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Gulf War illness (GWI) is a chronic and multisymptom disorder affecting military veterans deployed to the 1991 Persian Gulf War. It is characterized by a range of acute and chronic symptoms, including but not limited to, fatigue, sleep disturbances, psychological problems, cognitive deficits, widespread pain, and respiratory and gastrointestinal difficulties. The prevalence of many of these chronic symptoms affecting Gulf War veterans occur at markedly elevated rates compared to nondeployed contemporary veterans. To date, no effective treatments for GWI have been identified. The overarching goal of this umbrella review was to critically evaluate the evidence for the potential of Tai Chi mind-body exercise to benefit and alleviate GWI symptomology. Based on the most prevalent GWI chronic symptoms and case definitions established by the Centers for Disease Control and Prevention and the Kansas Gulf War Veterans Health Initiative Program, we reviewed and summarized the evidence from 7 published systematic reviews and meta-analyses. Our findings suggest that Tai Chi may have the potential for distinct therapeutic benefits on the major prevalent symptoms of GWI. Future clinical trials are warranted to examine the feasibility, efficacy, durability and potential mechanisms of Tai Chi for improving health outcomes and relieving symptomology in GWI.

Background Afamelanotide (AFA) is a synthetic analogue of α-melanocyte-stimulating hormone that is approved for the treatment of patients affected by erythropoietic protoporphyria (EPP). AFA induces a “sun free” tanning and changes of acquired melanocytic nevi (AMN) that are generically described as “darkening”. Objectives To assess clinical and dermoscopic AMN changes during AFA treatment. Methods Adult EPP patients treated with two AFA implants 50 days apart were enrolled. They underwent a clinical and dermoscopic examination of all AMN at baseline (T0), and after 5 (T1) and 12 (T2) months from the first AFA implant. The general pattern, symmetry, number, and size of pigmented globules, morphology of the pigment network, and dermoscopic melanoma features were assessed. Results Fifteen patients were enrolled with 103 AMN. At T1 all reticular and 2-component AMN showed a focal network thickening that returned to baseline by T2. The increase of globules’ number was observed at T1 but not at T2. The difference in number was not influenced by patients’ age or phototype. Dermoscopic changes suggestive of malignancy were never seen. The development of new AMN was never registered. Conclusions AFA treatment induces reversible changes of AMN dermoscopic morphology without findings suggestive of malignant transformation and it does not stimulate the development of new AMN.

Vector-borne pathogens are responsible for serious emerging diseases and Rangelia vitalii, the etiologic agent of canine rangeliosis, is one of the most pathogenic tick-borne pathogens for dogs in South America. This protozoan is transmitted by the Amblyomma aureolatum tick bite and the clinical features associated to the disease are fever, hemolytic anemia, jaundice, hepatosplenomegaly and bleeding from natural orifices, mainly from the ear egde. The reports of canine rangeliosis in Argentina are scarce. In the present study we report the detection of Rangelia vitalii in a naturally infected dog from Gualeguay, Entre Ríos, Argentina with history of tick infestation and clinical signs compatible with rangeliosis. An initial blood sample was positive to piroplasmids by blood smear examination and the molecular amplification of a fragment of the 18SrRNA gene. Sequencing of the fragment confirmed the pathogen identity. After treatment with imidocarb dipropionate, the clinical signs remitted and the blood smear tested negative. Instituto de Biotecnología Fil: Borras, Pablo. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán" (ANLIS). Centro Nacional de Diagnóstico e Investigación en Endemo Epidemias (CENDIE); Argentina Fil: Salvador, F. Laboratorio MF Salvador; Argentina Fil: Rinaldi, V. Laboratorio MF Salvador; Argentina Fil: Armitano, Rita Inés. Instituto Nacional de Enfermedades Infecciosas. Servicio Bacteriología Especial; Argentina Fil: Armitano, Rita Inés. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; Argentina Fil: Farber, Marisa Diana. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología. Laboratorio de Hemoparásitos; Argentina. Fil: Farber, Marisa Diana. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán" (ANLIS). INEI. Servicio Bacteriología Especial; Argentina Fil: Sanchez, R. ROSLAB Diagnostico Veterinario; Argentina Fil: Mori, L. Laboratorio MF Salvador; Argentina Fil: Guillemi, Eliana Carolina. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Biotecnología; Argentina Fil: Guillemi, Eliana Carolina. Administración Nacional de Laboratorios e Institutos de Salud “Dr. Carlos G. Malbrán" (ANLIS). INEI. Servicio Bacteriología Especial; Argentina

Brief Abstract: Small cell carcinoma of the urinary tract is an aggressive malignancy that comprises less than 1% of urinary bladder cancers. The renal pelvis and ureter, also lined by urothelium, are rare sites for small cell carcinoma. The diagnosis and staging of upper tract cancer are difficult due to the need for small, atraumatic instrument to access the upper tract. There are fewer than 40 reported cases of upper urinary tract small cell carcinoma. These include both pure and variant histologies. We present the management of a 72 year old male with small cell carcinoma of the upper urinary tract. Keywords: Small cell carcinoma, Neuroendocrine tumor, Renal pelvis and ureter cancer

Background Evaluations to determine one's readiness to initiate hormone therapy are often requested by endocrinologists or institutions who provide gender-affirming hormone therapy for transgender adults. Unfortunately, many mental health providers report unfamiliarity in working with gender-nonconforming individuals and with the needs of this population, and do not feel equipped to conduct these evaluations. Objectives The purpose of this paper is to introduce an instrument that can guide providers to conduct a hormone readiness evaluation that is consistent with the current best practices model of care put forth by the World Professional Association for Transgender Health Standards of Care. Methods Development of the Assessment of Readiness and Consent for Hormone Therapy (ARCH) was informed by published literature and consultation with subject matter experts. The tool has been revised through an iterative approach based on provider experience and client feedback. Results The ARCH has been used as part of a national training initiative in transgender healthcare and favorable feedback has been received. Providers have reported that using the ARCH has increased their confidence in their ability to provide sensitive care that is consistent with best practice recommendations. Conclusions Use of the ARCH has the potential to enhance care for a population that often encounters poor access to culturally competent providers and treatments. The focused nature of the interview helps providers support and advocate for their clients by providing and gathering information necessary to make meaningful recommendations that will help hormone treatment candidates enhance their gender related quality of life.

Background Low physical activity (PA) is associated with adverse health outcomes independent of airflow limitation in COPD. Self-reported assessments are often limited to global estimates of PA and may not be directly translatable to patients' goals and motivations. We developed a task-oriented PA checklist and examined its performance relative to pedometer-assessed daily step count in two COPD cohorts. Methods Task-oriented daily physical activity (DPA) was assessed in two COPD cohorts using either interviewer-administered recall questionnaire (DPA-R, Cohort 1, n = 109) or a self-administered diary-format daily checklist (DPA-C, Cohort 2, n = 175). Daily step count was measured in both cohorts using the Omron HJ-720 ITC pedometer. Univariate associations between individual DPA items and [a] cross-sectional and [b] longitudinal change (Cohort 1) in daily step count were assessed using a Pearson's correlation. Composite scores comprised of individual DPA items with univariate association p-values Results Tasks associated with average daily step count in both cohorts included putting on shoes, showering, washing hair, walking for exercise, the frequency of walks >10 min, and walking on an incline (Pearson's rho range = 0.14–0.43). A composite score of these 6 DPA items demonstrated significant associations with baseline average daily step count in both cohorts (ρ = 0.5 & 0.47, Cohorts 1 & 2, respectively) and longitudinal change in daily step count (ρ = 0.46, Cohort 1). Conclusions Self-reported task-oriented assessments complement direct monitoring and have potential clinical utility in exercise counseling to increase PA among COPD patients. Trial registration ClinicalTrials.gov NCT01772082.

Physical activity (PA) is recommended in all patients with chronic obstructive pulmonary disease (COPD). Technology-based interventions can deliver effective, scalable behavior-change techniques; though feasibility and acceptability among older adults is not established. Veterans with COPD (N=112, aged 49-89 years, median=68) were randomized to a 12-week web-based and pedometer intervention or a pedometer alone (control). Across groups, there was no significant difference between middle-aged (

Kidney cancer is the ninth most common malignancy in the United States. Most kidney cancers are clear cell renal cell carcinoma (RCC) and arise as solid tumors from kidney parenchyma. In the setting of metastatic disease, a primary renal tumor is usually identified, and metastases are often to lung, bone, liver, and brain. Metastatic RCC without an identifiable solid kidney tumor is exceedingly rare. We report the case of a 52 year old male with a rare cutaneous RCC metastasis without an identifiable primary renal tumor. Keywords: Kidney cancer, Renal cell carcinoma

Background Although there are effective evidence-based treatments for posttraumatic stress disorder (PTSD), many individuals drop out or do not benefit from treatment. There is a need for new treatments, including approaches that are nontrauma focused. Objective The purpose of this program evaluation was to investigate the acceptability of a Wellness Group designed to promote healthy behaviors and adaptive coping when offered to veterans with PTSD. Methods Nine veterans in a PTSD outpatient clinic enrolled in a 12-week, 24-session Wellness Group. Acceptability of the intervention was evaluated with attendance data, questionnaires, and interviews. Results Group attendance rates were high and no participants dropped out of treatment. Treatment satisfaction was high and all veterans reported gains in at least 3 of the 8 Wellness domains covered. Interview data supported the findings that veterans had positive reactions to the group. Conclusion A Wellness approach may offer a low-cost alternative or supplementary treatment for veterans with PTSD that is highly acceptable and may improve health behaviors, quality of life, and coping skills.

We present a new video-assisted minimally invasive technique for the treatment of pilonidal disease (E.P.Si.T: endoscopic pilonidal sinus treatment). Between March and November 2012, we operated on 11 patients suffering from pilonidal disease. Surgery is performed under local or spinal anesthesia using the Meinero fistuloscope. The external opening is excised and the fistuloscope is introduced through the small hole. Anatomy is identified, hair and debris are removed and the entire area is ablated under direct vision. There were no significant complications recorded in the patient cohort. The pain experienced during the postoperative period was minimal. At 1 month postoperatively, the external opening(s) were closed in all patients and there were no cases of recurrence at a median follow-up of 6 months. All patients were admitted and discharged on the same day as surgery and commenced work again after a mean time period of 4 days. Aesthetic results were excellent. The key feature of the E.P.Si.T. technique is direct vision, allowing a good definition of the involved area, removal of debris and cauterization of the inflamed tissue.

Objective To examine feasibility, qualitative feedback and satisfaction associated with a 4-session introduction to Tai Chi for veterans with post-traumatic stress symptoms. Design We observed and reported recruitment and retention rates, participant characteristics, adherence, and satisfaction across 2 cohorts. We also examined qualitative feedback provided by questionnaires, focus groups and individual interviews. Main outcome measures Rates of recruitment and retention, focus group and individual feedback interviews, self-reported satisfaction. Participants 17 veterans with post-traumatic stress symptoms. Results Almost 90% (17/19) of those eligible following the telephone screen enrolled in the programme. Three-quarters (76.4%) of the participants attended at least 3 of the 4 Tai Chi sessions. Qualitative data analysis revealed themes indicating favourable impressions of the Tai Chi sessions. In addition, participants reported feeling very engaged during the sessions, and found Tai Chi to be helpful for managing distressing symptoms (ie, intrusive thoughts, concentration difficulties, physiological arousal). Participants also reported high satisfaction: 93.8% endorsed being very or mostly satisfied with the programme. All participants (100%) indicated that they would like to participate in future Tai Chi programmes and would recommend it to a friend. Conclusions Tai Chi appears to be feasible and safe for veterans with symptoms of post-traumatic stress disorder (PTSD), is perceived to be beneficial and is associated with high rates of satisfaction. This study highlights the need for future investigation of Tai Chi as a novel intervention to address symptoms of PTSD.

Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult anterior urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulae occurring after previous surgery for hypospadias or those related to lichen sclerosus (LS). Success rates in these patient populations have improved when compared to earlier techniques. However, prior studies have demonstrated a number of patients requiring more than two procedures to complete the reconstruction, as well as some who have been content with their voiding pattern after the first operation and therefore elected to forego second stage tubularization. In this setting, we have reviewed the surgical technique and summarized previously published work. There may be an opportunity to complete more of these repairs in two operations using additional oral mucosa at the time of tubularization.

“Health is the vital principle of bliss, and exercise, of health.” —James Thomson, 18th century Scottish poet Exercise is considered a crucial component of disease management for individuals with type 2 diabetes, and it is associated with extensive health and mental health benefits. Although the benefits of exercise are well established, most people with diabetes do not engage in physical activity in a regular and sustained manner. To address this, it is important to develop interventions that are easily and broadly accessible and that address specific barriers that prevent individuals with diabetes from participating in physical activity. Several investigations have examined the efficacy of using various forms of technology to deliver or enhance interventions designed to promote regular physical activity. The outcomes have been promising, providing support for continued exploration of telehealth interventions that promote physical activity in the diabetic population. This article provides an overview of telephone, Internet-based, and home-based monitoring interventions that promote physical activity, with a focus on those with diabetes. It also discusses the potential advantages of using telehealth interventions in this context.

Recruiting sufficient numbers of participants for physical activity trials for individuals with diabetes can be difficult because there are often many behavioral demands for participants, and inclusion and exclusion criteria can be extensive. This study examined the recruitment strategies used for a randomized, controlled trial designed to investigate the efficacy of an automated telephone intervention to promote physical activity in adults with type 2 diabetes in an urban Veterans Administration health care system. Traditional recruitment approaches of posting flyers and obtaining referrals from clinicians did not yield sufficient numbers of interested patients. Using the electronic medical record system to identify patients with uncontrolled diabetes allowed staff to send targeted mailings to participants, and 77% of participants were recruited using this method. The targeted mailing approach elicited a positive response rate of 12% (328 of 2,764 potential participants identified) and appeared to produce a more representative and appropriate sample than other recruitment methods used. Lessons learned in this study may be helpful to researchers in future trials who attempt to recruit participants with diabetes for physical activity protocols.

Il villaggio di Fehwet è situato nella piccola oasi omonima, posta ca. 10 km a sud Ghat, in Libia sud-occidentale. Il sito archeologico è stato oggetto di scavo nel corso delle campagne 2002- 2006 della Missione Archeologica Italo-Libica diretta da Savino di Lernia e condotta da Sapienza Università di Roma e Dipartimento di Archeologia di Tripoli. La maggior parte dei reperti ha mostrato buono stato di conservazione. Dai dati raccolti emerge una larga predominanza di Tamarix (153 reperti-77%) che include T. tetragyna Ehrenb. (97 reperti), T. aphylla Karst. (26 reperti), e Tamarix sp. (30 reperti). Pure significativa è la presenza di Phoenix dactylifera L. (43 reperti - 22%), mentre rari sono Acacia sp. (1 reperto) e cf. Nerium oleander L. (1 reperto).

APENEXT is a new generation APE processor, optimized for LGT simulations. The project follows the basic ideas of previous APE machines and develops simple and cheap parallel systems with multi T-Flops processing power. This paper describes the main features of this new development., Comment: Lattice2001(plenary/machinestatus), 4 pages, 1 eps figure

Renal transplantation has profound improvements in mortality, morbidity, and overall quality of life compared to renal replacement therapy. This report aims to illustrate the use of ex-vivo partial nephrectomy in a patient with a renal angiomyolipoma prior to living donor transplantation. The surgical outcomes of the donor nephrectomy and recipient transplantation are reported with 2 years of follow-up. Both the donor and recipient are healthy and without any significant comorbidities. In conclusion, urologic techniques such as partial nephrectomy can be used to expand the living donor pool in carefully selected and well informed transplant recipients. Our experience demonstrated a safe and positive outcome for both the recipient and donor, and is consistent with other reported outcomes in the literature.

Physical activity (PA) is significantly reduced in persons with COPD. Assessing reasons why persons with COPD do not engage in PA can guide development of effective interventions to promote PA.We queried 102 participants with stable COPD about disease-related and general reasons why they do not walk more. The StepWatch Activity Monitor (Orthocare Innovations, Mountlake Terrace, WA, USA) assessed daily step count, a direct measure of PA. Regression models assessed daily step count by response categories, adjusting for age and FEV1 % predicted.Subjects had mean age 72 ± 8 years and mean FEV1 1.48 ± 0.55 L (52 ± 19% predicted). COPD-related worries of becoming short of breath (SOB), needing to use inhalers, or oxygen level becoming low were endorsed by 31, 14, and 12 subjects, respectively. Controlling for age and FEV1% predicted, those who worried about becoming SOB walked an average of 1,329 fewer steps per day than those who did not worry (p = 0.020). Those who worried about needing to use inhalers walked an average of 1,806 fewer steps per day than those who did not worry (p = 0.016). Subjects who were the most motivated and confident walked significantly more than those who were the least motivated and confident.Presence of COPD-related reasons and lower motivation and confidence are associated with lower daily step count. Management of dyspnea and education about medication use during exercise, and strategies to increase motivation and confidence could facilitate walking in COPD.

University students (73 men and 73 women) tasted and rated on a nine-point hedonic scale the texture and mouthfeel, flavor (taste and odor), and overall degree of liking for nine samples of vanilla ice cream varying in sugar (8.94 to 18.81%, wt/wt) and fat (8.73 to 19.30%, wt/wt) contents. Sugar consisted of 6% corn syrup solids [36 DE (dextrose equivalent)]; the balance was sucrose. Hedonic ratings differed significantly among samples, and the best-liked sample for texture and mouthfeel, flavor, and overall degree of liking contained 13.54% sugar and 14.99% fat. Men and women differed significantly in their liking of the flavor of the samples; men rated the flavor of the ice creams higher than did women. There was no gender difference for degree of liking of texture and mouthfeel or for overall degree of liking. Response surface methodology was used to relate hedonic ratings to sugar and fat percentages in the ice cream. Dome-shaped response surfaces were obtained for all three degree of liking parameters, and optimal sugar and fat, respectively, were 13.16% and 14.02% for degree of liking of texture and mouthfeel, 14.07% and 15.35% for degree of liking of flavor, and 14.30% and 14.77% for overall degree of liking. The response surfaces indicated that the level of sugar had a greater effect on all hedonic measures than did fat.

During the past 15 years, major advances in molecular genetics have led to the identification of several primary immune deficiency (PID) genes. In many cases, unravelling the genetic defect has been essential to disclose the molecular and cellular pathophysiology of PID. However, for Wiskott–Aldrich syndrome (WAS), whose gene was identified in 1994 [1], we are still waiting for a comprehensive understanding of the mechanisms that lead to immune deficiency, thrombocytopenia and eczema.

The problem of clock recovery for an MPEG audio/video decoder, when the MPEG stream is transmitted over an ATM network and the decoded signal is to be converted to a PAL/NTSC format, is addressed. The presence of ATM cell delay variation represents a jitter source for the reconstruction of the main presentation reference signals associated with the coded streams. Since the PAL/NTSC synchronization signals are obtained from these signals, care must be taken to avoid visible artifacts in the displayed images, typically hue changes. It is shown that the clock recovery design, based on consumer quality video display requirements, is not more complex than ordinary PLLs used in transmission systems, while the buffer size requirements can be certainly contained within acceptable limits.

SWR/J transgenic (tg) mice were generated expressing the TCR beta chain derived from an anticollagen type II (CII) arthritogenic T cell clone. The SWR/J strain was selected because it is resistant to collagen-induced arthritis (CIA) and lacks the V beta gene segment used by the T cell clone. Expression of the tg beta chain on all thymocytes and peripheral lymph node T cells led to a more efficient anti-CII immune response, but did not confer CIA susceptibility to SWR/J mice. Nevertheless, this tg beta chain enhanced predisposition to CIA as (DBA/1 x SWR) F1 beta tg mice were more susceptible than normal F1 littermates. Our results demonstrate that the expression of the tg beta chain contributes to CIA susceptibility, but by itself it is not sufficient to overcome CIA resistance in the SWR/J strain.

Although the health benefits of exercise for individuals with Persian Gulf War veterans illnesses (GWVI) are documented, many of these individuals do not exercise regularly enough to obtain benefits. The purpose of this study was to investigate factors predicting exercise compliance among individuals with GWVI in a multicenter, randomized, clinical trial. Participants were 1,092 veterans who reported at least two of the following cardinal symptoms of GWVI: (1) fatigue, (2) musculoskeletal pain, and (3) cognitive problems. Participants received exercise alone or exercise and cognitive-behavioral therapy. The overall level of compliance was relatively low during the exercise treatment phase (46.2%) and decreased by one-half during the follow-up period (23.0%). Predictors of compliance during treatment included less pain and greater age, motivation, and body mass index. Predictors of compliance during the follow-up period included less pain and greater age. The results highlight factors that affect adoption and maintenance of physical activity in a population with GWVI.

To study the genes in the mouse background which predispose to the development of collagen-induced arthritis (CIA).T cell receptor beta transgenic (TCRbetaL) mice that have a T cell repertoire that predisposes to the development of CIA were used. Classic genetic studies and microsatellite gene mapping were done in (SWR-betaL x DBA/1)F2 hybrid mice.Besides TCRbeta, major histocompatibility complex class II, and Igh-C, at least 2 other genes are absolutely required for CIA development in these mice. A strict association of CIA with the presence of functional complement C5 allele (Hc1) was found, suggesting that Hc1 or a closely linked gene might be one of these essential genes.This study provides new evidence of the pathogenetic role of complement C5 in CIA. Furthermore, these transgenic mice may facilitate molecular identification of other genes that predispose to CIA.