Factors associated with hemolysis during extracorporeal membrane oxygenation (ECMO)-Comparison of VA- versus VV ECMO

Venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) are effective support modalities to treat critically ill patients. ECMO-associated hemolysis remains a serious complication. The aim was to disclose similarities and differences in VA- and VV ECMO-associated hemolysis. This is a retrospective single-center analysis (January 2012 to September 2018) including 1,063 adult consecutive patients (VA, n = 606; VV, n = 457). Severe hemolysis (free plasma hemoglobin, fHb > 500 mg/l) during therapy occurred in 4% (VA) and 2% (VV) (p≤0.001). VV ECMO showed significantly more hemolysis by pump head thrombosis (PHT) compared to VA ECMO (9% vs. 2%; p≤0.001). Pretreatments (ECPR, cardiac surgery) of patients who required VA ECMO caused high fHb pre levels which aggravates the proof of ECMO-induced hemolysis (median (interquartile range), VA: fHb pre: 225.0 (89.3–458.0); VV: fHb pre: 72.0 (42.0–138.0); p≤0.001). The survival rate to discharge from hospital differed depending on ECMO type (40% (VA) vs. 63% (VV); p≤0.001). Hemolysis was dominant in VA ECMO patients, mainly caused by different indications and not by the ECMO support itself. PHT was the most severe form of ECMO-induced hemolysis that occurs in both therapies with low frequency, but more commonly in VV ECMO due to prolonged support time.

Low-level microsatellite instability phenotype in sporadic glioblastoma multiforme

PURPOSE

Genetic instability is a hallmark of glioblastoma multiforme (GBM). Microsatellite instability (MSI) is a significant event in the tumorigenesis of many sporadic malignancies. The aim of our investigation was to study microsatellite instability in newly diagnosed glioblastomas.

METHODS

MSI was investigated in 109 GBMs with 15 microsatellite markers. Immunohistochemistry was performed for the mismatch repair (MMR) proteins hMLH1, hMSH2, hPMS2, and hMSH6 in cases showing MSI. Sequence and promoter methylation status of hMLH1 were analyzed in the case of a decreased hMLH1 protein expression as well. To further investigate MSI(+) GBMs we carried out studies of LOH at selected chromosome regions, EGFR amplification, and sequence of p53 and PTEN.

RESULTS

MSI was observed in six GBMs (5.5%) and it was more frequent in GBMs with a previous lower grade astrocytoma (18.8% vs. 3.2%). MMR protein staining was positive in all MSI(+) GBMs except in one case, which showed an aberrant expression of hMLH1 and hPMS2 without hMLH1 inactivation. Among MSI(+) GBMs, one tumor corresponded to the GBM molecular type 1 (p53 mutation, no EGFR amplification), another tumor to type 2 (wild-type p53, EGFR amplification), and four tumors to neither type (wild-type p53, no EGFR amplification). None of the six tumors carried a PTEN mutation.

CONCLUSIONS

MSI in GBM might be caused by inactivation of minor MMR genes rather than by a deficiency of hMLH1 or hMSH2 and it appears not to play a decisive role in the pathogenesis of these tumors. MSI(+) GBMs predominantly showed a profile which included wild-type of p53 and PTEN and absence of EGFR amplification but MSI occurred in all GBM molecular subtypes.

[Sexual abuse of girls within the family--results of an analysis of expert psychological credibility assessment]

This study is based on 57 reports by a psychological expert witness who had examined the credibility of girls sexually abused by a family member. Compared with other studies not limited to cases known to the criminal court, the experiences of these girls were more severe, with regard to frequency, kind of sexual contact and use of direct physical force. Further results concern possible conditions of the abuse, the girls' reactions, the attitude of their social environment and aspects of the legal proceedings.

[Generational differences in perception of menstruation and attitude to menstruation]

Based upon a model of individual differences in menstrual experiences the study concerns the question of similarities and difference in menstrual experience and attitudes between mothers and their daughters. 60 mothers (mean age 46.5 years) and 60 daughters (mean age 19.9 years) were investigated using a comprehensive questionnaire which included standardized measures such as the German version of the Menstrual Attitude Questionnaire. Comparisons of both groups revealed significant differences in relation to sex education, preparation for menstruation, and the experience of menarche, which were described more positive by the generation of the daughters. Differences in menstrual cycle effects on wellbeing and behavior were less clear. Behavioral changes and restrictions both demonstrated the significance of the mothers influence on their daughters. Inspite of more positive conditions for a "menstruation related socialization" mothers and daughters showed only slight differences in their menstrual attitudes. This result could confirm the importance and persistence of cultural norms.

[The status of sexuality in routine psychiatric practice--results of a personal survey]

Based upon the observation that aspects of sexuality are rarely considered in psychiatric practice, a questionnaire study was performed to differentially assess the attitudes and experiences of psychiatric staff with this topic. 145 members of different professional groups and several psychiatric in-patient institutions answered the questions. The results of the study indicate for example that sexuality generally is more important in psychiatric institutions than one could have expected according to the psychiatric literature. Stereotypical attitudes concerning the sexual life of psychiatric patients were rare and more frequently found to be unspecific for psychiatry, for example those related to differential meanings of female and male sexuality. A further result of the study showed that sexual knowledge and confidence in handling conversations about sexuality seemed to be less important for the reduction of problems in the staff's reactions to sexually active patients than the possibility to discuss the own uncertainties and their recognition. Generally, the results could serve as a basis for psychiatric staff to facilitate the consideration of sexual matters within their institutions.

Effects of antiandrogen treatment on the sexuality of women with hyperandrogenism

Although one can reasonably infer that antiandrogens are likely to have a marked negative impact on female sexual responsiveness, the side effects of cyproterone acetate (CPA) treatment in hirsute women have been neglected in previous studies. The purpose of this study was to investigate the psychosexual situation of 61 hirsute women before and under hormonal treatment. 21% of the hirsute women were diagnosed as having been sexually dysfunctional before starting hormonal treatment. 44% of the women under antiandrogen treatment reported that their sexual enjoyment was impaired due to the hormonal treatment. Taking into account only those women living in a stable partnership, the percentage goes up to 61%. The conclusion from these results is to give a more detailed account of the possible side effects to the women involved in CPA treatment.

Alcoholic women treated by behaviorally orientated therapy: an 18-month follow-up study

Follow-up results of a behaviorally orientated treatment program for alcoholic women are presented. Sixty patients, carefully screened, were admitted on a special ward in groups of not larger than 12 for a period of 3 months. Abstinence was the declared goal of all individual and group treatments. More than 13 months after discharge interviews were carried out with 58 of the 60 former patients in their homes. Further information was collected from relatives and social workers. Forty per cent of those interviewed qualified as abstinent, 9% had improved, 3% were controlled drinkers, 5% had become worse and 43% had not improved. Specific aspects of the program are discussed.