Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

A transmembrane helix dimer: structure and implications.

The three-dimensional structure of the dimeric transmembrane domain of glycophorin A (GpA) was determined by solution nuclear magnetic resonance spectroscopy of a 40-residue peptide solubilized in aqueous detergent micelles. The GpA membrane-spanning alpha helices cross at an angle of -40 degrees and form a small but well-packed interface that lacks intermonomer hydrogen bonds. The structure provides an explanation for the previously characterized sequence dependence of GpA dimerization and demonstrates that van der Waals interactions alone can mediate stable and specific associations between transmembrane helices.

Modulation of glycophorin A transmembrane helix interactions by lipid bilayers: molecular dynamics calculations.

Starting from the glycophorin A dimer structure determined by NMR, we performed simulations of both dimer and monomer forms in explicit lipid bilayers with constant normal pressure, lateral area, and temperature using the CHARMM potential. Analysis of the trajectories in four different lipids reveals how lipid chain length and saturation modulate the structural and energetic properties of transmembrane helices. Helix tilt, helix-helix crossing angle, and helix accessible volume depend on lipid type in a manner consistent with hydrophobic matching concepts: the most relevant lipid property appears to be the bilayer thickness. Although the net helix-helix interaction enthalpy is strongly attractive, analysis of residue-residue interactions reveals significant unfavorable electrostatic repulsion between interfacial glycine residues previously shown to be critical for dimerization. Peptide volume is nearly conserved upon dimerization in all lipid types, indicating that the monomeric helices pack equally well with lipid as dimer helices do with one another. Enthalpy calculations indicate that the helix-environment interaction energy is lower in the dimer than in the monomer form, when solvated by unsaturated lipids. In all lipid environments there is a marked preference for lipids to interact with peptide predominantly through one rather than both acyl chains. Although our trajectories are not long enough to allow a full thermodynamic treatment, these results demonstrate that molecular dynamics simulations are a powerful method for investigating the protein-protein, protein-lipid, and lipid-lipid interactions that determine the structure, stability and dynamics of transmembrane alpha-helices in membranes.

Localisation of alpha(2,3) and alpha(2,6) linked terminal sialic acid groups in human trabecular meshwork.

Sialic acid specific lectins were used to localise isomers of sialyl glycosides in human trabecular meshwork (TM) at the ultrastructural level. A lectin immunogold method demonstrated that sialic groups were concentrated on the endothelial surface of Schlemm's canal (SC) and in the adjacent juxta-canalicular tissue (JCT). One sialyl glycoside, alpha(2,6) linked N-acetyl neuraminic acid, was present mainly on the luminal aspect of the SC endothelium and in the cytoplasm of the JCT cells. Another, alpha(2,3) linked N-acetyl neuraminic acid, was localised predominantly to the extracellular fibrillar material of the JCT. The existence of a topographical segregation of these two sialyl glycosides within the TM supports the view that highly charged anionic molecules may be of significance in regulating aqueous outflow.

Where is here and when is now? The adaptational challenge of mental health reform for group psychotherapy.

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.

Time-limited group psychotherapy.

The presence of a time limit shapes the entire therapeutic process and culminates in the management of termination. This paper outlines a protocol for dealing with termination in time-limited psychotherapy groups: (1) Select suitable members with similar capacity to use a time-limited format; (2) use a closed group format; (3) clarify the time boundaries at the beginning; (4) reinforce the time frame during the last half of the group; (5) provide focused interventions; (6) forestall premature termination; (7) reinforce termination themes of deprivation, resentment and anger, rejection, grief and loss, responsibility for self; (8) structure the final session; and (9) plan a 4-month follow-up visit to encourage ongoing application. These guidelines provide the therapist with a general structure to ensure that major termination themes are systematically addressed. They deal with powerful concepts of maturation and self-responsibility and incorporate the principal strategies that distinguish time-limited from time-unlimited group psychotherapy.

Recent developments in brief psychotherapy.

The clinical effectiveness and many of the therapeutic mechanisms of brief psychotherapy have been validated through research studies in recent years, as indicated in this review of developments in the psychodynamic and interpersonal brief therapies. However, the literature shows considerable variation in methods for establishing time limits and in exclusion criteria. In a major shift in therapeutic practice, interpersonal rather than intrapsychic concepts are used to identify the focus of therapy, and systematic techniques for defining the therapeutic focus have been developed. The therapeutic alliance and its relation to outcome also have received substantial attention. Trends in service delivery clearly indicate increasing emphasis on brief psychotherapy, which must be conceptualized as a specific modality, not just as long-term therapy compressed.

Interpersonal psychotherapy group (IPT-G) for depression.

A case study of a time-limited interpersonal psychotherapy group (IPT-G) is presented to illustrate the use of interpersonal therapy (IPT) to treat patients with major depression in a group psychotherapy format. The use of individual outcome measures as a helpful adjunct to clinical psychotherapeutic practice is demonstrated. Because IPT-G has only a few exclusion criteria (active suicidality and significant borderline personality features), it can be used in a broad range of clinical settings. This clinical example demonstrates IPT-G to be a useful modality for addressing a common and difficult patient population.

Relatedness, group work, and outcome in long-term inpatient psychotherapy groups.

Process and outcome measures were compared in two long-term groups. The measure "Relatedness" reflected an individual's attachment to and comfort with the group, and "Group Work" indicated perception of the group as having a positive working climate. High Relatedness scores predicted better outcome at 18-month follow-up. Group Work scores were not related to outcome. Relatedness and Group Work scores were not correlated. Results replicate in a group psychotherapy population the importance, reported in individual therapy literature, of an early and sustained positive therapeutic alliance (Relatedness). However, a measure that is closely related to the concept of "working alliance" (Group Work) did not predict outcome.

Developmental stages: an integrating theory of group psychotherapy.

The inadequate nature of research into group psychotherapy stems from the lack of a satisfactory general theory that accounts for the group as a social system as well as for the functioning of the individual. A critique is presented of the group-as-whole tradition and a brief introduction given to social system concepts, particularly as they relate to group developmental stages. The idea that groups progress through a series of stages implies the notion of the group as a single entity with its own organizational structure. Specific stages are described through which the group acquires interactional complexity. These are conceptualized as epigenetic phenomena in that the mature structure is attained through an invariate sequence of transformations. Adequate resolution of any one stage is a prerequisite for further development. Group developmental tasks are described for the following stages: Engagement, Differentiation, Individuation, Intimacy, Mutuality and Termination. This set of higher order concepts has been found useful as a theoretical background against which specific group events can be evaluated. By using the idea of stages, the leader can monitor the progress of the group as a unit and compare the activity of any one member with the collectivity.

Psychological self-perception in male transsexuals, homosexuals, and heterosexuals.

Gender-related aspects of self-perception were explored for 24 anatomical males consisting of three matched groups of transsexuals, heterosexuals, and homosexuals. MacKenzie's Diagnostic Criteria Scale ratings were used to confirm group membership. Instruments used were the Repertory Grid Technique, the Rosenberg Self-Esteem Scale, Bem Self Role Inventory, Maferr Inventory of Masculine Values, and Derogatis Sexual Functioning Inventory. Results for transsexual subjects reflected lowest self-esteem. Of the three groups, they perceived themselves to be the most like females and the most unlike other males. Transsexual subjects tended to describe themselves in nonmasculine terms and valued their gender role orientation. Homosexual subjects, on the other hand, reported the highest self-esteem. Additionally, they saw themselves as the most similar to males and the most dissimilar to females. As a group, homosexual subjects described themselves in comparatively strong masculine-stereotyped fashion and valued this posture. However, they believed that women do not value the self-orientation which these subjects endorsed for themselves. Heterosexual subjects scored moderately high in terms of global self-esteem. They described themselves as somewhat masculine to androgynous and reported valuing their gender role orientation. Results on the Repertory Grid and the Derogatis Sexual Functioning Inventory showed heterosexual subjects to be the least polarized in their gender-related self-descriptions. This group generally appeared to be least concerned with traditional gender role referents. The importance of a cognitive approach to clinical assessment of the transsexual individual is stressed.

Structure-based prediction of the stability of transmembrane helix-helix interactions: the sequence dependence of glycophorin A dimerization.

The ability to predict the effects of point mutations on the interaction of alpha-helices within membranes would represent a significant step toward understanding the folding and stability of membrane proteins. We use structure-based empirical parameters representing steric clashes, favorable van der Waals interactions, and restrictions of side-chain rotamer freedom to explain the relative dimerization propensities of 105 hydrophobic single-point mutants of the glycophorin A (GpA) transmembrane domain. Although the structure at the dimer interface is critical to our model, changes in side-chain hydrophobicity are uncorrelated with dimer stability, indicating that the hydrophobic effect does not influence transmembrane helix-helix association. Our model provides insights into the compensatory effects of multiple mutations and shows that helix-helix interactions dominate the formation of specific structures.