Ambivalent attitudes toward life and death and suicide ideation among adolescents-The mediating role of depression.

BACKGROUND: Ambivalence in attitudes towards life and death are associated with suicide ideation (SI) among adolescents. However, previous research was mainly cross-sectional and did not examine through which psychopathological mechanisms (such as depression) attitudes towards life and death are associated with SI. OBJECTIVE: The current longitudinal study examined the mediating role of depression at follow-up in the association between attitudes towards life and death at baseline and SI at follow-up among at-risk adolescents referred to an outpatient psychiatric clinic. METHODS: 129 adolescents aged 10-18 years (75.2% females) with a history of suicidal thoughts and behaviors were assessed at clinic intake and 1 month follow-up (80% retention rate at follow-up). All participants completed a questionnaire assessing attitudes towards life and death and SI severity at clinic intake, and depression and SI severity at 1 month follow-up. RESULTS: While controlling for SI severity at intake, attraction towards life at baseline, rather than attraction and repulsion towards death at baseline, led to higher SI severity at follow-up, while depression at follow-up fully mediated this association. CONCLUSIONS: Attitudes towards life, as well as depression play critical roles in the development of SI among adolescents. Interventions targeting reasons for living and promoting meaning of life may be beneficial in preventing depression and SI.

Implicit or explicit self-associations with life and death? Predicting short-term self-injurious thoughts and behaviors among adolescents.

Implicit self-association with death, measured by the Death/Suicide-Implicit Association Test (D/S-IAT), predicts short-term Self-Injurious Thoughts and Behaviors (SITBs) among adolescents. However, comparing the predictive utility of the D/S-IAT with explicit (i.e. self-report) self-association with life and death was not examined previously. The current study sought to examine whether the D/S-IAT and explicit self-association with life and death predict current and prospective SITBs, and to examine the association between the two measures. One-hundred and thirty-one Jewish Israeli adolescents with SITBs, aged 10-18 years (74.8% female) were assessed at clinic intake. Participants completed D/S-IAT, depression, attitudes toward life and death and suicide risk assessment at intake and one-month follow-up. Implicit, rather than explicit, attitudes toward life and death predicted SITBs at one-month follow-up, beyond depression and past SITBs. The implicit and explicit measures were not significantly related at intake, indicating that they might capture different aspects of SITBs.

Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room.

BACKGROUND: Implicit identification with death, measured by the Death-Suicide-Implicit Association Test (D/S-IAT), has been found to predict long-term suicide risk among adolescents. However, previous studies did not examine the predictive utility of D/S-IAT on short-term suicide risk trajectories among adolescents, especially during the critical period following discharge from the emergency room (ER) due to suicide behaviors. OBJECTIVE: This study examined the ability of the D/S-IAT to discriminate and predict suicide risk trajectories during the month following initial suicide risk assessment, among adolescents recently discharged from the ER. METHODS: One hundred and fifteen adolescents aged 9-18 years (77.4% female) were assessed at clinic intake. All participants completed D/S-IAT and self-report measures for suicide risk, depression, and anxiety during intake and 1-month follow-up. RESULTS: The D/S-IAT distinguished and predicted participants with continued heightened suicide risk at follow-up, above and beyond depression, anxiety, and suicide risk level at intake. CONCLUSIONS: Along with conventional measures, D/S-IAT may be utilized to predict short-term suicide risk during post-ER discharge.

A circadian clock entrained by melatonin is ticking in the rat fetal adrenal.

The adrenal gland in the adult is a peripheral circadian clock involved in the coordination of energy intake and expenditure, required for adaptation to the external environment. During fetal life, a peripheral circadian clock is present in the nonhuman primate adrenal gland. Whether this extends to the fetal adrenal gland like the rat is unknown. Here we explored in vivo and in vitro whether the rat fetal adrenal is a peripheral circadian clock entrained by melatonin. We measured the 24-h changes in adrenal content of corticosterone and in the expression of clock genes Per-2 and Bmal-1 and of steroidogenic acute regulatory protein (StAR), Mt1 melatonin receptor, and early growth response protein 1 (Egr-1) expression. In culture, we explored whether oscillatory expression of these genes persisted during 48 h and the effect of a 4-h melatonin pulse on their expression. In vivo, the rat fetal adrenal gland showed circadian expression of Bmal-1 and Per-2 in antiphase (acrophases at 2200 and 1300 h, respectively) as well as of Mt1 and Egr-1. This was accompanied by circadian rhythms of corticosterone content and of StAR expression both peaking at 0600 h. The 24-h oscillatory expression of Bmal-1, Per-2, StAR, Mt1, and Egr-1 persisted during 48 h in culture; however, the antiphase between Per-2 and Bmal-1 was lost. The pulse of melatonin shifted the acrophases of all the genes studied and restored the antiphase between Per-2 and Bmal-1. Thus, in the rat, the fetal adrenal is a strong peripheral clock potentially amenable to regulation by maternal melatonin.

Melatonin exerts direct inhibitory actions on ACTH responses in the human adrenal gland.

In nonhuman primates and rodents, melatonin acting directly on the adrenal gland, inhibits glucocorticoid response to ACTH. In these species, an intrinsic adrenal circadian clock is involved in ACTH-stimulated glucocorticoid production. We investigated whether these findings apply to the human adrenal gland by determining i) expression of clock genes in vivo and ii) direct effects of melatonin in ACTH-stimulated adrenal explants over a) expression of the clock genes PER1 (Period 1) mRNA and BMAL1 [Brain-Muscle (ARNT)-like] protein, ACTH-induced steroidogenic acute regulatory protein (StAR), and 3ß-hydroxysteroid dehydrogenase (3ß-HSD) and b) over cortisol and progesterone production. Adrenal tissue was obtained from 6 renal cancer patients undergoing unilateral nephrectomy-adrenalectomy. Expression of the clock genes PER1, PER2, CRY2 (Cryptochrome 2), CLOCK (Circadian Locomotor Output Cycles Kaput) and BMAL1, was investigated by RT-PCR in a normal adrenal and in an adenoma. In independent experiments, explants from 4 normal adrenals were preincubated in culture medium (6 h) followed by 12 h in: medium alone; ACTH (100 nM); ACTH plus melatonin (100 nM); and melatonin alone. The explants' content of PER1 mRNA (real-time PCR) and StAR, 3ß-HSD, BMAL1 (immuno slot-blot), and their cortisol and progesterone production (RIA) were measured. The human adrenal gland expresses the clock genes PER1, PER2, CRY2, CLOCK, and BMAL1. ACTH increased PER1 mRNA, BMAL1, StAR, and 3ß-HSD protein levels, and cortisol and progesterone production. Melatonin inhibited these ACTH effects. Our study demonstrates, for the first time, direct inhibitory effects of melatonin upon several ACTH responses in the human adrenal gland.

Cryptochrome 2 expression level is critical for adrenocorticotropin stimulation of cortisol production in the capuchin monkey adrenal.

Timely production of glucocorticoid hormones in response to ACTH is essential for survival by coordinating energy intake and expenditure and acting as homeostatic regulators against stress. Adrenal cortisol response to ACTH is clock time dependent, suggesting that an intrinsic circadian oscillator in the adrenal cortex contributes to modulate the response to ACTH. Circadian clock gene expression has been reported in the adrenal cortex of several species. However, there are no reports accounting for potential involvement of adrenal clock proteins on cortisol response to ACTH. Here we explored whether the clock protein cryptochrome 2 (CRY2) knockdown modifies the adrenal response to ACTH in a primate. Adrenal gland explants from adult capuchin monkey (n = 5) were preincubated for 6 h with transfection vehicle (control) or with two different Cry2 antisense and sense probes followed by 48 h incubation in medium alone (no ACTH) or with 100 nm ACTH. Under control and sense conditions, ACTH increased cortisol production, whereas CRY2 suppression inhibited ACTH-stimulated cortisol production. Expression of the steroidogenic enzymes steroidogenic acute regulatory protein and 3beta-hydroxysteroid dehydrogenase at 48 h of incubation was increased by ACTH in control explants and suppressed by Cry2 knockdown. Additionally, we found that Cry2 knockdown decreased the expression of the clock gene brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein (Bmal1) at the mRNA and protein levels. Altogether these results strongly support that the clock protein CRY2 is involved in the mechanism by which ACTH increases the expression of steroidogenic acute regulatory protein and 3beta-hydroxysteroid dehydrogenase. Thus, adequate expression levels of components of the adrenal circadian clock are required for an appropriate cortisol response to ACTH.

Artroplastia bilateral de cadera en un tiempo quirúrgico: evaluación de complicaciones y grado de satisfacción de pacientes / Bilateral total hip arthroplasty

Objective: To assess the complication rate in bilateral total hip arthroplasty (THA) performed in one stage, and to evaluate the patient satisfaction after the surgery. Methods: We analyzed the pen-operative data from 40 patients who underwent bilateral total hip arthroplasty in one stage, between November 2002 and December 2008 in our institution. We registered the operative risk, based on the American Society of Anesthesiologists (ASA) risk score classification system, the type of anesthesia and postoperative complications. All patients completed a questionnaire by telephone regarding the level of satisfaction after the surgery. Results: Forty patients (80 THAs), 26 females and 14 males were evaluated. The average age was 50.7 years (19-76 years). Twenty-five patients (62.5 percent) had ASA 1 operative risk, 12 (30 percent ) ASA 2 and 3 patients (7.5 percent) had ASA 3. Thirty-eight (95 percent) patients received combined anesthesia and 25 patients (62.5 percent) hypotensive anesthesia. Twelve patients (30 percent) received blood transfusion during or after the surgery. The average length of stay was 7.8 days. One patient (2.5 percent) had an intraoperative incomplete calcar fracture and another patient (2.5 percent) had local wound infection. No other complications were reported. Thirty-nine (97.5 percent) patients answered the telephonic questionnaire on July 2009, after a mean follow up of 33.6 months (6-78 months). Thirty-eight (97.4 percent) of them were very satisfied after the surgery. Conclusion: A bilateral total hip arthroplasty performed in one stage is a controlled low risk procedure in ASA 1 and 2 patients, with a high level of patient satisfaction after a short term follow up.

Objetivo: Evaluar la incidencia de complicaciones al realizar una artroplastia bilateral de cadera en un tiempo quirúrgico. Evaluar además el grado de satisfacción de los pacientes a corto plazo. Métodos: Análisis retrospectivo de 40 pacientes (26 mujeres, 14 hombres, edad promedio 50,7 años) operados de una artroplastia bilateral de cadera en un tiempo quirúrgico entre noviembre de 2002 y diciembre de 2008. Se revisaron los protocolos operatorios, las fichas clínicas realizándose además una encuesta telefónica para evaluar grado de satisfacción de los pacientes operados. Resultados: De los 40 pacientes, en relación al riesgo quirúrgico 25 pacientes (62,5 por ciento) correspondieron a ASA 1, 12 (30 por ciento) a ASA 2y3 (7,5 por ciento) a ASA 3. Veinticinco pacientes (62,5 por ciento) recibieron anestesia hipotensiva. Doce pacientes (30 por ciento) requirieron transfusión de glóbulos rojos durante la cirugía o en el postoperatorio. El tiempo de estadía hospitalaria fue de promedio 7,8 días. Un paciente (2,5 por ciento) presentó como complicación intraoperatoria una fractura incompleta del calcar y 1 (2,5 por ciento) como complicación local una infección superficial de herida operatoria. Ninguno presentó alguna complicación sistémica. Treinta y nueve pacientes se contactaron vía telefónica en junio de 2009 (tiempo de evolución 6-78 meses), 38 de estos (97,4 por ciento) manifestaron una alta satisfacción con la cirugía. Conclusión: La artroplastia bilateral de cadera en un tiempo quirúrgico es un procedimiento de bajo riesgo en pacientes seleccionados (ASA 1 y 2) y con un alto grado de satisfacción por parte de éstos a corto plazo.

[Trends of etiology of acute bacterial meningitis in Chilean children from 1989 to 1998. Impact of the anti-H influenzae type b vaccine]. / Tendencias en la etiología de la meningitis bacteriana aguda en niños chilenos, período 1989-1998. Impacto de la vacuna anti-H influenzae tipo b (Hib).

BACKGROUND: Acute bacterial meningitis still has a high mortality and rate of complications. AIM: To assess the impact of anti H influenzae vaccination on the epidemiology of acute bacterial meningitis in Chilean children. MATERIAL AND METHODS: A retrospective study of hospital discharge records of patients with acute bacterial meningitis. Causative agents were studied globally, by hospital and by age group. The changes in etiology from 1989 to 1995 were also assessed. Between 1996 and 1998, only those patients with acute bacterial meningitis caused by H influenzae were recollected. RESULTS: In the period prior to vaccination (1989-1995), 1000 cases were registered. The main causative agents were N meningitidis in 33.8%, H influenzae type b in 21.9% and S pneumoniae in 15.4%. The incidence of H influenzae decreased in the period from 36.4 to 9.9% (p < 0.001) and the incidence of N meningitidis increased from 22.9 to 52.1% (p < 0.001). The incidence of S pneumoniae did not change significantly. H influenzae predominated in children between 4 and 24 months of age and N meningitidis predominated in children over 25 months of age. In the period after the introduction of vaccination (1995-1998), there was a further decrease in the incidence of H influenzae from 10 to 2% (p < 0.001). Until 1997, there was a considerable increase in the incidence of N meningitidis, specially in children over 25 months of age. It declined in 1998 to 38%. CONCLUSIONS: There was a reduction in the incidence of acute bacterial meningitis caused by H influenzae prior to the introduction of the vaccine against H influenzae type b. The decrease was more pronounced after the introduction of the vaccine.

[Calcified bladder squamous carcinoma: radiologic considerations]. / Carcinoma escamoso vesical calcificado: consideraciones radiológicas.

OBJECTIVE: To report a case of squamous cell carcinoma of the bladder, an uncommon tumor type, that presented with wide calcified areas. The literature on calcified bladder tumors is reviewed with special reference to the diagnostic aspects. METHODS/RESULTS: The plain film, US and CT findings are presented. All the diagnostic imaging techniques demonstrated calcifications on the tumor surface and the characteristic curvilinear shape of this lesion. CONCLUSIONS: Calcified bladder carcinoma is rare and occurs in only 0.5% of the cases evaluated by conventional radiology. All calcifications probably arising in the bladder detected on conventional radiological evaluation should be studied further with other imaging techniques. If its etiology is unclear, cystoscopy with biopsy and/or a microbiological study should be performed.

Traffic and seasonal dependence of the light absorption coefficient in santiago de chile.

We have designed and built a compact, low-cost automated system to measure the optical absorption coefficient of air. Because most of the light absorption is due to black carbon, this method is a direct measure of the amount of black carbon in the atmosphere. The equipment was used to measure absorption over a period of one year in a central area of Santiago. Our results show a strong correlation with the daily traffic pattern. The highest value of the absorption coefficient during most of the year occurs during the morning rush hour (0700-0800), and the lowest value either early in the morning (0300-0500) or in the afternoon (1400-1700). The absorption coefficient also shows a strong dependence with the season of the year, with values 10-20 times higher in winter than in summer. The data show that, during most of the year, the amount of black carbon present in the atmosphere is due to traffic. At night, during winter, the high concentration of black carbon is due to the temperature inversion effect.

Diurnal changes in light intensity inside the pregnant uterus in sheep.

Penetration of light into the pregnant sheep uterus was studied in 9 ewes, gestational ages 40 to 142 days (term 147 days). Light sensors were placed inside the pregnant horn and over the flank skin overlying the position of the uterine horn. To perform the experiments, the ewes were placed in a study cage outdoors and light sensors were connected to a luxometer. Simultaneous measurements were obtained from the intrauterine and the external sensors in the shade at noon. The amount of light detected inside the uterus increased with gestational age from two lux at 40 days to 51.1 +/- 16.5 (n = 5) lux at 142 days (0.2 and 5.4% of the amount of light detected at the maternal flank). Measurements through the 24 h were done in four pregnant ewes at 142 days gestation under natural photoperiod (13.5 light:10.5 dark). In these experiments, the intensity of intrauterine light changed through the 24 h, reflecting the changes in the intensity of the sunlight. Maximal intrauterine light values were observed at noon, corresponding to 4.7% of incident light. Small but detectable values were observed at 0900 and 1800 h. Our data show that, at mid gestation, light reaches the pregnant uterus and that, at late gestation, changes in intrauterine lighting throughout the 24 h are present reflecting the changes in external daylight. Therefore the sheep fetus is exposed to light-dark transitions at dawn and dusk, and to a peak of light at midday.

[CT in Fournier's gangrene]. / T.C. en la gangrena de Fournier.

OBJECTIVE: To analyze the information provided by computed tomography (CT) in Fournier's gangrene, particularly in regard to the early diagnosis of the disease, and its utility as a complementary diagnostic imaging technique. METHODS: A retrospective study identified five cases of Fournier's gangrene. These patients had been evaluated by CT at least twice. The radiological, clinical and epidemiological aspects are analyzed. RESULTS: Fournier's gangrene was diagnosed in one patient with no clinical suspicion of this disease. Gas was demonstrated in the scrotal region in five patients and in the perineal region in four patients. The abdominal wall was the most frequent extragenito-perineal location. A good correlation was found between the CT and surgical findings in all cases. CONCLUSION: CT evaluation prior to surgery is recommended in patients with Fournier's gangrene, particularly in order to determine the extent of the disease.

Reflujo gastroesofágico en niños y adultos familiares / Gastroesophageal reflux in children and adults

Se comunican los resultados de un estudio transversal de un grupo de 805 niños y 672 adultos, en el que se demuestra que la proporción de casos con reflujo gastroesofágico es semejante en niños y adultos. Se hacen consideraciones sobre estudios futuros

Nicotinic and muscarinic components in acetylcholine stimulation of porcine adrenal medullary cells.

Adrenal medullary chromaffin cells secrete catecholamines (CA) in response to cholinergic receptor activation by acetylcholine (ACh) released from splacnic nerve terminals. In cultured bovine chromaffin cells nicotinic receptors play a preponderant (> 90%) role in the control of CA release. By contrast, we found and report here that up to 40% of the ACh-evoked CA secretion from cultured porcine chromaffin cells can be associated with muscarinic receptor activation. The following results support our belief that in porcine adrenal medullary cells ACh (100 microM) evoked CA secretion is mediated by both nicotinic and muscarinic cholinergic receptors. 1) Hexamethonium (100 microM), a nicotinic receptor antagonist, inhibited ACh-induced CA secretion to ca. 40% of the control release and atropine (1 microM), a muscarinic receptor antagonist, inhibited to ca. 60% of the control value. 2) We also found that ACh (100 microM) evoked intracellular Ca2+ concentration ([Ca2+]i) rise was inhibited by these receptor antagonists to a different extent, and reversibly reduced by lowering the concentration of Ca2+ in the external medium ([Ca2+]o). This last maneuver ([Ca2+]o < 0.1 microM) per se caused a marked reduction in the peak phase of the [Ca2+]i rise evoked by ACh (40% of the control response). Switching the external medium back to physiologic [Ca2+]o in the continued presence of ACh caused a partial recovery of the elevated [Ca2+]i. This [Ca2+]o-dependent [Ca2+]i rise was blocked by hexamethonium (100 microM) but not by atropine (1 microM). Conversely, the ACh-evoked [Ca2+]i rise in low external [Ca2+]o was blocked by atropine but not by hexamethonium. From these data we conclude that in porcine adrenal medullary cells an important fraction (ca. 0.4) of both ACh-induced CA secretion and peak [Ca2+]i rise is due to muscarinic receptor activation.

Reflujo gastroesofágico. Presentación de casos clínicos con complicaciones / Gastroesophageal reflux. Report of clinical cases with complications

Se presentan cuatro casos de reflujo gastroesofágico (RGE) que sufrieron complicaciones detectadas a distintas edades: un lactante menor presentó bronconeumonía por aspiración; otro, tuvo dolor abdominal recurrente; un niño de 10 años presento estenosis esofágica de aparición rápida; un adulto de 25 años sufrió laringitis crónica debida a RGE. Se hacen consideraciones acerca de estas compliaciones; sobre la necesidad de la vigilancia clínica de todo niño con RGE; sobre la utilidad de un registro escrito con el diagnóstico y las medidas preventivas que deben tomarse, para documentarse en cualquier padecimiento que presente en su vida

[Indicators of atherosclerosis risk. Evaluation with coronary angiography in non diabetic men with total cholesterol levels equal to or below 240 mg/dl]. / Indicadores de riesgo de ateroesclerosis. Evaluación mediante coronariografía en hombres no diabéticos con colesterol total igual o menor a 240 mg/dl.

We studied 90 male non diabetic patients aged between 40 and 65 years old with a total cholesterol of less than 240 mg/dl and not receiving cholesterol reducing drugs, that were subjected to elective coronary arteriography. Weight, height, blood pressure and smoking habits were recorded and a fasting blood sample was drawn to measure total and HDL cholesterol, triglycerides, apoproteins A1 and B, Lipoprotein(a) and plasma cholesteryl ester transfer activity. Arteriography disclosed coronary lesions in 54 patients. Compared to patients without lesions, the former had lower HDL cholesterol (34 +/- 9.8 vs 40.2 +/- 11.6 mg/dl) and higher total cholesterol/HDL cholesterol and apoB/apoA1 ratios. No differences were found for lipoprotein(a) and plasma cholesteryl ester transfer activity. Univariate analysis showed that low HDL cholesterol had the best predictive capacity for atherosclerosis.

[Triple ureter in crossed renal ectopy: an embryologic rarity]. / Triplicidad ureteral en la ectopia renal cruzada: una rareza embriológica.

Presentation of one case of CRE (crossed renale ectopia) with triplicity (trifidity) of the ortho and ectopic collector systems, due to the existence in both cases of pyelourethral bifidity and a third cranial blind ureter. This case represents a casual finding during a routine study of a female patient with orthostatic and exertion urinary incontinence (EUI). The case idiosyncrasies, which initially elicited the possibility of urethral ectopia, are analyzed. Incidence and variants of this unusual congenital anomaly are commented upon.

[Uterovaginal duplication with right hematocolpos caused by imperforate septum and ipsilateral renal agenesia: report of a case diagnosed using non-invasive methods]. / Duplicidad ureterovaginal con hematocolpos derecho por septo imperforado y agenesia renal ipsilateral: aportación de un caso diagnosticado por métodos no invasivos.

Case report of a pubertal female patient with clinical signs of hypogastric pain initiated with the menarche, dysmenorrhoea and a palpable pelvic mass. The suspected clinical signs, ultrasound scans, urographies and CAT, confirmed the existence of an uterovaginal duplicity with right hematocolpos due to imperforate septum and pool of menstrual blood, as well as ipsilateral renal agenesis. The vagina examination and resection of the septum under sedation solved the case.

Comparative subcellular distribution of apyrase from animal and plant sources. Characterization of microsomal apyrase.

1. Apyrase (ATP: diphosphohydrolase) has been found in the microsomal fraction of rat salivary gland, mammary gland and uterus. 2. This enzyme, already described in plant tissue, is mainly present as a soluble polypeptide in tubers of Solanum tuberosum. 3. A fraction of this enzyme is associated with the microsomal fraction with a higher specific activity than the soluble one, for either ATP or ADP as substrate. 4. Apyrase bound to microsomes from rat and potato tissues was characterized in its substrate specificity and effect of inhibitors. 5. The Km values for ATP and ADP, optimum pH and metal ion requirement were determined. 6. A characteristic common to the microsomal and soluble apyrases is the stimulatory effect of a potato activator protein of soluble plant apyrase. 7. The microsomal-bound apyrase from rat and potato tissues were solubilized and subjected to size-exclusion chromatography. 8. The mammary gland and salivary gland apyrases eluted as molecular aggregates, in contrast to the uterus and potato enzyme.