The Victoria Stroop Test: Normative Data in Quebec-French Adults and Elderly.

OBJECTIVE: Despite the widespread use of the Victoria Stroop Test (VST; Regard, 1981) in clinical and research settings, information regarding the impact of sociodemographic variables on test performance in Quebec-French adults and elderly people is still nonexistent. Thus, this study aimed to establish normative data for error scores and completion time on all test trials (Dot, Word, and Interference) taking into account the impact of age, education, and sex on test performance. METHOD: The sample consisted of 646 community-dwelling and healthy Quebec-French individuals aged between 47 and 87 years. RESULTS: Regression analyses indicated that age was associated with completion time and error scores on all trials. The association was also positive for low and high interference conditions. Education was associated with completion time on Word and Interference trials, and with both interference scores. Finally, sex was associated with completion time on all trials, with women being consistently faster than men. Equations to calculate Z scores and percentiles are presented. CONCLUSIONS: Norms for the VST will ease interpretation of executive functioning in Quebec-French adults and elderly and favor accurate discrimination between normal and pathological cognitive states.

Verbal irony comprehension in older adults with amnestic mild cognitive impairment.

OBJECTIVE: The present study examined verbal irony comprehension in 31 aMCI and 33 healthy control (HC) subjects. Although nonliteral language impairments have been evidenced in individuals with amnestic mild cognitive impairment (aMCI) or Alzheimer's disease (AD), verbal irony comprehension remained somewhat underinvestigated in these populations. METHOD: A task measured the capacity to attribute Second-order mental state (i.e., theory of mind; ToM) as well as the ability to distinguish an ironic statement from a lie. Subjects were asked to identify, in a short story, whether the final assertion was a lie or an ironic joke. RESULTS: Our results showed lower performance on a verbal irony comprehension task for aMCI individuals compared with those in the HC group. This pattern of results was related to Second-order ToM and executive functions. CONCLUSION: These findings have implications for the conceptualization of aMCI, and foster investigation of social language comprehension in neurodegenerative diseases such as prodromal AD. Results are discussed in light of actual linguistic theories. The importance of evaluating the role of underlying cognitive processes in verbal irony comprehension is also emphasized.

Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation.

OBJECTIVE: To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps. METHODS: Between 2002 and 2007, 10665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149 (1.4%) developed a DSWI. Negative pressure wound therapy (NPWT) followed by sternal osteosynthesis with musculocutaneous coverage was used in 92 (61.7%) patients. A retrospective review was done using a prospectively maintained database to identify risk factors for recurrent infection in this group of patients. RESULTS: Of the 92 patients who underwent sternal osteosynthesis, nine (9.8%) developed recurrent sternal infection requiring hardware removal. Univariate analysis showed that preoperative methicillin-resistant Staphylococcus aureus (MRSA) status (33.3% vs 6.1%; p=0.03) and prolonged intubation time in ICU (44.4% vs 14.6%; p<0.05) were significant risk factors. Two-thirds of these patients were also found to be infected with the same germ as the one responsible for their initial DSWI. No death was reported and sternal integrity was preserved in all patients despite plate removal. CONCLUSIONS: To lower the rate of RSI in patients treated with transverse sternal ostheosynthesis along with myocutaneous coverage for DSWI, surgeons must consider the MRSA preoperative status as a significant predictor of RSI and/or persistent infection. Chest-wall integrity in patients with RSI can be maintained after hardware removal, even after only a few weeks following initial plating.

Impact of deep sternal wound infection management with vacuum-assisted closure therapy followed by sternal osteosynthesis: a 15-year review of 23,499 sternotomies.

OBJECTIVE: This study was undertaken to examine the outcome of patients with deep sternal wound infection (DSWI) now treated with vacuum-assisted closure (VAC) therapy as a bridge to sternal osteosynthesis with horizontal titanium plate fixation. METHODS: From 1992 to 2007, a consecutive cohort of 23,499 patients underwent open-heart surgery (OHS) in our institution. The period under study was divided in two according to the use of therapeutic modalities: conventional (1992-2001, N=118 DSWI): debridement/drainage with primary closure and irrigation (N=37), debridement/drainage, open packing followed by pectoralis myocutaneous flaps (PMFs) (N=81); contemporary (2002-2007, N=149 DSWI): conventional treatment (N=24) and VAC therapy (N=125/83.8%). VAC was followed by sternal osteosynthesis with horizontal titanium plates in 92 patients (61.7%). RESULTS: DSWI was diagnosed in 267 out of 23 499 (1.1%) patients of our entire series according to Center for Disease Control - Atlanta (CDC) criteria, 118 out of 13 180 (0.9%) in the first and 149 out of 10 319 (1.4%) in the second period (p=0.001). Hospital mortality (N=267/23,499) has been 10.25% for the entire cohort under study without any difference between groups (1992-2001: 11.4%; 2002-2007: 9.1%, p=0.67). More recently, VAC therapy (N=125) was associated with a lower mortality (4.8% vs 14.1%, p=0.01). Stepwise multivariable logistic regression analysis for both periods revealed that prolonged intubation in the intensive care unit (ICU), use of bilateral internal thoracic artery grafting (BIMA), diabetes, re-operation for bleeding and body mass index (BMI) >30 kgm(-2) are the most powerful predictors of DSWI. In the more recently treated patients using VAC therapy, combined procedures (valve and graft) also emerged as a significant predictor. For the entire study, Staphylococcus epidermidis (49.6%) has been the most frequently identified pathogen, followed by Staphylococcus aureus (38.8%). Methicillin-resistant S.aureus (MRSA) was observed in 4.9% of the cohort. Neither of these bacteria was associated with increased mortality. Survival analysis with Cox regression model and propensity score adjustment in patients with DSWI showed freedom from all-cause mortality at 1, 5 and 10 years to be, respectively, 91.8%, 80.4% and 61.3% compared with 94.0%, 85.5% and 70.2%, respectively, for patients submitted to OHS without DSWI (p=0.01). Early adjusted survival for patients with DSWI treated with VAC therapy was 92.8%, 89.8% and 88.0%, respectively, at 1, 2 and 3 years, compared with 83.0%, 76.4% and 61.3%, respectively, for patients with DSWI treated without VAC (p=0.02). CONCLUSIONS: DSWI remains a major and challenging complication of OHS. VAC therapy with sternal preservation followed by delayed sternal osteosynthesis and PMF has been recently proposed as a new therapeutic strategy. Most patients treated with VAC therapy in our second group showed decreased perioperative mortality and increased short-term survival.

Involvement of N-methyl-d-aspartate (NMDA) receptors in a rat model of visceral hypersensitivity.

N-Methyl-d-aspartate (NMDA) is known to be involved in the transmission of nociceptive information. In the present study, we investigated the effect of peripheral and central NMDA receptor antagonist MK-801 in visceral hypersensitivity. In an animal model of colorectal distension (CRD), administration of both intrathecal MK-801 (1.5 nmol) and intraperitoneal MK-801 (0.15 mg/kg) completely abolished the CRD-induced visceral hypersensitivity of noxious and innocuous stimuli. Thus, the results from this experiment demonstrate the efficacy of MK-801 in blocking the visceral hypersensitivity mediated by central and peripheral mechanisms.

Role of tachykinin NK1, NK2 and NK3 receptors in the modulation of visceral hypersensitivity in the rat.

Tachykinins are known to be involved in the processing of information leading to central sensitization and nociception. Using an animal model of repetitive colorectal distensions (CRD), we investigated the effect of spinal administration of tachykinin receptor antagonists in the mediation of visceral hypersensitivity. Intrathecal administration of the NK(1) receptor antagonist RP-67,580 (6.5 nmol) and the NK(3) receptor antagonist R-820 (6.5 nmol) completely blocked the CRD-induced hyperalgesia for both noxious and innocuous stimuli. The intrathecal administration of SR-48,968, a tachykinin NK(2) receptor antagonist, did not affect the visceral pain threshold of hypersensitive animals. Thus, the results from the present experiment support the concept that tachykinins with actions at spinal NK(1) and NK(3) but not NK(2) receptor sites are involved in visceral hypersensitivity mediated by nociceptive and non-nociceptive afferent inputs.