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Objective: This study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors., Design: Participants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial., Setting: SGM males 18 years or older, residing in the U.S. or Canada, were recruited online., Participants: This study included younger (aged 18-39; n = 1,435), middle-aged (aged 40-59; n = 546), and older (aged 60+; n = 40) SGM men who reported a history of sexual abuse/assault., Measurements: Participants were asked about their sexual abuse history, experience of other traumas, symptoms of depression, and past 60-day mental health treatment engagement., Results: Older SGM men reported a lower rate of occurrence of adult sexual assault, exposure to other traumas, and depression. However, older and younger groups did not differ on any childhood sexual assault variable, the frequency of or number of attackers for adult sexual assault, the frequency of accidents and other injury traumas, or the occurrence or frequency of mental health treatment. Trauma load, including childhood and adult sexual assault, were more strongly related to current depressive symptoms than age group., Conclusion: While there were some age-based or cohort differences in the rates of sexual trauma, the clinical response of both groups was similar. Implications for working clinically with middle-aged and older SGM men with untreated sexual assault-related mental health difficulties are discussed, including outreach and availability of gender- and older-inclusive survivor treatment and resources., (Copyright © 2023 American Association for Geriatric Psychiatry. All rights reserved.)

Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal mental health care and assist in symptom reduction. This paper describes the rationale for and methodology of a randomized controlled trial comparing the effectiveness of Motivational Interviewing (MI) versus MI with affirmative care (MI-AC) for sexual and gender minority men who have been sexually traumatized. This study is designed to randomly assign 356 participants to either condition of six online group sessions delivered by two trained peers with lived experience of sexual trauma. Assessments will be conducted at baseline, post-treatment, 60- and 120-day follow-up. The primary hypotheses are that participants assigned to MI-AC, compared to those in MI only, will report reduced symptoms of depression and increased levels of engagement in formal mental health treatment. Additional hypotheses relate to secondary outcome variables, including post-traumatic stress disorder, suicidality, and substance use., (Copyright © 2021. Published by Elsevier Inc.)

Many drugs have been reported to cause thrombotic microangiopathy (TMA), yet evidence supporting a direct association is often weak. In particular, TMA has been reported in association with recombinant type I interferon (IFN) therapies, with recent concern regarding the use of IFN in multiple sclerosis patients. However, a causal association has yet to be demonstrated. Here, we adopt a combined clinical and experimental approach to provide evidence of such an association between type I IFN and TMA. We show that the clinical phenotype of cases referred to a national center is uniformly consistent with a direct dose-dependent drug-induced TMA. We then show that dose-dependent microvascular disease is seen in a transgenic mouse model of IFN toxicity. This includes specific microvascular pathological changes seen in patient biopsies and is dependent on transcriptional activation of the IFN response through the type I interferon α/β receptor (IFNAR). Together our clinical and experimental findings provide evidence of a causal link between type I IFN and TMA. As such, recombinant type I IFN therapies should be stopped at the earliest stage in patients who develop this complication, with implications for risk mitigation., (© 2016 by The American Society of Hematology.)

The Banff Working Group on Liver Allograft Pathology reviewed and discussed literature evidence regarding antibody-mediated liver allograft rejection at the 11th (Paris, France, June 5-10, 2011), 12th (Comandatuba, Brazil, August 19-23, 2013), and 13th (Vancouver, British Columbia, Canada, October 5-10, 2015) meetings of the Banff Conference on Allograft Pathology. Discussion continued online. The primary goal was to introduce guidelines and consensus criteria for the diagnosis of liver allograft antibody-mediated rejection and provide a comprehensive update of all Banff Schema recommendations. Included are new recommendations for complement component 4d tissue staining and interpretation, staging liver allograft fibrosis, and findings related to immunosuppression minimization. In an effort to create a single reference document, previous unchanged criteria are also included., (© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Introduction: This 2-part study hypothesized that a bioactive scaffold containing a sustained transforming growth factor (TGF)-β1-releasing nanoparticle system will promote migration and enhance differentiation of stem cells from the apical papilla (SCAP). The study aimed to develop and characterize a novel modified chitosan-based scaffold containing TGF-β1-releasing chitosan nanoparticles (TGF-β1-CSnp) to enhance migration and differentiation of SCAP., Methods: Part I concerns the synthesis and characterization of a carboxymethyl chitosan-based scaffold and TGF-β1-CSnp. Part II examines the effect of sustained TGF-β1 release from scaffold containing TGF-β1-CSnp on odontogenic differentiation of SCAP., Results: The scaffold demonstrated properties conducive to cellular activities. The incorporation of TGF-β1 in CSnp allowed sustained release of TGF-β1, facilitating delivery of a critical concentration of TGF-β1 at the opportune time. TGF-β1 bioactivity was maintained for up to 4 weeks. SCAP showed greater viability, migration, and biomineralization in the presence of TGF-β1-CSnp than in the presence of free TGF-β1. SCAP cultured in TGF-β1-CSnp + scaffold showed significantly higher dentin matrix protein-1 and dentin sialophosphoprotein signals compared with free TGF-β1 + scaffold or CSnp + scaffold., Conclusions: These experiments highlighted the potential of a carboxymethyl chitosan-based scaffold with growth factor releasing nanoparticles to promote migration and differentiation of SCAP. The results of this study may have direct application to improve current endodontic regenerative protocols., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The liver is an immunoregulatory organ in which a tolerogenic microenvironment mitigates the relative "strength" of local immune responses. Paradoxically, necro-inflammatory diseases create the need for most liver transplants. Treatment of hepatitis B virus, hepatitis C virus, and acute T cell-mediated rejection have redirected focus on long-term allograft structural integrity. Understanding of insults should enable decades of morbidity-free survival after liver replacement because of these tolerogenic properties. Studies of long-term survivors show low-grade chronic inflammatory, fibrotic, and microvascular lesions, likely related to some combination of environment insults (i.e. abnormal physiology), donor-specific antibodies, and T cell-mediated immunity. The resultant conundrum is familiar in transplantation: adequate immunosuppression produces chronic toxicities, while lightened immunosuppression leads to sensitization, immunological injury, and structural deterioration. The "balance" is more favorable for liver than other solid organ allografts. This occurs because of unique hepatic immune physiology and provides unintended benefits for allografts by modulating various afferent and efferent limbs of allogenic immune responses. This review is intended to provide a better understanding of liver immune microanatomy and physiology and thereby (a) the potential structural consequences of low-level, including allo-antibody-mediated injury; and (b) how liver allografts modulate immune reactions. Special attention is given to the microvasculature and hepatic mononuclear phagocytic system., (© Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Increasing interstitial fibrosis (IF) in native and kidney transplant biopsies is associated with functional decline and serves as a clinical trial end point. A Banff 2009 Conference survey revealed a range in IF assessment practices. Observers from multiple centers were asked to assess 30 renal biopsies with a range of IF and quantitate IF using two approaches on trichrome, Periodic acid-Schiff (PAS) and computer-assisted quantification of collagen III immunohistochemistry (C-IHC) slides, as well as assessing percent of cortical tubular atrophy% (TA%) and Banff total cortical inflammation score (ti-score). C-IHC using whole slide scans was performed. C-IHC assessment showed a higher correlation with organ function (r = -0.48) than did visual assessments (r = -0.32--0.42); computerized and visual C-IHC assessment also correlated (r = 0.64-0.66). Visual assessment of trichrome and C-IHC showed better correlations with organ function and C-IHC, than PAS, TA% and ti-score. However, visual assessment of IF, independent of approach, was variable among observers, and differences in correlations with organ function were not statistically significant among C-IHC image analysis and visual assessment methods. C-IHC image analysis correlated among three centers (r > 0.90, p < 0.0001, between all centers). Given the difficulty of visual IF assessment standardization, C-IHC image could potentially accomplish standardized IF assessment in multicenter settings., (© Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.)

We present the results of a multicenter clinical trial using Epstein-Barr virus (EBV)-specific cytotoxic T lymphocytes (CTLs) generated from EBV-seropositive blood donors to treat patients with EBV-positive posttransplantation lymphoproliferative disease (PTLD) on the basis of the best HLA match and specific in vitro cytotoxicity. Thirty-three PTLD patients who had failed on conventional therapy were enrolled. No adverse effects of CTL infusions were observed and the response rate (complete or partial) in 33 patients was 64% at 5 weeks and 52% at 6 months. Fourteen patients achieved a complete remission, 3 showed a partial response, and 16 had no response at 6 months (5 died before completing treatment). At 5 weeks, there was a significant trend toward better responses with higher numbers of CD4(+) cells in infused CTL lines (P = .001) that were maintained at 6 months (P = .001). Patients receiving CTLs with closer HLA matching responded better at 6 months (P = .048). Female patients responded better than male patients, but the differences were not statistically significant. Our results show that allogeneic CTLs are a safe and rapid therapy for PTLD, bypassing the need to grow CTLs for individual patients. The response rate in this poor prognosis patient group is encouraging.

Liver, small intestine, and heart allografts in residence for 4 days to 16 years were analyzed by simultaneous XY fluorescent in situ hybridization to search for evidence of the recently described process of transdifferentiation of recipient bone marrow stem cells to allograft parenchymal cells. These studies were carried out in an effort to find conditions associated with maximal levels of engraftment or expansion of the recipient parenchymal cells. Despite prolonged survival up to 16 years, regeneration after severe preservation injury or use of split livers, only rare, isolated and tentatively identified recipient hepatocytes were detected in liver allografts. In intestinal allografts, despite survival of up to 8 years and extensive mucosal regeneration because of severe damage from acute rejection, there was no crypt replacement by recipient epithelial cells. In cardiac allografts, no recipient myocytes were detected despite recipient survival for 2-3 days and 3-4 weeks after myocardial infarcts at 5 and 8 years after transplantation. Parenchymal cell transdifferentiation from recipient bone marrow stem cells was rare to nonexistent in severely injured, regenerating, and long-surviving allografts. The rare isolated recipient parenchymal cells tentatively identified did not appear to behave as stem cells: they did not form clusters and did not increase with time after transplantation. Because of the extremely low frequency, interpretation was difficult. Regardless of these results, a more vigorous search for conditions that promote transdifferentiation is warranted.

Objective: To report the early experience, clinical results and histopathologic findings of Directional Coronary Atherectomy from a UK centre experienced in coronary angioplasty., Design: Prospective study of the first 45 Directional Coronary Atherectomy (DCA) procedures using the Simpson coronary atherectomy device., Results: Forty-five procedures were performed in 33 male and 5 female patients (mean age, 55.1 years). Directional Coronary Atherectomy was performed to 50 lesions (39 de novo, 11 restenosis; 44 left anterior descending, 3 right, 2 circumflex coronary arteries and 1 saphenous vein graft). Clinical and primary angiographic success was achieved in 43 of 45 cases (95.5%) and in 47 of 50 lesions (94%) after DCA alone. Before DCA the mean diameter stenosis was 88.7% (range, 50-100%) but following DCA (and percutaneous coronary angioplasty (PTCA) if necessary) the mean diameter stenosis was 3.5% (range, 0-15%; P < 0.001). Complications included occlusive dissection requiring coronary artery bypass surgery in two patients; abrupt closure of right coronary artery in one patient successfully reopened by PTCA and thrombolysis, complicated by excessive blood loss; reversible coronary artery spasm due to minor nose-cone trauma in four patients and temporary side branch loss in one patient. There were no coronary artery perforations, guide catheter complications, peripheral vascular trauma or deaths. On average 5.6 specimens (range, 1-18) were removed per case. Histology showed fibrous intimal plaque in 98%, media in 39% and adventitia in 7%. Neo-intimal hyperplasia was found in all restenosis lesions but also in 30% of de novo lesions., Conclusions: This small initial series indicates that directional coronary atherectomy is an effective and safe procedure for the treatment of obstructive coronary artery disease in carefully selected patients. With care, a high success rate can be achieved even during a learning phase. The technique is particularly effective for morphologically complex lesions that are unfavourable for PTCA. The procedure is unlike PTCA and requires additional training if pitfalls are to be avoided, high success rates achieved and complication rates kept low.

We describe direct and quantitative evidence of free-radical production in the early stage after recanalisation in a patient undergoing primary coronary angioplasty for acute myocardial infarction. After successful initial dilation, the procedure was complicated by re-occlusion of the artery at the same site, with subsequent fall in free-radical generation. After repeat angioplasty, recanalisation was again accompanied by increased free-radical production.

A patient underwent dual chamber pacemaker implantation by puncture of the left subclavian vein. During the procedure we observed persistence of the left superior vena cava. An active fixation atrial lead was required to prevent instability induced by the odd course of the electrode and produced excellent long term pacing and sensing.

A 21-year-old patient developed tricuspid endocarditis with the distal sections of two redundant ventriculo-atrial shunts remaining in the right atrium. We report their percutaneous removal using a Dotter basket.