In 2003, what are the indications of brachytherapy in coronary arteries?

Significant results obtained with coated stents in "de novo" coronary lesion treatment, particularly in complex lesions, have substituted brachytherapy indications. However, curitherapy results in diffuse or proliferative in-stent restenosis treatment show a significant reduction (30-50%) of restenosis and major adverse cardiac events. So, without sufficient scientific proofs with active stents in this indication, curitherapy is the only validated and authorized treatment of second diffuse or proliferative in-stent restenosis.     

Ethical dilemmas associated with genetic testing: which are most commonly seen and how are they managed?

PurposeThe aim of this study was to document the range and frequency of ethical dilemmas associated with genetic testing encountered by genetic health professionals and to determine the strategies used to manage them.MethodsAn online survey was used to document how often the 11 key ethical dilemmas have been encountered; whether any additional dilemmas have been encountered; and how these dilemmas have been managed. Members of the Australasian Association of Clinical Geneticists, Australasian Society of Genetic Counsellors, and genetic social workers practicing in Australia and New Zealand were invited to participate.ResultsA total of 102 responses were received (31% response rate). Respondents had encountered all of the 11 ethical dilemmas included in the survey, and 18 respondents had encountered 14 additional dilemmas. Respondents encountered an average of 2.2 dilemmas per year of practice. Peer and clinical supervision were the most common strategies used to manage dilemmas, and seeking advice from clinical ethics committees was rare. Occasionally, respondents facilitated practices they deemed unethical as a consequence of client deception.ConclusionEthical dilemmas of genetic testing are encountered regularly in clinical genetics practice. Evidence provided by our study can assist in targeting training, support, and guidance to help genetic health professionals navigate such dilemmas in the future.     

Where are the Behavioral Sleep Medicine Providers and Where are They Needed? A Geographic Assessment

Although it is widely acknowledged that there are not enough clinicians trained in either Behavioral Sleep Medicine (BSM) in general or in Cognitive Behavioral Therapy for Insomnia (CBT-I) in specific, what is unclear is whether this problem is more acute in some regions relative to others. Accordingly, a geographic approach was taken to assess this issue. Using national directories as well as e-mail listservs (Behavioral Sleep Medicine group and Behavioral Treatment for Insomnia Roster), the present study evaluated geographic patterning of CBSM and BSM providers by city, state, and country. Overall, 88% of 752 BSM providers worldwide live in the United States (n = 659). Of these, 58% reside in 12 states with ≥ 20 providers (CA, NY, PA, IL, MA, TX, FL, OH, MI, MN, WA, and CO), and 19% reside in just 2 states (NY and CA). There were 4 states with no BSM providers (NH, HI, SD, and WY). Of the 167 U.S. cities with a population of > 150,000, 105 cities have no BSM providers. These results clearly suggest that a targeted effort is needed to train individuals in both the unserved and underserved areas.     

Obesity and asthma, what are the links?

PURPOSE OF REVIEW: Obesity is a major cause of morbidity accounting for approximately 300 000 deaths each year and about 7% of the health care budget with an economic impact greater than US dollar 100 billion annually in the United States. Obesity and its sequelae such as cardiovascular disease, diabetes, arthritis or cancer have been on the rise over the last decades. The parallel time trend with an increasing prevalence of asthma has induced a lively debate about a potential link between both conditions. RECENT FINDINGS: A number of prospective studies have shown that weight gain can antedate the development of asthma. Effect modification by sex may occur as some studies have shown effects of body mass index on asthma only among females. However, sex differences are not consistent. Several hypotheses have been proposed to explain the epidemiological associations including alterations in airway mechanics and immune responses, hormonal influences and genetic factors. SUMMARY: There is evidence that obesity and overweight are associated with the development of asthma. Yet, the mechanisms underlying this relation are unclear. Weight reduction among asthmatic patients can result in improvements of lung function demonstrating the potential clinical impact of the findings.     

Practice guidelines and outcomes. Where are we headed?

Major forces are at work within the health care system that drive the development of clinical standards or guidelines. This process must be tied in a "feedback-loop" system to a more accurate assessment of patient outcomes. There is a major controversy at the foundation of the process that is pitting the opinions from consensus panels of experts against the inability of individual physicians to accurately estimate the outcomes of different options through implicit systems. In many instances, the quality of medical evidence is poor. Many groups within organized medicine are attempting to write guidelines, and at least four major challenges must be confronted before guidelines are widely adopted by clinicians. A new federal agency may provide the necessary resources to focus the debate on guidelines. Guidelines may eventually enhance the quality of medical care.     

Can application of a pelvic belt change injured hamstring muscle activity?

Hamstring injuries are commonly reported in various sports involving sprinting, high-velocity running and kicking. Aberrant biomechanics and neuromotor control of the lumbopelvic and thigh segments have been reported to play a significant role in hamstring injury incidence and recurrence. Recent evidence suggests that external pelvic compression (EPC) applied with a pelvic belt can augment the stability of the pelvic joints, and alter neuromotor control of the lumbopelvic and thigh muscles in individuals with and without (somatic) lumbopelvic and groin dysfunction. However, the effects of EPC on neuromotor control of injured hamstring muscles remain unknown. We have explored the putative neuromotor link between the lumbopelvic segment and hamstring muscles, and generated hypotheses based on plausible mechanisms through which EPC could affect injured hamstring muscle strength and recruitment. Recent guidelines argue that rehabilitation of hamstring injuries should follow a multi-modal approach and include strategies to improve stability and neuromotor control of the lumbopelvic segment. Further investigations exploring these hypotheses would confirm whether EPC could be recommended as an assessment, intervention and rehabilitation tool for hamstring injury.     

Immunity in salamander regeneration: Where are we standing and where are we headed?

Salamanders exhibit the most extensive regenerative repertoire among vertebrates, being able to accomplish scar-free healing and faithful regeneration of significant parts of the eye, heart, brain, spinal cord, jaws and gills, as well as entire appendages throughout life. The cellular and molecular mechanisms underlying salamander regeneration are currently under extensive examination, with the hope of identifying the key drivers in each context, understanding interspecies differences in regenerative capacity, and harnessing this knowledge in therapeutic settings. The immune system has recently emerged as a potentially critical player in regenerative responses. Components of both innate and adaptive immunity have been found at critical stages of regeneration in a range of salamander tissues. Moreover, functional studies have identified a requirement for macrophages during heart and limb regeneration. However, our knowledge of salamander immunity remains scarce, and a thorough definition of the precise roles played by its members is lacking. Here, we examine the evidence supporting roles for immunity in various salamander regeneration models. We pinpoint observations that need revisiting through modern genetic approaches, uncover knowledge gaps, and highlight insights from various model organisms that could guide future explorations toward an understanding of the functions of immunity in regeneration.     

Internet use among patients with psychosomatic disorders: what are the health-related demands and needs?

While Internet-based health-related offers for various disorders are increasing, little is known about the way patients with psychosomatic disorders use the Internet. We conducted a questionnaire survey in outpatient clinics at two university hospitals' Departments of Psychosomatic Medicine. Seventy-four percent of N = 274 patients had Internet home access and 60 percent of those patients reported health-related Internet use. Patients expressed the wish for more professional, evidence-based online information and expert-guided treatment. The survey results support the Internet's high potential in future treatment strategies for patients with psychosomatic disorders.     

Influenza vaccine: Where are we and where do we go?

The alarming rise of morbidity and mortality caused by influenza pandemics and epidemics has drawn attention worldwide since the last few decades. This life‐threatening problem necessitates the development of a safe and effective vaccine to protect against incoming pandemics. The currently available flu vaccines rely on inactivated viral particles, M2e‐based vaccine, live attenuated influenza vaccine (LAIV) and virus like particle (VLP). While inactivated vaccines can only induce systemic humoral responses, LAIV and VLP vaccines stimulate both humoral and cellular immune responses. Yet, these vaccines have limited protection against newly emerging viral strains. These strains, however, can be targeted by universal vaccines consisting of conserved viral proteins such as M2e and capable of inducing cross‐reactive immune response. The lack of viral genome in VLP and M2e‐based vaccines addresses safety concern associated with existing attenuated vaccines. With the emergence of new recombinant viral strains each year, additional effort towards developing improved universal vaccine is warranted. Besides various types of vaccines, microRNA and exosome‐based vaccines have been emerged as new types of influenza vaccines which are associated with new and effective properties. Hence, development of a new generation of vaccines could contribute to better treatment of influenza.     

Geriatric depression and vascular diseases: what are the links?

BACKGROUND: The term "vascular depression" has been proposed to describe a subset of depressive disorders that occurs in old age as a consequence of cerebrovascular disease. However, depression has been shown to result from other cardiovascular diseases such as coronary heart diseases, as well as to precipitate, worsen or precede vascular diseases. Depression also increases the likelihood of the incidence of vascular risk factors such as diabetes. AIMS: To review clinical and epidemiological evidence linking geriatric depression and vascular diseases, and to discuss the potential mechanisms that could underlie this association. METHOD: Systematic review of the literature of the last 5 years through Medline database search. RESULTS: Papers report the following potential ways of association: (1) there is a direct influence of vascular disease, in particular, arteriosclerosis, on the incidence of depression; (2) depressive disorders have a direct impact on the cardiovascular system; (3) depression and vascular disease share either a common pathophysiological process or genetic determinants. DISCUSSION: Depression can be understood as the direct consequence of brain damage in neurodegenerative disorders such as Parkinson's or Huntington's diseases. Similarly, vascular depression is mostly considered to be the consequence of microvascular lesions on prefrontal and subcortical regions. However, this functional neuroanatomical model offers no explanation for cases where depression has been shown to precede vascular diseases. Since cardiovascular diseases develop in a context of acquired environmental factors together with genetically determined disease, it may be postulated that geriatric depression could both result from brain lesions of vascular origin and also share some pathogenic or genetic determinants.