Plasma cytokine and growth factor response to acute psychosocial stress in major depressive disorder.

BACKGROUND: Pro-inflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor (TNF)-α are elevated in response to psychosocial stress; however, less is known about other inflammatory markers. METHODS: We explored response to the Trier Social Stress Test (TSST) of 16 cytokines and growth factors in patients with major depressive disorder (MDD, n = 12) vs. healthy volunteers (HV, n = 16). Outcomes were baseline and post-stress levels estimated by area under the curve (AUCi) and peak change over 3 timepoints. We also explored correlations between biomarkers and clinical characteristics. RESULTS: Baseline concentrations were higher in MDD for platelet-derived growth factor (PDGF)-AB/BB (p = 0.037, d = 0.70), granulocyte-macrophage colony-stimulating factor (GM-CSF, p = 0.033, d = 0.52), and IL-8 (p = 0.046, d = 0.74). After TSST, AUCi was higher in MDD for GM-CSF (p = 0.003, d = 1.21), IL-5 (p = 0.014, d = 1.62), and IL-27 (p = 0.041, d = 0.74). In MDD, depression severity correlated positively with soluble CD40L (sCD40L) for AUCi (Spearman's ρ = 0.76, p = 0.004) and with baseline vascular endothelial growth factor A (VEGFA, r = 0.85, p < 0.001), but negatively with baseline monokine induced by gamma interferon (MIG, aka CXCL9; r = -0.77, p = 0.003). CONCLUSIONS: Effect sizes were robust in this exploratory study, although interpretation of the results must be cautious, given small sample size and multiple comparisons. Differential study of stress-induced biomarkers may have important ramifications for MDD treatment.

Complete remission of unresectable hepatocellular carcinoma treated with reduced dose of sorafenib: a case report.

Hepatocellular carcinoma (HCC) is a highly aggressive cancer. For patients who are diagnosed with advanced stage disease that are not surgical candidates, the disease is universally lethal. Advance has been made to extend survival with molecular target therapy, but durable complete responses are extremely rare. We report an unusual case where a 74-year-old patient with unresectable HCC received eight months of reduced-dose of sorafenib, a tyrosine kinase inhibitor, and achieved a durable complete remission. At the most recent follow up, he remains in remission 16 months after cessation of treatment, without clinical or imaging evidence of disease recurrence.

The resident scholar program: a research training opportunity for internal medicine house staff.

BACKGROUND: Housestaff research training is a challenging task that is complicated by the lack of a structured process and dedicated time. The Resident Scholar Program (RSP) at the University of Cincinnati, Department of Internal Medicine was created to overcome these challenges. METHODS: Interested internal medicine house staff are required to submit an application to the residency research director including a project description signed by a faculty mentor. If the project is approved, a 4-month elective rotation is scheduled for the following year. Residents spend the first month on a consult service in the subspecialty area of their research and the remaining 3 months performing their research project. The RSP was launched in July 2003. RESULTS: The percentage of residents participating in research more than tripled. The subspecialty areas represented by RSP research were more diverse than those represented in prior years. Most participants participated in clinical research projects (84%), with 63% of projects being prospective in design. The RSP residents were twice as likely to obtain subspecialty fellowship positions compared to non-RSP residents (89% vs 46%, respectively). CONCLUSION: The RSP enables house staff to participate in research opportunities in their areas of interest. Development of a more systematic assessment method to study the impact of the program is underway, but the high participation rate reflects resident interest in such a program, particularly for residents with aspirations in pursuing fellowship training.

The clinical use of karyotyping spontaneous abortions.

OBJECTIVE: The objective of this study was to assess the clinical use of routinely karyotyping spontaneous abortion material. STUDY DESIGN: We retrospectively reviewed the records of the Pittsburgh Cytogenetics Laboratory from January 1, 1998, to December 31, 2001, for all tissues from spontaneous losses at 20 weeks' gestation or less for which complete medical records were available. RESULTS: There were 517 submitted samples of which 28 (5.4%) failed to grow in culture. Overall, 55.8% of samples were abnormal; 52.3% of normal results were male. In samples from pregnancies at 13 weeks or less the rate of abnormality was 69.1%. When analyzed by maternal age, the rate of abnormality for first-trimester losses was 57.2% in women younger than 35 years, and 82.3% in those 35 years or older. There was no difference in the rate of abnormality when comparing first loss with two or more losses, first pregnancy with two or more pregnancies, or the presence or absence of at least one live birth. CONCLUSION: Chromosome abnormalities are the cause for pregnancy loss in 50% to 80% of cases, depending on maternal age and gestational age at time of the loss. Karyotyping of spontaneous losses in the first trimester beginning with the patient's second loss provides clinically important etiologic information and decreases the number of evaluations necessary for recurrent pregnancy loss.

Parental evaluation of informing interviews for cleft lip and/or palate.

OBJECTIVE: This study was conducted to record subjective information concerning parental experiences and preferences with regard to informing interviews for cleft lip and/or palate. The analysis of these data was intended to help informants improve the way in which such conversations are conducted. METHODS: The study used a self-administered questionnaire. Study participants were the biological parents of children who had cleft lip and/or palate and were seen in the University of Pittsburgh Cleft Palate-Craniofacial Center. RESULTS: Results revealed that parents wanted informing health professionals to be in greater control of the informing conversation, to show more caring and confidence, to show more of their own feelings, to give parents more of an opportunity to talk and show feelings, to make a greater effort to comfort parents, to provide more information, to initiate more of a discussion about the association between clefts and mental retardation/learning disabilities, and to provide more referrals to other parents during the informing interview. A positive association between the degree to which parents reported knowing the health professionals and reported satisfaction was identified for 10 dimensions of health professional behavior. CONCLUSIONS: Parents are dissatisfied with several aspects of informing interviews for cleft lip and/or palate. The results of this study suggest ways to improve informing interviews for oral-facial clefts and other congenital anomalies.