Neurofeedback and meditation technology in outpatient offender treatment: a feasibility and usability pilot study.

Introduction: Although Cognitive Behavioral Therapy (CBT) is the most often used intervention in forensic treatment, its effectivity is not consistently supported. Interventions incorporating knowledge from neuroscience could provide for more successful intervention methods. Methods: The current pilot study set out to assess the feasibility and usability of the study protocol of a 4-week neuromeditation training in adult forensic outpatients with impulse control problems. The neuromeditation training, which prompts awareness and control over brain states of restlessness with EEG neurofeedback, was offered in addition to treatment as usual (predominantly CBT). Results: Eight patients completed the neuromeditation training under guidance of their therapists. Despite some emerging obstacles, overall, the training was rated sufficiently usable and feasible by patients and their therapists. Discussion: The provided suggestions for improvement can be used to implement the intervention in treatment and set up future trials to study the effectiveness of neuromeditation in offender treatment.

[Functioning of parents and adolescents after family intervention Parenting with Love and Limits]. / Functioneren van ouders en jongeren na gezinsinterventie Ouderschap met Liefde en Grenzen.

BACKGROUND: Parenting with Love and Limits (PLL) is a family intervention aimed at reducing behavioral problems in adolescents up to the age of 18 by, among other things, improving communication between family members and the parenting skills of the parents. AIM: This prospective study examined whether parental communication and parenting skills and youth externalizing problem behavior were positively changed after PLL. METHOD: The study group consisted of 48 adolescents who had completed the PLL-intervention with their primary caregivers. Data from two measurements completed by the primary caregivers (44 mothers and 4 fathers) were used: prior to PLL (T0) and after PLL (T1). RESULTS: Results of the paired t-test indicated strong positive changes in communication, parenting and aggressive behavior after nearly eight months of PLL. A statistically significant (reliable change) decrease in aggressive behavior was found in one third of the adolescents, but not in deviant behavior. CONCLUSION: PLL improved functioning in some of the families, but further research is needed into the effective elements and for whom the intervention is effective under what circumstances.

Full and Short Versions of the Coping Inventory for Stressful Situations and Social Problem-Solving Inventory-Revised: Examining Their Factor Structure in a Dutch Outpatient Sex Offender Sample.

Inadequate problem solving is associated with recidivism in sex offenders. However, the psychometric properties of two of the most widely used coping self-report questionnaires, the Social Problem-Solving Inventory-Revised and Coping Inventory for Stressful Situations, have not been established for outpatient sex offenders. Using structural equation modeling, the present study aims to contribute to an empirically based decision as to which version of the Coping Inventory for Stressful Situations or Social Problem-Solving Inventory-Revised is best suited to use with forensic outpatient sex offenders. The sample consisted of 530 Dutch sex offenders treated in an outpatient forensic facility. Results support the use of the Coping Inventory for Stressful Situations-Short Form 20 for identifying problem-solving deficits among outpatient sex offenders, consequently facilitating the assessment of treatment needs.

Rapidly progressive hepatic alveolar echinococcosis in an ABO-incompatible renal transplant recipient.

We report on the case of an ABO-incompatible renal re-transplant recipient maintained on an intensified immunosuppressive regimen for recurrent cellular rejection episodes and transplant glomerulopathy who presented with rapidly growing hepatic tumors, radiologically suggestive of hemangiosarcoma. Upon resection and pathological work-up, the lesions revealed alveolar echinococcosis, a rare but potentially life-threatening parasitosis. Usually infection with Echinococcus multilocularis remains asymptomatic for extended periods of time and can go unrecognized for years. In the case presented, we observed an atypically rapid growth pattern of E. multilocularis that might have been due to the extent of the immunosuppressive regimen, which included repetitive anti-CD20 treatments. Retrospectively performed serological studies with enzyme-linked immunosorbent assays known to provide high sensitivity and specificity for the detection of echinococcosis in the general population, yielded ambiguous results in our immunocompromised host, which could be, in part, explained by B-cell depletion and its effects on antibody production and indirect actions on cellular immunity. In conclusion, this is the first report to our knowledge of hepatic alveolar echinococcosis in a renal transplant recipient. This case documents an altered clinical course of the parasitosis and the challenge of serological diagnostic tools under an intensified regimen of immunosuppressive agents, including rituximab.

Leflunomide therapy for polyomavirus-induced allograft nephropathy: efficient BK virus elimination without increased risk of rejection.

BACKGROUND: Optimal treatment of polyomavirus-induced allograft nephropathy (PVAN) with immunosuppressive and antiviral therapy is uncertain at present. Reduced immunosuppression is accompanied by increased risk of rejection, and antiviral agents are nephrotoxic. Leflunomide has immunosuppressive and antiviral properties and may be an alternative treatment agent. We report a two-center experience with use of leflunomide for treatment of PVAN. PATIENTS AND METHODS: Thirteen renal allograft recipients were diagnosed with biopsy-proven PVAN. Treatment consisted of lowering the calcineurin-inhibitor trough level, discontinuing mycophenolate mofetil therapy, and initiating leflunomide therapy. In 8 of the 13 patients, the serum concentration of the leflunomide active metabolite A771726 was monitored. RESULTS: Exchange of mycophenolate mofetil with leflunomide in patients with PVAN was well tolerated and safe, with no serious adverse effects or episodes of graft rejection. Mean follow-up after transplantation was 717 days, and after initiation of leflunomide therapy was 465 days. With the modified therapy, 12 patients cleared the virus at a mean of 109 days. One graft was lost due to refractory rejection accompanied by a decreasing viral load. In the other 12 patients, graft function stabilized or improved (mean [median] creatinine concentration at diagnosis, 2.39 [2.5] mg/mL, vs 2.27 [2.0] mg/dL at follow-up). Leflunomide concentration did not correlate with treatment efficiency. CONCLUSIONS: Treatment of PVAN with leflunomide, a low-dose calcineurin inhibitor, and prednisone seems to reduce viral load and stabilize renal graft function without increasing the risk of rejection. Even low serum concentrations of leflunomide support viral elimination and prevention of graft rejection.

[Disseminated histoplasmosis with involvement of mediastinum and skin in an immunocompetent patient]. / Disseminierte Histoplasmose mit Befall des Mediastinums und der Haut bei immunkompetenter Patientin.

HISTORY AND ADMISSION FINDINGS: A 29-years-old Brazilian woman was admitted to hospital because of progressive dyspnoea, shivering and fever. She reported a noticeable swelling at the right mandible and an ulcerative tumor at the side of the nose. INVESTIGATIONS: Laboratory tests showed normocytic, normochromic anemia with an elevation of the inflammatory parameters. Radiology showed an enlargement of the upper mediastinum. Computed tomography revealed extensive, confluent lymphoma. There were groups of cervical lymph nodes, especially in the area of the right jaw. Bronchoscopy showed extensive space-occupying lesions with severe inflammation of the trachea. DIAGNOSIS: Bronchial biopsy revealed necrotizing, granulomatous inflammation with dense infiltration of lymphatic cells. Small and spheroidal pathogens were seen within giant cells. Grocott-silver stain was positive, indicating histoplasmosis. Histological work-up of the ulcerating tumor at the side of the nose also showed Histoplasma capsulatum. TREATMENT AND COURSE: 8 weeks after starting specific treatment with oral itraconazole the inflammatory parameters had fallen to normal and computed tomography showed regression of the mediastinal bulge. CONCLUSION: Large mediastinal and cervical lymphatic masses with space-occupying bronchial lesions suggest should, in the differential diagnosis, consider not only malignant tumor but also infections. If the patient had been abroad (in this case in Brazil), pathogens like Histoplasma capsulatum, which is not present in Europe, have to be considered. In this immunocompetent patient the severe progression and dissemination of the disease, involving mediastinum, throat and skin, is most unusual.

ABO-incompatible kidney transplantation with antigen-specific immunoadsorption and rituximab - insights and uncertainties.

Several protocols have been developed to effectively overcome the blood group barrier in renal transplantation. In the evolution of these protocols, one of the latest steps was the combination of anti-CD20 treatment with antigen-specific immunoadsorptions. Over the last years we have learned that these relatively new protocols carry very promising short-term and intermediate-term results which compare favorably to the outcome of ABO-compatible living donor transplantations. Latest reports suggest that combining immunoadsorptions with rituximab does not result in an increased risk of infectious complications or tumors in the first years after transplantation compared to ABO-compatible living donor transplantations. We recently demonstrated that a majority of patients with isoagglutinin titers >1:128 can be safely transplanted using rituximab and immunoadsorptions without an added risk of early antibody-mediated rejections. We have also shown that a cost saving 'on-demand strategy' of postoperative immunoadsorptions based on careful titer monitoring can be used as an alternative to preemptively scheduled immunoadsorptions. Although rituximab and antigen-specific immunoadsorptions are significantly less invasive than splenectomy and plasma-pheresis, long-term follow-up of patients treated with a combination of anti-CD20 antibody and antigen-specific immunoadsorption will be needed to benchmark this therapeutic option in relation to more established protocols.

Microarray analysis reveals influence of the sesquiterpene lactone parthenolide on gene transcription profiles in human epithelial cells.

Sesquiterpene lactones are known for their anti-inflammatory activity which has been proven in various assays on DNA, mRNA and protein level. Here we report on the change in the gene expression profile in TNF-alpha stimulated human 293 cells after treatment with parthenolide using a cDNA microarray analysis. Twenty-one of 7028 genes were found to be up- and 18 down-regulated. They encode for chemoattractants, immune system proteins, glycoproteins, metabolism, serine proteinases, and transcription factors. Confirmatory analyses were carried out using quantitative real-time RT-PCR (TaqMan). Additional studies with selected genes revealed the concentration-dependent influence of parthenolide on the expression of these genes.

Evaluation of a portable recording device (Somnocheck) for use in patients with suspected obstructive sleep apnoea.

BACKGROUND: Portable recording devices for the diagnosis of obstructive sleep apnoea (OSA) should be carefully evaluated before being used on a routine basis in out-patients. OBJECTIVE: This study was designed to evaluate the diagnostic accuracy of the new portable recording device, Somnocheck (SC). METHODS: Nocturnal polysomnographies (PSG) and SC recordings were performed simultaneously in the sleep laboratory in 51 patients with suspected OSA, and were analysed manually by a blinded investigator. RESULTS: The apnoea/hypopnoea index (AHI) obtained by manual SC analysis correlated closely with that obtained by PSG (r = 0.98), but the correlation with AHI obtained by automatic SC analysis was markedly lower (r = 0.83). When an AHI > or =10 was defined as indicative of OSA, the sensitivity of manual SC analysis was 0.97 and its specificity 1.00. The sensitivity of automatic analysis was 0.83 and its specificity 0.95. CONCLUSIONS: In this experimental setting, the SC showed a very high diagnostic accuracy for the diagnosis of OSA and was able to define its severity precisely. The diagnostic accuracy of manual analysis was found to be superior to that of automatic analysis. Considering the results of this technical evaluation, the SC may also be expected to work reliably when it is used in an ambulatory setting.