Longitudinal associations between hair cortisol, PTSD symptoms, and sleep disturbances in a sample of firefighters with duty-related trauma exposure.

Several studies have found evidence of altered cortisol levels in patients with posttraumatic stress disorder (PTSD). Based on these findings, it is assumed that these patients may show signs of cortisol dysregulation after trauma. Posttrauma cortisol levels are thus considered a potential biomarker of PTSD. However, longitudinal studies using indicators of long-term cortisol secretion such as hair cortisol concentrations (HCC) are scarce. The current study investigated prospective associations between HCC and PTSD symptoms in a sample of Dutch firefighters taking into account varying levels of work-related trauma severity. In addition, we assessed posttraumatic sleep disturbances as a secondary outcome measure to investigate whether effects generalize to this frequent comorbidity of PTSD. Three hundred seventy-one Dutch firefighters with a mean of 14.01 years of work experience were included in the analyses. Baseline assessment included the collection of hair samples and the measurement of work-related trauma severity, PTSD symptoms, and sleep disturbances. PTSD symptoms and sleep disturbance were re-assessed after six and twelve months. Multilevel analyses indicate a significant positive correlation between HCC and baseline PTSD symptoms in those with average or above-average work-related trauma severity. A similar pattern was evident for posttraumatic sleep disturbances at baseline. Moreover, higher HCC predicted more posttraumatic sleep disturbances after 6 months in participants with above-average work-related trauma severity. No other associations emerged for PTSD symptoms or posttraumatic sleep disturbances at six or twelve months. As such, our study supports the existence of a cross-sectional association between HCC and trauma symptoms, which may vary for different levels of subjective trauma severity. The longitudinal stability of this association should be reinvestigated by future research.

Wakefulness impairs selective consolidation of relevant trauma-associated memories resulting in more frequent intrusions.

Recent studies show that sleep reduces intrusive memories after analog trauma. This effect is assumed to be caused by sleep's impact on memory consolidation. However, the underlying processes of this phenomenon have not been uncovered. Thus, the current study investigates the hypothesis that sleep reduces intrusive memories by supporting the selective consolidation of relevant memories. Seventy-five participants were exposed to traumatic picture stories before nocturnal sleep or wakefulness during daytime. Memory for relevant and irrelevant trauma-associated stimuli was assessed prior to and after the retention period. Consistent with the hypothesis, results demonstrate reduced memory loss for relevant as opposed to irrelevant trauma-associated stimuli after sleep but not after wakefulness. Moreover, an incremental retention benefit for relevant trauma-associated stimuli was negatively correlated with the number of intrusive trauma memories after wakefulness. These results suggest that lack of sleep impairs selective gating of relevant trauma-associated memories, thereby enhancing intrusion development after trauma.

Evaluation of established and new reference lines for the standardization of transperineal ultrasound.

OBJECTIVES: To examine the performance of a new reference line for the assessment of pelvic organ descent by transperineal ultrasound. METHODS: We compared our newly proposed reference line, between two hyperechoic contours of the symphysis pubis (Line 3), with the horizontal reference line proposed by Dietz and Wilson (Line 1) and the central pubic line proposed by Schaer et al. (Line 2). Ultrasound volumes of 94 women obtained in routine clinical practice were analyzed. The perpendicular distance from the reference lines to the internal sphincter and the most dependent part of the bladder base was measured for volumes obtained at rest, on pelvic floor muscle contraction, on Valsalva maneuver and during coughing. Measurements were repeated 4 months later by the same examiner. Rates of assessment were calculated, and intrarater reliability was evaluated using Bland-Altman plots and intraclass correlation coefficients. RESULTS: Line 2 had to be excluded from reliability analysis because of an assessment rate of only 12%, whereas Lines 1 and 3 could be assessed in 100% of volumes. The intrarater repeatability of Lines 1 and 3 was shown to be very similar. CONCLUSION: In this comparison of three potential reference lines for the assessment of pelvic organ descent by transperineal ultrasound, the central pubic line was shown to be inferior owing to poor visibility in our volumes. Inter-rater reliability analysis and validation studies are required to confirm our results.

[Perineal ultrasound for diagnostics of male stress incontinence: comparative study on the application of urogynecological standards for men and women]. / Die Perinealsonographie zur Diagnostik der männlichen Belastungsinkontinenz : Eine Vergleichsstudie zur Anwendbarkeit von urogynäkologischen Standards bei Mann und Frau.

BACKGROUND: The diagnostic options for persistent urinary incontinence following prostatectomy are limited despite incidence numbers of up to 40%. Perineal ultrasound, which is already well established in urogynecology to quantify urethral mobility, can also be used for the diagnostics of incontinence in men. The present study investigated whether there is a difference in reproducibility concerning the quantification of urethral mobility between men and women. MATERIAL AND METHODS: A total of 27 men and 27 women aged 65-85 years participated in the study. All underwent perineal ultrasound examination following standardized criteria under the three conditions of rest, contraction and a Valsalva maneuvre. Ultrasound images were taken under each condition and given to two independent examiners for evaluation. For all conditions it was recorded which of the three reference points for the quantification of urethral mobility, the urethra, internal urethral meatus and the base of the urinary bladder, could be assessed. The results were compared by means of a coefficient of agreement (p0) and the difference of the results between the two groups was validated for statistical significance using Student's t-test. RESULTS: At a t-value of 1.58 (p=0.154) there were no significant differences in the reproducibility in visualizing the three sonographic reference points, the urethra, internal urethral meatus and the base of the urinary bladder, between men and women. CONCLUSIONS: Using perineal ultrasound for quantification of urethral mobility in the diagnostics of incontinence in men after prostatectomy is just as reproducible in men as in women. For both sexes the technique is comfortable and pain-free due to the non-invasive nature. Perineal ultrasound is a cheap, non-invasive and reproducible diagnostic procedure which can be recommended for the evaluation of incontinence and the selection of a suitable surgical procedure also in men.

[Using contrast inversion to extend the diagnostic value of perineal ultrasound for urethral and paraurethral pathologies]. / Die Kontrastumkehr als Methode zur Optimierung der perinealen Ultraschalldiagnostik bei urethralen und paraurethralen Pathologien.

PURPOSE: The aim of our study was to show how using contrast inversion extends the diagnostic value of perineal ultrasound, in particular with regard to paraurethral pathologies. MATERIALS AND METHODS: To assess the practical value of contrast inversion in the daily routine, 42 women with urinary incontinence underwent perineal ultrasound examination. Pictures were converted to contrast inversion and then checked for the visibility of sonographic reference points for urogynecological measurements (urethra, meatus urethrae internus, vesical base) by two independent evaluators both in B-mode and contrast inversion. Visibility was compared using a coefficient of agreement. The results were then tested for significance. In addition, in our clinical routine we detected several paraurethral pathologies (e. g. paraurethral abscess, glandula paraurethralis, urethral diverticulum), each being presented in B-mode and contrast inversion. RESULTS: There was no significant difference between contrast inversion and B-mode with regard to the reproducibility of visibility of the three sonographic reference points. Contrast inversion was superior for depicting paraurethral pathologies and postoperative anatomical findings. CONCLUSION: With respect to routine evaluation, the two modes do not reveal any significant difference. For the sonographic evaluation of paraurethral pathologies, contrast inversion provides better contour sharpness than B-mode, suggesting a higher diagnostic value for ambiguous anatomical settings. The nature of contrast inversion nevertheless facilitates misinterpretations and requires frequent comparison with B-mode pictures. In conclusion, we propose contrast inversion as an initial screen and a refinement to established diagnostic methods, such as MRI and voiding cysturethrography, not as their substitute.

Prevalence of bovine leukemia virus infection in Florida.

A serologic study was undertaken to determine the prevalence of bovine leukemia virus (BLV) infection in dairy and beef cattle in Florida. Using the agar gel immunodiffusion test with a glycoprotein antigen 47.8% of 7,768 dairy cattle and 6.7% of 4,911 beef cattle were found to have antibodies to BLV. The prevalence of BLV antibodies increased significantly (P less than 0.0001) with increasing age. After data were adjusted for age, prevalence of BLV antibodies was significantly associated with dairy breed (P less than 0.05) but not with species (Bos taurus and B indicus) or sex.

Serologic survey for Toxoplasma gondii in wild animals in Florida.

Blood samples were collected for serum separation from 114 species of wild animals (25 species of mammals, 82 species of birds, and 7 species of reptiles) in Florida. Each of the 3,471 samples was tested for antibodies to Toxoplasma gondii, using the indirect hemagglutination test. The highest prevalences of T gondii antibodies were 19% in armadillos (Dasypus novemcinctus), 18% in raccoons (Procyon lotor), 13% in black rats (Rattus rattus), and 11% in opossums (Didelphis marsupialis). Antibody prevalences were significantly higher in male than in female raccoons (P less than 0.05) and in adult than in nonadult raccoons and opossums (P less than 0.005). A high proportion of seropositive animals was found in three other mammalian species: 4 of 4 black bears (Ursus americanus), 2 of 3 bobcats (Lynx rufus), and 2 of 8 Norway rats (Rattus norvegicus) tested. Antibodies were found in 8 of the 1,279 avian serums; they were not found in any of the 13 reptilian serums tested. There were no significant geographic variations in antibody prevalence in any species.