Platelets and Breast Cancer.

BACKGROUND: An association was shown between thrombocytosis and future development of several cancers. OBJECTIVES: To investigate whether pre-treatment platelet counts correlated with clinical outcomes of patients with breast cancer. METHODS: This retrospective study included 22 patients who had been diagnosed with stage I breast cancer and were 66.8 ± 13.2 years of age. Of these, 22 with stage II were 61.6 ± 12.3 years old and 9 with stage III and IV were 64.4 ± 15.3 years old. Clinical and hematological data from the first visit to the oncology clinic were collected. The follow-up period was 12 months to 5 years. RESULTS: A significant difference in platelet counts was found between patients who died (187,000 ± 4000 µ/L) and those who were disease free for 5 years (248,000 ± 83,000 µ/L, P = 0.0001). A significant difference in platelet-to-lymphocyte ratio was found between patients who died and those with recurrence (192 ± 81 vs. 124 ± 71, P = 0.01). A negative correlation was found between age and lymph nodes (Ps = -0.305, P = 0.02) and staging and white blood cells count (Ps = -0.280, P = 0.04). A positive correlation was found between clinical staging and lymph nodes (Ps = 0.443, P = 0.001) and clinical staging and metastases (P = 0.308, P = 0.02). CONCLUSIONS: Platelet counts may be a prognostic marker for breast cancer. Patients who died within 1 year had lower pre-treatment platelet count, which could represent an insidious disseminated intravascular coagulopathy cancer related consumption process.

Reluctance Versus Urge to Disclose Child Maltreatment: The Impact of Multi-Type Maltreatment.

Child maltreatment is a major public health issue in Israel. According to a recent Israeli national epidemiological survey, approximately half of Jewish and Arab girls and boys between the ages 12 and 17 experienced at least one type of child maltreatment, at any severity level. The purpose of the present study was to investigate the influence of multi-type maltreatment on Israeli children and youth survivors' reluctance versus urge to disclose; with the effects of gender, age, and ethnicity taken into account. The study is important since non-disclosure has deleterious effects in terms of continuation of the abuse, delays in criminal prosecution and commencement of treatment. A self-report questionnaire incorporating the following instruments was administered: the Juvenile Victimization Questionnaire, the Childhood Trauma Questionnaire, and the Disclosure of Trauma Questionnaire. The sample consisted of 6,253 Jewish and Arab children and youth who reported experiencing at least one lifetime child maltreatment event. Study results indicated that children and youth's reluctance to disclose is positively associated with their emotional reactions to disclosure, as well as with higher instances of child maltreatment exposure; whereas urge to talk is negatively correlated with their emotional reactions to disclosure.

Willingness to disclose child maltreatment: CSA vs other forms of child abuse in relation to gender.

The aim of the study was to examine the role of gender in willingness to disclose childhood sexual abuse (CSA) compared to other forms of abuse (physical, emotional and neglect) in young adolescents. Willingness was examined through two terms: reluctance- the level of unwillingness or disinclination to disclose, and urge-the need to share in order to get rid of unbearable feelings. The sample consisted of 3,156 boys (n = 1,544) and girls (n = 1,612) between the ages of 11-16 who reported having been abused at least once during their life. Participants were divided into three groups: experiencing other than CSA, sexual abuse with no physical contact, and sexual abuse with physical contact. Regarding measures, a self-report questionnaire incorporating the following instruments was administered: Demographics, the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Study results indicated that CSA victims were more reluctant to disclose than victims of other than CSA forms of abuse. The more severe the CSA (physical contact) the lower was the willingness to disclose. Boys were more reluctant than girls to disclose sexual abuse whether or not it involved physical contact. Reluctance to disclose was positively associated with emotional reactions to disclosure while urge to talk was negatively correlated with emotional reactions to disclosure.

Prevalence of Child Maltreatment in Israel: A National Epidemiological Study.

The current study is based on data collected from Jewish and Arab 6th, 8th and 10th grade students (age range 12-17) within the Israeli national school system (N = 12,035). Data collection for the study utilized two complementary instruments: the Childhood Trauma Questionnaire (CTQ) and the Juvenile Victimization Questionnaire (JVQ). Study results revealed that the lifetime prevalence of child maltreatment in contemporary Israeli society is within the range of estimates from other countries. However, contrary to others, Israeli boys reported higher rates of abuse, including sexual abuse, compared to girls. Additionally, Arab compared to Jewish children and youth reported higher rates of all types of abuse. The need for widely accepted, uniform definitions of the various child maltreatment types, a standardized methodology of data collection, and regularly updated national and international data bases is discussed.

Factors affecting disclosure among Israeli children in residential care due to domestic violence.

Disclosure of child abuse may enable initiating interventions to end maltreatment and mediate its negative physical and psychological consequences. The present study reviews the field of disclosure and examines factors affecting disclosure among a service population of abused children who were placed in residential care due to various forms of abuse (e.g., physical, sexual, emotional, neglect and witnessing domestic violence). The sample consisted of 286 Israeli (Hebrew and Arabic speaking) children aged 12-17 (mean=14±1). Following approval of the Ethics committee of the University and parents' written consent, participants were administered a self-report questionnaire that included the following measures: a Socio-Demographic Questionnaire, the Childhood Trauma Questionnaire (CTQ), the Juvenile Victimization Questionnaire (JVQ), and the Disclosure of Trauma Questionnaire (DTQ). Results indicated that the three key factors enhancing the likelihood of disclosure were: moral factors, external initiatives and intolerable physical pain. The three key factors inhibiting disclosure were feelings of shame, fear of losing social support and uncertainty as to how and to whom to disclose. Results also showed that children preferred to disclose to their nuclear family members (parents and siblings) in comparison with professionals.

The effects of reboxetine treatment on depression-like behavior, brain neurotrophins, and ERK expression in rats exposed to chronic mild stress.

Chronic mild stress (CMS) in rats is an established rodent depression model. Antidepressants attenuate the depression-like symptoms and prevent the biochemical changes caused by stress. In the present study, we examined the effect of CMS and the selective norepinephrine reuptake inhibitor (NRI) reboxetine (REB) treatment on behavioral parameters in rats and on hippocampal and cortical neurotrophic factors. Male Sprague Dawley rats were exposed for 5 weeks to a variety of mild stressors. REB (5 mg/kg/i.p.) was daily injected to half of the stressed and unstressed groups. Animal behavior following CMS was tested using the Morris Water Maze (MWM) cognitive paradigm and by monitoring sucrose intake and weight gain. After 5 weeks of CMS, stressed rats showed decreased sucrose intake, and REB treatment normalized this decrease. CMS reduced hippocampal brain-derived neurotrophic factor (BDNF) levels, and REB treatment reversed this alteration and increased BDNF receptor (TrkB) levels. REB elevated hippocampal extracellular signal-regulated kinase (ERK) phosphorylation of both stressed and unstressed rats. In conclusion, our study shows that BDNF, its receptor TrkB, and ERK participate in the neurobiological response to chronic stress and in the molecular and cellular activities of REB in the hippocampus.

The effects of fluoxetine treatment in a chronic mild stress rat model on depression-related behavior, brain neurotrophins and ERK expression.

Depression is associated with hippocampus (HC) volume loss. Chronic mild stress (CMS) in rats is a model of depression. Antidepressants attenuate HC volume loss and reverse the depression-like symptoms of stressed animals. We evaluated the effect of CMS and the selective serotonin reuptake inhibitor, fluoxetine (FLX) treatment on behavioral and cognitive parameters in rats, and on HC and frontal cortex (FC) neurotrophic factors levels. Male rats were exposed sequentially, over a period of 5 weeks, to a variety of mild stressors. FLX (5 mg/kg/day ip) was administered to the stressed group and controls (unstressed). After 5 of CMS, animals were tested using the Morris Water Maze (MWM). In the MWM, we observed that FLX had a transitory effect on unstressed rats. CMS reduced insulin-like growth factor-1 receptor (IGF-1R) levels in the HC whereas after FLX treatment these levels reverted to normal range. CMS rats revealed a significant decrease in extracellular signal-regulated kinase (ERK) phosphorylation in both HC and FC regions, while FLX normalized these levels. This study suggests that IGF-1R and ERK may have a role in mediating the neural stress response and the mode of action of FLX. This role seems to be independent of the BDNF alterations.

Left atrial ablation for atrial fibrillation: creating the "box lesion" with a bipolar radiofrequency device.

The maze procedure is the gold standard for the ablation of atrial fibrillation, and the "box lesion" around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins).From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around the pulmonary veins by means of a bipolar radiofrequency device. Ablation lines were created by connecting the left atriotomy to the amputated left atrial appendage, with 2 ablation lines made with a bipolar radiofrequency device above and below the pulmonary veins. Lesions were made along the transverse and oblique sinuses by epicardial and endocardial application of a bipolar device. The left atrial isthmus was ablated by bipolar radiofrequency and cryoprobe. No complications were associated with the box lesion: 90% and 89% of patients were in sinus rhythm at 3 and 6 months of follow-up, respectively.By creating a box lesion around the pulmonary veins, we expect to improve transmurality by means of epicardial and endocardial ablation of 1 rather than 2 layers of atrial wall, as in epicardial pulmonary vein isolation. Isolation of the entire posterior wall of the left atrium is better electrophysiologically and renders dissection around the pulmonary veins unnecessary.

Efficacy of surgical ablation of atrial fibrillation in patients with rheumatic heart disease.

BACKGROUND: Although atrial fibrillation (AF) ablation is efficient in many patient cohorts, its effect on rheumatic heart disease remains controversial. We describe a retrospective comparison of surgical ablation using the same technique in rheumatic versus nonrheumatic patients. METHODS: Between 2004 and 2009, we performed AF ablation as a part of another cardiac surgery in 192 patients with bipolar radiofrequency ablator and a cryoprobe. Patients were retrospectively allocated to a rheumatic heart disease group (76 patients, 40%) and a nonrheumatic heart disease group (116 patients, 60%). All demographic characteristics were similar in both groups, as well as in a number of patients with permanent and persistent AF and long-standing AF. Permanent AF was present in 37 patients (49%) and 51 patients (44%) in the rheumatic and nonrheumatic groups, respectively. Heart function and functional class were also similar, whereas more rheumatic patients had a severely enlarged left atrium (200 to 300 cc [p = 0.02]). RESULTS: There were 2 perioperative deaths. Postoperative complications were similar in both groups, with 51 rheumatic patients (67%) and 81 nonrheumatic patients (70%) in sinus rhythm at discharge. Total, mean follow-up was 16 months, after which 63 patients (83%) and 96 patients (84%) were in sinus in the rheumatic group and nonrheumatic group, respectively, of whom 72% were without antiarrhythmic medications. Ablation failure risk factors included AF duration of 10 years or longer before ablation (p < 0.05), and preoperative permanent AF (p = 0.03). CONCLUSIONS: The efficacy of AF ablation proved similar in rheumatic and nonrheumatic patients, providing preoperative AF type and duration were similar. Larger left atria in rheumatic patients did not influence ablation results.