Publications

OBJECTIVE

Since cardic fibrosis was previously found more frequently in patients with sudden unexpected death in epilepsy (SUDEP) than control cases, we compared blinded and quantitative reviews of cardiac pathology in SUDEP to multiple control groups.

METHODS

We adjudicated causes of death in epilepsy patients as part of consecutive out-of-hospital sudden cardiac deaths (SCDs) from the Postmortem Systematic Investigation of Sudden Cardiac Death (POSTSCD) study. Blinded cardiac gross and microscopic examinations were performed by forensic and cardiac pathologists.

RESULTS

Of 541 SCDs over 37 months (mean age 62.8 years, 69% male), 525 (97%) were autopsied; 25/525 (4.8%) had epilepsy (mean age 56.4 years ± 15.4, range 27-92; 67% male). The 25 epilepsy patients died of definite SUDEP/definite SUDEP-plus (n = 8), possible SUDEP (n = 10), or other causes (n = 7). Comparison groups included autopsy-defined sudden arrhythmic death (SAD; n = 285) and trauma (n = 104) and we adjusted for age, sex, HIV, coronary artery disease, congestive heart failure, and cardiomyopathy in the analyses. Compared to SAD cases, SUDEP cases had less gross and histologic evidence of cardiac pathology; significant for cardiac mass ( < 0.0011), coronary artery disease ( < 0.0024), total cardiac fibrosis (CF) ( = 0.022), and interstitial CF ( = 0.013). Compared to trauma cases, SUDEP cases had similar cardiac pathology including CF.

CONCLUSION

Among SUDEP cases, cardiac pathology was less severe than in SAD cases but similar to trauma and epilepsy controls. Our data do not support prior studies finding elevated rates of CF among SUDEP cases compared to controls. Larger studies including molecular analyses would further our understanding of cardiac changes associated with SUDEP.

In recent years we have seen a dramatic evolution of therapeutic approaches in the management of acute leukemia with hematopoietic stem cell transplantation (HCT). For both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), alloHCT provides the best chance of long-term disease-free survival for significant subsets of patients. During this interval, we have witnessed an evolution of HCT from a therapy based on high-dose conditioning to our current understanding that its success depends both on cytoreduction and graft-versus-leukemia (GVL) effects mediated by adoptively transferred donor immune cells. Improvements in conditioning, infectious disease monitoring and management, histocompatibility testing and graft selection have successively improved outcomes, primarily due to a reduction in non-relapse mortality. Unfortunately, disease relapse remains a significant cause of treatment failure in both AML and ALL. Here, two distinguished experts, Prof. Charles Craddock and Prof. Dieter Hoelzer, reflect on the significant challenge of disease relapse following allogeneic HCT for AML and ALL, respectively. This is a review of the biology, current approaches, and future directions in the field and reflects concepts that were presented at the Third International Workshop on Biology, Prevention, and Treatment of Relapse after Stem Cell Transplantation held in Hamburg, Germany in November 2016 under the auspices of the EBMT and the ASBMT.

OBJECTIVE

College students are known to experience unintended pregnancy and seek abortions. However, few student health centers currently offer abortion services. In this exploratory study, we aimed to expand understanding of student perspectives regarding on-campus abortion services.

STUDY DESIGN

We invited UC Davis students to complete an anonymous web-based survey using 16 campus listservs and in-person recruitment. We elicited student knowledge of and opinions about on-campus Student Health and Counseling Services (SHCS) with 29 questions.

RESULTS

The 502 participating students primarily identified as female (80%) and heterosexual (86%); most (90%) were undergraduates. In the past year, 9% of female respondents had used emergency contraception (EC), and 9% had sought clinic-based pregnancy testing. Only 68% of respondents were aware that SHCS provides EC. Although SHCS has not yet offered abortions, 24% of respondents believed that SHCS currently offers medication abortion and 13% believed that SHCS clinicians perform abortion procedures. Most respondents (64%) believed that SHCS should offer abortion services; 12% of respondents felt SHCS should not. Reasons for support of on-campus abortion services included the need to compassionately care for campus survivors of sexual assault and abortion's role in allowing students facing undesired pregnancy to complete their education. Reasons for opposition included concerns regarding SHCS's ability to offer high-quality abortion services, the potential for controversy related to on-campus abortion services and personal opposition to abortion.

CONCLUSION

Most responding students favor on-campus abortion services, and a number of students incorrectly believe that abortion services are currently offered on the UC Davis campus.

IMPLICATIONS

Student health centers should offer medication abortion on campus.