapy during whole-brain radiotherapy (WBRT) is hypothesized to preserve cognition. METHODS This phase III trial enrolled adult patients with brain metastases to HA-WBRT plus memantine or WBRT plus memantine. The primary end point was time to cognitive function failure, defined as decline using the reliable change index on at least one of the cognitive tests. Secondary end points included overall survival (OS), intracranial progression-free survival (PFS), toxicity, and patient-reported symptom burden. RESULTS Between July 2015 and March 2018, 518 patients were randomly assigned. Median follow-up for alive patients was 7.9 months. Risk of cognitive failure was significantly lower after HA-WBRT plus memantine versus WBRT plus memantine (adjusted hazard ratio, 0.74; 95% CI, 0.58 to 0.95; P = .02). This difference was attributable to less deterioration in executive function at 4 months (23.3% v 40.4%; P = .01) and learning and memory at 6 months (11.5% v 24.7% [ P = .049] and 16.4% v 33.3% [ P = .02], respectively). Treatment arms did not differ significantly in OS, intracranial PFS, or toxicity. At 6 months, using all data, patients who received HA-WBRT plus memantine reported less fatigue ( P = .04), less difficulty with remembering things ( P = .01), and less difficulty with speaking ( P = .049) and using imputed data, less interference of neurologic symptoms in daily activities ( P = .008) and fewer cognitive symptoms ( P = .01). CONCLUSION HA-WBRT plus memantine better preserves cognitive function and patient-reported symptoms, with no difference in intracranial PFS and OS, and should be considered a standard of care for patients with good performance status who plan to receive WBRT for brain metastases with no metastases in the HA region.

Background: Previous studies have shown that virtual reality (VR) is effective in reducing acute and chronic pain both in adults and in children. Given the emergence of new VR technology, and the growing body of research surrounding VR and pain management, an updated systematic review is warranted. Purpose: The purpose of this systematic review is to compare the effectiveness of VR in reducing acute and chronic pain in adults. Data Sources: A search was conducted in three databases (PubMed, CINAHL, Trip) using standardized search terms. Study Selection: Twenty experimental and quasi-experimental trials published between January 2007 and December 2018 were included based on prespecified inclusion and exclusion criteria. Pain intensity was the primary outcome. Data Extraction: We extracted data and appraised the quality of articles using either the PEDro or Modified Downs and Black risk of bias tools. Data Synthesis: The majority of studies supported the use of VR to reduce acute pain both during the procedure and immediately after. Numerous studies found VR reduced chronic pain during VR exposure but there is insufficient evidence to support lasting analgesia. There was considerable variability in patient population, pain condition and dosage of VR exposure. Limitations: Due to heterogeneity, we were unable to perform meta-analyses for all study populations and pain conditions. Conclusions: VR is an effective treatment for reducing acute pain. There is some research that suggests VR can reduce chronic pain during the intervention; however, more evidence is needed to conclude that VR is effective for lasting reductions in chronic pain. Keywords: virtual reality, analgesia, acute, chronic, pain management, adult

Background: Gender bias has been an ongoing issue in health care, examples being underrepresentation of women in health studies, trivialization of women's physical complaints, and discrimination in the awarding of research grants. We examine here a different issue—gender disparity when it comes to the allocation of research funding among diseases. Materials and Methods: We perform an analysis of funding by the U.S. National Institutes of Health (NIH) to ascertain possible gender disparity in its allocation of funds across diseases. We normalize funding level to disease burden, as measured by the Disability Adjusted Life Year, and we specifically consider diseases for which both disease burden and funding level are provided. We apply a power-law regression analysis to model funding commensurate with disease burden. Results: We find that in nearly three-quarters of the cases where a disease afflicts primarily one gender, the funding pattern favors males, in that either the disease affects more women and is underfunded (with respect to burden), or the disease affects more men and is overfunded. Moreover, the disparity between actual funding and that which is commensurate with burden is nearly twice as large for diseases that favor males versus those that favor females. A chi-square test yields a p -value of 0.015, suggesting that our conclusions are representative of the full NIH disease portfolio. Conclusions: NIH applies a disproportionate share of its resources to diseases that affect primarily men, at the expense of those that affect primarily women.

This 12-week, prospective, randomised, controlled multi-centre study compared the proportion of healed diabetic foot ulcers and mean healing time between patients receiving acellular matrix (AM) (study group) and standard of care (control group) therapies. Eighty-six patients were randomised into study (47 patients) and control (39 patients) groups. No significant differences in demographics or pre-treatment ulcer data were calculated. Complete healing and mean healing time were 69.6% and 5.7 weeks, respectively, for the study group and 46.2% and 6.8 weeks, respectively, for the control group. The proportion of healed ulcers between the groups was statistically significant (P = 0.0289), with odds of healing in the study group 2.7 times higher than in the control group. Kaplan-Meier survivorship analysis for time to complete healing at 12 weeks showed a significantly higher non healing rate (P = 0.015) for the control group (53.9%) compared with the study group (30.4%). After adjusting for ulcer size at presentation, which was a statistically significant covariate (P = 0.0194), a statistically significant difference in non healing rate between groups was calculated (P = 0.0233), with odds of healing 2.0 times higher in the study versus control group. This study supports the use of single-application AM therapy as an effective treatment of diabetic, neuropathic ulcers.

Leptin, a 16 kDa pleiotropic cytokine primarily expressed in adipose tissue, has been shown to cause multiple systemic biological actions. Recently, leptin has also been documented as an important component of the wound healing process and its receptor appears to be expressed in wound tissue. We have previously demonstrated that leptin is a potent angiogenic factor exerting direct effects on endothelial cells and that transcription of its encoding gene is regulated by hypoxia. Here, we hypothesize that leptin expression is acutely up-regulated in the ischemic tissue of experimental wounds. Using a combination of in situ hybridization and quantitative RT-PCR experiments, we show that leptin expression is rapidly and steadily up-regulated in skin tissue from incisional and excisional wounds. By immunohistochemistry, we demonstrate increased and sustained leptin protein levels in basal keratinocytes, blood vessel walls, and fibroblasts. To determine whether leptin is required for normal healing, excisional wounds were treated with neutralizing anti-leptin antibodies. This treatment markedly hampered healing progression and prevented wound closure and contraction. Finally, a transient rise in circulating blood leptin levels was detected within the first 24 h after inflicting the injury; we present evidence suggesting that this elevation is due to increased leptin production at the ischemic wound site. We conclude that leptin is acutely up-regulated in the injured skin and propose that this local production of leptin serves a critical functional role as an autocrine/paracrine regulator of normal wound healing.

CONTEXT: The human adrenal gland produces small amounts of testosterone that are increased under pathological conditions. However, the mechanisms through which the adrenal gland produces testosterone are poorly defined. OBJECTIVE: Our objective was to define the role of type 5 17beta-hydroxysteroid dehydrogenase (AKR1C3) in human adrenal production of testosterone. DESIGN AND METHODS: Adrenal vein sampling was used to confirm ACTH stimulation of adrenal testosterone production. Adrenal expression of AKR1C3 was studied using microarray, quantitative real-time RT-PCR, and immunohistochemical analyses. AKR1C3 knockdown was accomplished in cultured adrenal cells (H295R) using small interfering RNA, followed by measurement of testosterone production. RESULTS: Acute ACTH administration significantly increased adrenal vein testosterone levels. Examination of the enzymes required for the conversion of androstenedione to testosterone using microarray analysis, quantitative real-time RT-PCR, and immunohistochemistry demonstrated that AKR1C3 was present in the adrenal gland and predominantly expressed in the zona reticularis. Decreasing adrenal cell expression of AKR1C3 mRNA and protein inhibited testosterone production in the H295R adrenal cell line. CONCLUSIONS: The human adrenal gland directly secretes small, but significant, amounts of testosterone that increases in diseases of androgen excess. AKR1C3 is expressed in the human adrenal gland, with higher levels in the zona reticularis than in the zona fasciculata. AKR1C3, through its ability to convert androstenedione to testosterone, is likely responsible for adrenal testosterone production.

Abstract We examine the variability of peak horizontal and vertical accelerations of the large California strong-motion data set for the time period 1957 to 1991 and find a statistically significant dependence of the standard error on earthquake magnitude. Specifically, the standard error decreases with increasing magnitude. The analysis was conducted using a rigorous methodology that examines both earthquake to earthquake (inter-event) variability and within earthquake (intra-event) variability. The magnitude dependence is stronger for inter-event variability than intra-event variability, and stronger for horizontal peak acceleration than for vertical peak acceleration. The data from the recent Landers, Big Bear, and Northridge earthquakes are consistent with these results.

OBJECTIVES: To evaluate the effectiveness of cyclosporine in inducing and maintaining remission of the inflammatory process in autoimmune hepatitis, when used in combination with low doses of prednisone and azathioprine and to identify the prognostic factors associated with sustained remission. METHODS: Eighty-four patients with autoimmune hepatitis were consecutively recruited from 5 centers between January 1994 and March 2001. Cyclosporine was administered during the first 6 months. Thereafter, in patients with aminotransferase levels of lower than twice the normal values, prednisone and azathioprine were initiated. RESULTS: Normal aminotransferase levels were observed in 94.05% (79/84) of the patients, 72% of them within the first 6 months of treatment. Total serum bilirubin level of greater than 1.2 mg/dL and portal hypertension at diagnosis jointly predicted a significant delay in remission. Adverse effects related to cyclosporine remained mild and transient. Low doses of prednisone and standard doses of azathioprine were not implicated in relapse of the disease during the follow-up of any patient. CONCLUSIONS: This protocol allowed control of the liver inflammatory process and was well tolerated. The response to this immunosuppressive therapy can be predicted with accuracy. Factors delaying remission can be identified early at diagnosis and may contribute to the development of more effective treatment policies for this condition.

The adrenal glands are the primary source of mineralocorticoids, glucocorticoids, and the so-called adrenal androgens. Under physiological conditions, cortisol and adrenal androgen synthesis are controlled primarily by ACTH. Although it is well established that ACTH can stimulate steroidogenesis in the human adrenal gland, the effect of ACTH on overall production of different classes of steroid hormones has not been defined. In this study, we examined the effect of ACTH on the production of 23 steroid hormones in adult adrenal primary cultures and 20 steroids in the adrenal cell line, H295R. Liquid chromatography/tandem mass spectrometry analysis revealed that, in primary adrenal cell cultures, cortisol and corticosterone were the two most abundant steroid hormones produced with or without ACTH treatment (48 h). Cortisol production responded the most to ACTH treatment, with a 64-fold increase. Interestingly, the production of two androgens, androstenedione and 11β-hydroxyandrostenedione (11OHA), that were also produced in large amounts under basal conditions significantly increased after ACTH incubation. In H295R cells, 11-deoxycortisol and androstenedione were the major products under basal conditions. Treatment with forskolin increased the percentage of 11β-hydroxylated products, including cortisol and 11OHA. This study illustrates that adrenal cells respond to ACTH through the secretion of a variety of steroid hormones, thus supporting the role of adrenal cells as a source of both corticosteroids and androgens.

Journal Article Airborne Contagion and Air Hygiene: An Ecological Study of Droplet Infections Get access Airborne Contagion and Air Hygiene. An Ecological Study of Droplet Infections. By Firth Wells William. 423 pp., 85 figs., 89 tables. $6.00Cambridge, Massachusetts: Harvard University Press, 1955. Frank R. Dutra Frank R. Dutra Castro Valley, California Search for other works by this author on: Oxford Academic Google Scholar American Journal of Clinical Pathology, Volume 25, Issue 11, 1 November 1955, Page 1301, https://doi.org/10.1093/ajcp/25.11.1301 Published: 01 November 1955

A case is reported of a slow-growing papillary carcinoma of the thyroid that caused clinically apparent implantation along the tract of a fine needle aspiration (FNA) biopsy. This appears to be the first report of a cutaneous needle tract metastasis from a papillary thyroid carcinoma. It represents a highly unusual complication of an FNA biopsy of an indolent, slow-growing tumor.

Recent experiments have adapted existing magnetically insulated induction voltage adders (Sabre, Hermes III) to drive a 10-MV diode immersed in magnetic fields as high as 50 T. In such a diode, an electron beam of tens of kiloamperes can be confined by the magnetic field to a diameter of about 1 mm, and when it strikes a high-Z anode, it can create a bremsstrahlung X-ray source intense enough to radiograph massive objects with high resolution. The radiographic integrated test stand (RITS) is an adder system designed specially to drive such diodes, and it will be used to develop and exploit them. As in other adder-based pulsers, such as Sabre, Hermes III, and Kalif-Helia, the induction cells have amorphous-iron cores, and the pulse-forming system consists of water dielectric pulselines and self-closing water switches that are pulse-charged from Marx-charged intermediate water capacitors through laser-triggered Rimfire switches. An oil prepulse switch in series with each pulseline is designed to reduce cathode prepulse to less than /spl plusmn/5 kV, and a means is provided to bias the cathode and avoid negative prepulse entirely. The RITS pulse-forming system consists of two modules. Each module has one Marx that charges two 3-MV intermediate stores, each of which charges three 7.8 /spl Omega/ pulselines, making six pulselines per module. The two modules in concert can supply 1.35-MV, 50-ns pulses to a 12-cell adder and thus drive a 16-MV diode with a single pulse. The 1,35-MV induction cells each have a single-point feed, from which a single, slotted azimuthal oil transmission line distributes energy uniformly around the cell. The modules can also be pulsed separately at different times, either to power two 8-MV adders that each drive one of two closely spaced cathodes immersed in a common magnetic field or to provide two separate pulses to a common six-cell adder and a single 8-MV diode; in these two-pulse modes, the spacing of the two 50-ns pulses may be chosen to be anything from a few hundred nanoseconds upward. The use of only one pulseline per cell has been shown to increase the extent to which the cell voltages can vary with the timing of closure of the water switches. This and all other functions of RITS have been simulated in detail, and a conservative electrical design has been developed. This will be illustrated, along with the conceptual design of a pulse sorting network that can couple two pulselines efficiently to one cell when the two RITS modules drive a common adder in two-pulse mode.

HLA-G is expected to play an important role during fetal development. Recently, a healthy individual homozygous for the HLA-G*0105N allele has been described, suggesting that HLA-G expression was not essential for fetal survival. We now report studies of one family with five healthy siblings homozygous for HLA-G*0105N, who had been normally delivered; three of these siblings were females who also had normal deliveries. In addition, HLA-G*0105N cDNA has been fully sequenced, and normal G1 membrane anchored protein cannot be translated since after the codon 130 cytosine deletion (exon 3) a reading frameshift is observed leading to the existence of premature stop codon at position 189 (beginning of exon 4). Other protein isoforms (G2, G3 and G6), all containing the leader peptide and the alpha1 domain, are possible and their messenger mRNAs were found; any of these may undertake the necessary HLA-G functions. Our data show that the membrane anchored HLA-G molecule is not necessary in either mother or fetus for a normal pregnancy and survival. Also, individuals homozygous for HLA-G*0105N are healthy and with no indications of immunodeficiency or autoimmunity.

San Francisco, Calif. From the Division of Plastic Surgery at the University of California at San Francisco and the Davies Medical Center. Received for publication February 5, 1997; revised March 5, 1997. John Q. Owsley, M.D. Davies Medical Center 45 Castro Street Suite 111 San Francisco, Calif. 94114

Three cases demonstrating avulsion of the coracoid process from the scapula associated with acromioclavicular separation are presented. Two patients were adolescents and one a young adult, suggesting that the coracoid base epiphyseal plate in this age group may be weaker than the coracoclavicular ligaments. A cranially-angled view of the shoulder was diagnostic in two cases. Recognition of this condition is mandatory if the orthopedist is planning fixation of the clavicle to the coracoid to remedy an acromioclavicular separation.

We update the US prevalence and economic impact estimates of the 2015 National Academy of Medicine report on myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS), taking into account growth in population, economic inflation, and inclusion of children. We find a rough doubling of the ME/CFS prevalence and economic impact figures in the US, with low-end prevalence coming out to 1.5 million and economic impact having a range of 36–51 billion dollars per year.

G/T lesion recognition by MMR initiates mismatch excision, the reinsertion of a mismatched thymidine during resynthesis could initiate futile repair cycles. One consequence of futile repair cycles might be a disruption of overall DNA replication in the affected cell. Herein, we show that in MMR-proficient HeLa cancer cells, treatment with a DNA alkylating agent slows S phase progression, yet cells still progress into the next cell cycle. In the first S phase following treatment, they activate ataxia telangiectasia and Rad3-related (ATR)-Checkpoint Kinase 1 (Chk1) signaling, which limits DNA damage, while inhibition of ATR kinase activity accelerates DNA damage accumulation and sensitivity to the DNA alkylating agent. We also observed that exposure of human embryonic stem cells to alkylation damage severely compromised DNA replication in a MMR-dependent manner. These cells fail to activate the ATR-Chk1 signaling axis, which may limit their ability to handle replication stress. Accordingly, they accumulate double-strand breaks and undergo immediate apoptosis. Our findings implicate the MMR-directed response to alkylation damage as a replication stress inducer, suggesting that repeated MMR processing of mismatches may occur that can disrupt S phase progression.

We explore the need for empathy in diverse groups, conceptualize the epistemology of empathy in relationship to whole-person dialogue, and examine strategies for creating empathic space that take into consideration the paradox of diversity. Two examples from our practice illustrate the role of empathic connection in personal learning and organizational change.

Intraglandular Morules of the Endometrium Frank R. Dutra, M.D. Frank R. Dutra, M.D. Eden Hospital, Castro Valley, California Search for other works by this author on: Oxford Academic Google Scholar American Journal of Clinical Pathology, Volume 31, Issue 1, 1 January 1959, Pages 60–65, https://doi.org/10.1093/ajcp/31.1.60 Published: 01 January 1959 Article history Received: 18 August 1958 Accepted: 19 September 1958 Published: 01 January 1959