Extramediastinal surgical problems in heart transplant recipients.

BACKGROUND: As heart transplantation has gained wide acceptance, a growing number of recipients are at risk of experiencing extramediastinal surgical problems. STUDY DESIGN: We retrospectively reviewed our experience in the diagnosis and management of surgical problems occurring in 94 consecutive patients having heart transplantation. During the period of the study, we progressively adopted a policy of low-level immunosuppression, aiming toward monotherapy with cyclosporine. RESULTS: Seventy-four extramediastinal surgical problems developed in 44 of 94 patients (47%). The type of problems were gastrointestinal in 17 of 74 (23%), vascular in 13 of 74 (17.5%), urogenital in 8 of 74 (11%), and neurologic in 4 of 74 (5.5%). There were also 9 of 74 cases of trauma (12%), 9 of 74 skin tumors (12%), and 14 of 74 miscellaneous diseases (19%). Sixty-two surgical diseases occurring in 40 patients required 75 surgical interventions, 11 of them (15%) on an emergency basis. Operations were performed for 12 of 74 neoplasms (16%) and 12 of 74 infectious or potentially infectious diseases (16%). Surgical diseases occurred most commonly within the first 6 months after transplantation (20 of 74; 27%). Complications occurred in 8 of 75 surgical interventions (9%). A high proportion of surgical disease was potentially related to immunosuppressive therapy (37 of 74; 50%) or to transplantation itself (7 of 74; 9%). CONCLUSIONS: Extramediastinal diseases after heart transplantation involve most surgical specialties. Most of them are potentially linked with either the immunosuppressive therapy or the transplantation procedure, supporting our low-level immunosuppression policy. Expectant management is not justified in this population, who withstands operations well both early and late after transplantation.

Emotional and neuroendocrine regulation in very preterm and full-term infants at six months of age

Emotional and neuroendocrine regulation have been shown to be associated. However, results are inconsistent. This paper explores the functioning and relationships between these two systems in 54 healthy preterm and 25 full-term born infants at six months of age. Results showed significant differences between very preterm and full-term children in emotional intensity and regulation, as well as in neuroendocrine regulation. No evidence of an association between neuroendocrine and emotional regulations was found. Results suggest a possible delay in the maturation of the neuroendocrine system as well as in emotional regulation in very preterm infants.

Sudden death: ethical and legal problems of post-mortem forensic genetic testing for hereditary cardiac diseases.

Hereditary non-structural diseases such as catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT, and the Brugada syndrome as well as structural disease such as hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) cause a significant percentage of sudden cardiac deaths in the young. In these cases, genetic testing can be useful and does not require proxy consent if it is carried out at the request of judicial authorities as part of a forensic death investigation. Mutations in several genes are implicated in arrhythmic syndromes, including SCN5A, KCNQ1, KCNH2, RyR2, and genes causing HCM. If the victim's test is positive, this information is important for relatives who might be themselves at risk of carrying the disease-causing mutation. There is no consensus about how professionals should proceed in this context. This article discusses the ethical and legal arguments in favour of and against three options: genetic testing of the deceased victim only; counselling of relatives before testing the victim; counselling restricted to relatives of victims who tested positive for mutations of serious and preventable diseases. Legal cases are mentioned that pertain to the duty of geneticists and other physicians to warn relatives. Although the claim for a legal duty is tenuous, recent publications and guidelines suggest that geneticists and others involved in the multidisciplinary approach of sudden death (SD) cases may, nevertheless, have an ethical duty to inform relatives of SD victims. Several practical problems remain pertaining to the costs of testing, the counselling and to the need to obtain permission of judicial authorities.

Selective attention to emotional stimuli: What IQ and Openness do, and emotional intelligence does not

We examined how general intelligence, personality, and emotional intelligence-measured as an ability using the MSCEIT-predicted performance on a selective-attention task requiring participants to ignore distracting emotion information. We used a visual prime in which participants saw a pair of faces depicting emotions; their task was to focus on one of the faces (the target) while ignoring the other (the distractor). Next, participants categorized a string of letters (word or nonword), which was either congruent to the target or the distractor. The speed of response to categorizing the string was recorded. Given the emotional nature of the stimuli and the emotional information processing involved in the task, we were surprised to see that none of the MSCEIT branches predicted performance. However, general intelligence and openness to experience reduced response time.

Quality of life after pulmonary embolism: validation of the French version of the PEmb-QoL questionnaire.

Background The PEmb-QoL is a validated 40-item questionnaire to quantify health-related quality of life in patients having experienced pulmonary embolism (PE). It covers six health dimensions: frequency of complaints, activities of daily living limitations, work-related problems, social limitations, intensity of complaints, and emotional complaints. Originally developed in Dutch and English, we sought to prospectively validate the psychometric properties of a French version of the PEmb-QoL.MethodsWe performed a forward and backward translation of the English version of the PEmb-QoL into French. French-speaking consecutive adult patients with an acute, objectively confirmed PE admitted to the emergency department of a Swiss university hospital between 08/2009 and 09/2011 were recruited telephonically. We used standard psychometric tests and criteria to evaluate the acceptability, reliability, and validity of the French version of the PEmb-QoL. We also performed an exploratory factor analysis.ResultsOverall, 102 patients were enrolled in the study. The French version of the PEmb-QoL showed good reliability (internal consistency, item¿total and inter-item correlations), reproducibility (test-retest reliability), and validity (convergent, discriminant) in French-speaking patients with PE. The exploratory factor analysis suggested three underlying dimensions: limitations in daily activity (items 4b-m, 5a-d), symptoms (items 1a-h and 7), and emotional complaints (items 9a-f and j).ConclusionWe successfully validated the French version of the PEmb-QoL questionnaire in patients with PE. Our results show that the PEmb-QoL is a valuable tool for assessing health-related quality of life after PE in French-speaking patients.

The Fry method applied to an augen orthogneiss: Problems and results

The application of the Fry method to measure strain in deformed porphyritic granites is discussed. This method requires that the distribution of markers has to satisfy at least two conditions. It has to be homogeneous and isotropic. Statistics on point distribution with the help of a Morishita diagram can easily test homogeneity. Isotropy can be checked with a cumulative histogram of angles between points. Application of these tests to undeformed (Mte Capanne granite, Elba) and to deformed (Randa orthogneiss, Alps of Switzerland) porphyritic granite reveals that their K-feldspars phenocrysts both satisfy these conditions and can be used as strain markers with the Fry method. Other problems are also examined. One is the possible distribution of deformation on discrete shear-bands. Providing several tests are met, we conclude that the Fry method can be used to estimate strain in deformed porphyritic granites. (c) 2006 Elsevier Ltd. All rights reserved.

Causality and endogeneity: Problems and solutions

Most leadership and management researchers ignore one key design and estimation problem rendering parameter estimates uninterpretable: Endogeneity. We discuss the problem of endogeneity in depth and explain conditions that engender it using examples grounded in the leadership literature. We show how consistent causal estimates can be derived from the randomized experiment, where endogeneity is eliminated by experimental design. We then review the reasons why estimates may become biased (i.e., inconsistent) in non-experimental designs and present a number of useful remedies for examining causal relations with non-experimental data. We write in intuitive terms using nontechnical language to make this chapter accessible to a large audience.

Being Drunk to Have Fun or to Forget Problems? Identifying Enhancement and Coping Drinkers Among Risky Drinking Adolescents

Prevention programs in adolescence are particularly effective if they target homogeneous risk groups of adolescents who share a combination of particular needs and problems. The present work aims to identify and classify risky single-occasion drinking (RSOD) adolescents according to their motivation to engage in drinking. An easy-to-use coding procedure was developed. It was validated by means of cluster analyses and structural equation modeling based on two randomly selected subsamples of a nationally representative sample of 2,449 12- to 18-year-old RSOD students in Switzerland. Results revealed that the coding procedure classified RSOD adolescents as either enhancement drinkers or coping drinkers. The high concordance (Sample A: kappa - .88, Sample B: kappa - .90) with the results of the cluster analyses demonstrated the convergent validity of the coding classification. The fact that enhancement drinkers in both subsamples were found to go out more frequently in the evenings and to have more satisfactory social relationships, as well as a higher proportion of drinking peers and a lower likelihood to drink at home than coping drinkers demonstrates the concurrent validity of the classification. To conclude, the coding procedure appears to be a valid, reliable, and easy-to-use tool that can help better adapt prevention activities to adolescent risky drinking motives.