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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.

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 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.

The primary objective of this pilot study was to develop and implement a telephone intervention for veterans with diabetes and posttraumatic stress symptoms (PTSS). Additional objectives were to evaluate study feasibility and to conduct exploratory analyses of the influence of the intervention on diabetic self-care, quality of life, treatment adherence, and mental health functioning. Twenty-three veterans with PTSS and diabetes enrolled in the study and received an initial assessment interview and intervention session. Twenty participants completed the study protocol in its entirety and also received 7 weekly motivational telephone calls with a clinician and a final assessment. Results revealed high levels of compliance with telephone calls. Participants reported satisfaction with and benefit from the intervention that occurred during weekly telephone calls. Participants reported a statistically significant increase in exercise behaviors and healthy eating from pre- to postintervention. Results also revealed a decrease in psychological distress. Although these data are preliminary, they speak to the feasibility and benefits of a brief telephone intervention to address self-care behaviors critical to the management of diabetes for individuals with PTSS.

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.

The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554-558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376-382, 2007; Lanyon and Maxwell in Obes Surg 17:321-328, 2007; Sogg and Mori in Obes Surg 14:370-380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.

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.

Identifying and treating depression has been a major focus in primary care over the last decade. Unfortunately, treatments have not been as successful as originally hoped. The current study investigated factors that may contribute to poor outcomes in a sample of VA primary care patients. Results indicate that 15.5% of the patients in this investigation had significant symptoms of depression. The vast majority (89.6%) of these patients also had significant symptoms of at least one additional comorbid psychiatric condition. Furthermore, an association between depression and unhealthy behaviors (smoking, not exercising) was demonstrated. Finally, sexual dysfunction and chronic pain were more frequently observed in individuals with depressive symptoms. These findings illustrate that depression is only one of many problems for most primary care patients identified with depression. A multidisciplinary team in primary care is recommended to provide a coordinated approach to the treatment of depression and its associated problems.

The purpose of this paper is to introduce the Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV). This comprehensive interview expands upon a standard psychiatric interview by including those medical, psychological, and behavioral factors that are essential to determining a patient’s psychological appropriateness for interferon therapy. A detailed description of the SIT-HCV is provided, highlighting its utility in developing recommendations that positively impact patients’ treatment outcomes. The advantages of the SIT-HCV will be presented, including a discussion on how this approach can ensure comprehensive assessment and facilitate research, training, and patient education.

Despite the prevalence of psychiatric disorders in medical settings, mental health problems often go undetected and patients do not receive appropriate treatment. The main goal of this study is to provide additional information about the Beck Anxiety Inventory – Primary Care (BAI–PC), a brief instrument that screens for patients with anxiety. This study provides information on the performance of the BAI–PC as a screening instrument for depression and PTSD in addition to its original purpose as a screening instrument for anxiety. This efficient tool can identify patients who can benefit from effective psychological treatments and facilitate referrals to psychologists working in medical settings.

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.

Cytogenetic studies were performed on three species of eyelidless microteiids, Procellosaurinus erythrocerus, P. tetradactylus, and Vanzosaura rubricauda (Squamata, Gymnophthalmidae), all with a diploid number of 2n = 40. The specimens were collected in the palaeoquartenary dune fields of the middle Rio São Francisco in the State of Bahia, Brazil. Chromosomes from fibroblast cultures were studied after routine Giemsa staining, CBG- and RBG-banding, and Ag-NOR staining. Despite similarities in chromosome number and morphology, each species can be differentiated by the position and amount of C-heterochromatin. Our cytogenetic and DNA content data indicate that there are more similarities between the two species of Procellosaurinus than exist between either species and V. rubricauda, reinforcing the importance of banding techniques for the characterization of reptilian species.

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 standard treatment for chronic hepatitis C (pegylated interferon and ribavirin) causes challenging physical and psychological side effects. The current pilot study evaluated the efficacy of a brief, telephone-based, cognitive-behavioral self-management intervention designed to address mood and quality of life within a sample of veterans on antiviral treatment for hepatitis C. Results from this pilot study support the feasibility of this telehealth intervention, showing that veterans were highly satisfied with the content of the intervention and compliant with the telephone calls. Findings further indicate that symptoms of depression and anxiety and mental health quality of life either remained stable or improved in those participants who received the brief telephone intervention, while those receiving usual care showed significant declines in mood and mental health quality of life. The findings from this study provide evidence that a brief, clinician-administered phone intervention may help individuals on antiviral therapy for hepatitis C to cope more effectively with the negative treatment side effects.

Behavioral procedures have proven efficacious in the ward-wide treatment of psychiatric inpatients. These procedures are often recommended and administrated by behaviorally oriented staff who work as consultants. While numerous published reports show that behavioral consultation is effective for changing patients' targeted behavior, few data show whether it affects recidivism and other general indicators of patients' functioning. The present report describes group and case study data for 7 patients regarding the effects of behavioral consultation on frequency and duration of hospital admissions, distress upon readmission, proportion of time spent at regressive versus autonomous privilege levels, and other molar indices of patients' functioning.

This study was designed to investigate the comparability of the original MMPI (1950) and the MMPI-2 (1989) with a psychiatric patient population. 34 male and 3 female patients, shortly after admission to one of two acute psychiatry units, completed the old and revised versions of the MMPI. Paired t tests indicated but scant differences for raw scores, while many more differences were found among T scores for validity, clinical, and supplemental scales. Analyses, however, showed all scales on the two forms to be highly correlated. Analysis of the high-point and two-point codes across the two administrations also showed relative stability, although the proportion of Scales 2 (Depression) and 8 (Schizophrenia) decreased, while those for Scales 6 (Paranoia) and 7 (Psychasthenia) increased markedly in the MMPI-2 protocols. Examination of each version's discriminability among mood- and thought-disordered subsamples suggested that the MMPI provides slightly better delineation between diagnostic classes. Discriminant function analyses showed that there were essentially no differences between the two forms in the accurate classification of clinical and nonclinical groups. The findings reported here provide support for the MMPI-2; despite modification, the newer form retains the advantages of the original MMPI. Differences found here may be unique to psychiatric patients and their patterns of MMPI/MMPI-2 equivalence and may not generalize to other special populations.

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.

Living unrelated kidney donors have been increasingly sought out as potential resources for patients with end-stage renal disease. Several psychiatric issues must be factored into the presurgical evaluation of prospective donors. This paper describes a proposed guideline intended to assist clinicians in the psychiatric evaluation of prospective kidney donors. Topics covered in the interview include the prospective donor's stability and ability to make an informed decision, the donor's understanding of the recipient's illness and of the transplant surgery, and extenuating factors that may influence the decision to donate. While efficient and thorough, the guideline is intended to be flexible enough to address the variety of issues that can affect the prospective donor's decision to pursue surgery.

Epidermoid cysts are about 1 % of all testicular tumours. The Authors report a case observed at their Urological Department and justify the choice of radical surgical treatment due to the possible malignancy of the lesion, which could not be ascertained through the diagnostic means available; overall the Authors analyse critically the rationale for conservative surgical management.

During the last 10 years, 18 patients affected by kidney neoplasia have been operated on conservatively (2 patients with bilateral carcinoma, 1 patient with damaged controlateral kidney, and 15 patients with controlateral healthy kidney). All the tumors were smaller than 5 cm. In 14 cases the histological examination showed the tumor as being renal cell carcinoma, in 3 cases oncocytoma and in 1 case angiomyolipoma. All the patients had a normal post operative course and are alive with a mean follow up of 21.1 months.

Despite the fact that the demand for psychiatric evaluations of organ transplant recipients is increasing, there is not a commonly agreed upon protocol that can guide clinicians. A standard psychiatric interview, although necessary, is not sufficient when interviewing transplant candidates. In addition, it is important to acquire information specific to the medical regimen associated with renal disease and renal transplantation. The purpose of this paper is to present the Structured Interview for Renal Transplantation (SIRT). The SIRT was developed as a tool to guide clinicians through the interview process by providing a comprehensive structure while still allowing for flexibility. There are many advantages of using the SIRT--it is a tool that facilitates a clinician's ability to conduct a thorough evaluation in a time-efficient manner. It is also an excellent instrument for training clinicians, and the structure of the interview is appropriate for use in research.

We studied 19 nonsmoker male volunteers, 9 healthy (mean age 30.5 +/- 8.5), and 10 with previous myocardial infarction (mean age 53.8 +/- 5.3), who underwent exercise stress testing twice: in a smoke-free environment and in a smoking environment (carbon monoxide concentration 30-35 ppm). We measured peak exercise power, time to recovery of pre-exercise heart rate, expired concentration of carbon monoxide and plasma carbon monoxide. Obtained data were compared by using t-test. P less than 0.05 was statistically significant. Mean data observed in healthy people were as follows. Peak exercise power 220 +/- 30 watts in a smoking environment versus 220 +/- 30 in a smoke-free environment (P greater than 0.05). Time to recovery of pre-exercise heart rate 19 +/- 4 minutes in a smoking environment versus 8.5 +/- 4 in a smoke-free environment (P less than 0.01). Expired concentration of carbon monoxide before exercise 2.3 +/- 2.01 ppm versus 8.5 +/- 1.6 (P less than 0.01) after exercise in a smoking environment, and 2.3 +/- 2 ppm before exercise versus 2.1 +/- 1.9 after exercise in a smoke-free environment (P less than 0.05). Plasma carbon monoxide before exercise 1.4 +/- 0.2% versus 1.7 +/- 0.4 after exercise in a smoking environment (P greater than 0.05), and 1.2 +/- 0.4% before exercise versus 1.2 +/- 0.4 in a smoke-free environment (P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of caerulein and some related substances were investigated on the sphincter of Oddi which had been contracted by morphine in the guinea-pig, and on the isolated terminal bile duct in the calf. In the first test caerulein (50–100 ng/kg i.v.) was the most potent spasmolytic drug whereas in the second test the peptide (0.75-1 Μg/ml) produced actually a spasmogenic effect. The peptide resembled epinephrine in both preparations.

It is still undecided in clinical medicine if an increased serum CK-MB level indicates irreversible myocardial damage. We measured CK and AST activities on three serum samples obtained during the first 24 hours following admission of patients with a clinical history suggesting myocardial ischemia. Isoenzymes were not separated when CK and AST activities were less than 300 U/L and 35 U/L respectively, but were fractionated when the enzyme activities doubled during the first 24 hours even within their normal ranges. Over a three-year period this doubling occurred in 30 patients, one of whom was admitted twice to the hospital. The serum CK-MB fractions of these patients were 6% or greater in 26 and less than 6% in 5 admissions. The final clinical diagnosis given to the patients on 20 of these 26 admissions was acute sub-endocardial infarction. None of the five patients with a CK-MB fraction less than 6% had a clinical diagnosis of acute myocardial infarction. A comparative study of 102 patients with higher average enzyme activities but without doubling of both enzymes during a 24-hour period, did not yield a CK-MB of 6% or greater. None of this group of patients was diagnosed clinically as having had acute myocardial infarction.