The synergetic effect of childhood trauma and recent stressful events in psychosis: associated neurocognitive dysfunction.

BACKGROUND: A higher incidence of childhood trauma (CT) has been reported in first episode of psychosis (FEP). There is, however, a lack of knowledge about the synergetic effect between CT and recent stressful events (RSE). METHODS: Information on specific types of CT (under 17 years) and RSE (within the past 3 years) was available for 290 FEP patients and 52 healthy controls (HC). Cognitive function at baseline was assessed through a comprehensive neuropsychological test battery. RESULTS: While 45.2% of FEP patients and 25% of HC reported at least one CT event, 62.7% of FEP and 21.2% of HC reported an RSE. Meanwhile, 36.2% of FEP patients and 9.6% of HC encountered both childhood and recent stressful events. The patients that just reported CT showed normality in all but the verbal memory cognitive domain; those with additive CT and RSE presented worse general cognitive function, specifically on working memory, processing speed, and executive function. RSE and general cognitive dysfunction were significant determinants of psychosis onset. CONCLUSIONS: These results support a synergetic influence of trauma and stressful events on brain function and allow a better understanding of mediators for psychotic disorders useful in the design of specific strategies based on stress-targeted therapies.

Stopping cannabis use benefits outcome in psychosis: findings from 10-year follow-up study in the PAFIP-cohort.

OBJECTIVE: To examine the long-term (up to 10 years) patterns related to cannabis use in a sample of patients with first episode of psychosis (FEP) and the effect that consumption might have on clinical, functioning, and neurocognition at long-term. METHODS: Cannabis use was described in 209 FEP patients. Patients were divided into three groups according to cannabis use: persistent users, ex-users, and never-users. Groups were longitudinally (baseline and 10-year follow-up) compared on clinical, functional, and cognitive variables. RESULTS: Clinical differences at 10-year follow-up were observed between persistent cannabis users and the other two groups (ex-users and never-users), showing persistent users more severe symptoms (BPRS: x2  = 15.583, P ≤ 0.001; SAPS: x2  = 12.386, P = 0.002) and poorer functionality (DAS: x2  = 6.067, P = 0.048; GAF: x2  = 6.635, P = 0.033). Patients who stopped cannabis use prior to the reassessment showed a similar pattern to those who had never consumed. CONCLUSION: The use of cannabis could negatively affect the evolution of the psychotic disorder. Perhaps the negative effects caused by cannabis use could be reversed with the cessation of consumption. It is necessary to make an effort in the intervention toward an early withdrawal from the use of cannabis, since this could play an important role in the prognosis of the disease.

Effects of advanced carbohydrate counting guided by an automated bolus calculator in Type 1 diabetes mellitus (StenoABC): a 12-month, randomized clinical trial.

AIMS: To test whether concomitant use of an automated bolus calculator for people with Type 1 diabetes carrying out advanced carbohydrate counting would induce further improvements in metabolic control. METHODS: We conducted a 12-month, randomized, parallel-group, open-label, single-centre, investigator-initiated clinical study. We enrolled advanced carbohydrate counting-naïve adults with Type 1 diabetes and HbA1c levels 64-100 mmol/mol (8.0-11.3%), who were receiving multiple daily insulin injection therapy. In a 1:1-ratio, participants were randomized to receive training in either advanced carbohydrate counting using mental calculations (MC group) or advanced carbohydrate counting using an automated bolus calculator (ABC group) during a 3.5-h group training course. For 12 months after training, participants attended a specialized diabetes centre quarterly. The primary outcome was change in HbA1c from baseline to 12 months. RESULTS: Between August 2012 and September 2013, 168 participants (96 men and 72 women) were recruited and randomly assigned to the MC group (n = 84) and the ABC group (n = 84). Drop-out rates were 23.8 and 21.4%, respectively (P = 0.712); 130 participants completed the study. The baseline HbA1c was 75 ± 9 mmol/mol (9.0 ± 0.8%) in the MC group and 74 ± 8 mmol/mol (8.9 ± 0.7%) in the ABC group. At 12 months, change in HbA1c was significant within both groups: MC group: -2 mmol/mol (95% CI -4 to -1) or -0.2% (95% CI -0.4 to -0.1; P = 0.017) and ABC group: -5 mmol/mol (95% CI -6 to -3) or -0.5% (95% CI -0.6 to -0.3; P < 0.0001), but HbA1c reductions were significantly greater in the ABC group (P = 0.033). No episodes of severe hypoglycaemia were reported. CONCLUSIONS: People with Type 1 diabetes initiating advanced carbohydrate counting obtained significantly greater HbA1c reductions when guided by an automated bolus calculator (NCT02084498).

Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture.

It is unknown whether the bone bruise that occurs in connection with acute anterior cruciate ligament (ACL) rupture is causing pain and dysfunction. We followed prospectively 17 patients [10 men, seven women, mean age 28 years (range 23-34)] with acute ACL rupture for 2 months. A magnetic resonance imaging (MRI) scan was performed shortly after the injury, and at 2 weeks, 1 month and 2 months. The patients reported the level of pain every day and filled in a Knee injury and Osteoarthritis Outcome Score sheet in connection with MRI. For every MRI of the knee, volume of bone bruise was calculated, and intensity was visually graded. Our study showed a reduction of the pain to 50% approximately 2 weeks after the injury, at which time the bone bruise was at maximum. There was a significant relationship between pain and the volume and intensity of the bone bruise in the medial tibia condyle, as well as pain and the bone bruise volume of the lateral femoral condyle. Patients with bone bruise of the medial tibia and patients with meniscal lesions had more pain. It is suggested that pain and decreased function after acute ACL injury most likely is related to soft tissue and cartilage injury and not to bone bruise.

Effects of aging on human skeletal muscle after immobilization and retraining.

Inactivity is a recognized compounding factor in sarcopenia and muscle weakness in old age. However, while the negative effects of unloading on skeletal muscle in young individuals are well elucidated, only little is known about the consequence of immobilization and the regenerative capacity in elderly individuals. Thus the aim of this study was to examine the effect of aging on changes in muscle contractile properties, specific force, and muscle mass characteristics in 9 old (61-74 yr) and 11 young men (21-27 yr) after 2 wk of immobilization and 4 wk of retraining. Both young and old experienced decreases in maximal muscle strength, resting twitch peak torque and twitch rate of force development, quadriceps muscle volume, pennation angle, and specific force after 2 wk of immobilization (P < 0.05). The decline in quadriceps volume and pennation angle was smaller in old compared with young (P < 0.05). In contrast, only old men experienced a decrease in quadriceps activation. After retraining, both young and old regained their initial muscle strength, but old had smaller gains in quadriceps volume compared with young, and pennation angle increased in young only (P < 0.05). The present study is the first to demonstrate that aging alters the neuromuscular response to short-term disuse and recovery in humans. Notably, immobilization had a greater impact on neuronal motor function in old individuals, while young individuals were more affected at the muscle level. In addition, old individuals showed an attenuated response to retraining after immobilization compared with young individuals.

Traumatic knee extension deficit (the locked knee): can MRI reduce the need for arthroscopy?

In the present study we investigated the validity of magnetic resonance imaging (MRI) and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluated whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. The study consisted of 50 patients who had an acute, traumatic extension deficit of the knee. All patients were submitted to MRI prior to arthroscopy. Following MRI and surgery, standardized forms were filled out, attempting to objectify the findings. The orthopaedic surgeon was not aware of the MRI result prior to surgery. Evaluating MRI, all grade-3 meniscal lesions were considered able to cause a mechanical block as well as acute partial or total anterior cruciate ligament (ACL)-ruptures. ACL-ruptures with an old appearance were not considered able to cause locking. Assuming that arthroscopy was the gold standard, the following results were calculated for the overall appearance of a lesion able to cause locking: Positive predictive value = 0.85, negative predictive value = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (one bucket-handle lesion and one pathological synovial plica). MRI of the knee with acute, traumatic extension deficit is in the acute or subacute phase a safe method to identify the patients that have a mechanical reason for locking and therefore can benefit from arthroscopic treatment.

Long-term computed tomography follow-up after open surgical repair of abdominal aortic aneurysms.

PURPOSE: To describe the findings on computed tomography (CT) of the aortic sac (AS) in patients operated on for abdominal aortic aneurysm (AAA) with insertion of a coated Dacron prosthesis. MATERIAL AND METHODS: A prospective study of 36 consecutive patients operated on for AAA over 2 years and followed longitudinally with CT for up to 10 years. RESULTS: All patients had a fluid-filled AS on CT 7-10 days postoperatively. At 6 months, the AS had decreased in most patients, mainly in the antero-posterior diameter, and in two had disappeared completely. In five patients with complications, the AS increased in size. The AS disappeared completely at 10 years' follow-up in 13 patients. When present, a retroperitoneal hematoma always disappeared after 6 months. CONCLUSION: These data indicate that the AS after graft implantation will diminish gradually but will persist for at least 6 months. Usually the transverse diameter is bigger than the antero-posterior diameter. If the AS enlarges and becomes rounded and distended with an inhomogeneous interior, it might be a sign of graft infection. In these cases an ultrasound-guided or CT-guided puncture is recommended.

Load-displacement properties of the human triceps surae aponeurosis and tendon in runners and non-runners.

The load-displacement and stress-strain characteristics of the human triceps surae tendon and aponeurosis, in vivo, was examined during graded maximal voluntary plantarflexion efforts in runners who trained 80 km/ week or more and age-matched non-runners. Synchronous real-time ultrasonography of triceps surae tendon and aponeurosis displacement, electromyography of the gastrocnemius, soleus and dorsiflexor muscles, and joint angular rotation were obtained. Tendon cross-sectional area and ankle joint moment arm were obtained from magnetic resonance imaging. Tensile tendon force was calculated from the joint moments and tendon moment arm and stress was obtained by dividing force by cross-sectional area. Strain was obtained from the displacements normalized to tendon length. Antagonist coactivation and small amounts of ankle joint rotation significantly affected tensile tendon force and aponeurosis and tendon displacement, respectively (P < 0.01). Plantarflexion moment was similar in runners (138 +/- 27 Nm, mean +/- SEM) and non-runners (142 +/- 17 Nm). Tendon moment arm was alike in non-runner (58.3 +/- 0.2 mm) and runners (55.1 +/- 0.1 mm). Similarly, there was no difference in tendon tensile force between runners (2633 +/- 465 N) and non-runners (2556 +/- 401 N). The cross-sectional area of the Achilles tendon was larger in runners (95 +/- 3 mm2) than non-runners (73 +/- 3 mm(2)) (P < 0.01). The load-deformation data yielded similar stiffness (runners 306 +/- 61 N/mm, non-runners 319 +/- 42 N/mm). The maximal strain and stress was 4.9 +/- 0.8% and 38.2 +/- 9.8 MPa in non-runners and 4.1 +/- 0.8% and 26.3 +/- 5.1 MPa in runners. The larger tendon cross-sectional area in trained runners suggests that chronic exposure to repetitive loading has resulted in a tissue adaptation.

Triplex US in the diagnosis of asymptomatic deep venous thrombosis.

PURPOSE: To evaluate the accuracy of triplex ultrasound (TUS) compared with venography as a screening test for deep venous thrombosis (DVT), and to evaluate interobserver variation in the interpretation of the venographic studies. MATERIAL AND METHODS: A total of 133 postoperative hip fracture patients, asymptomatic of DVT, were prospectively examined with TUS and venography. All venograms were reviewed blindly and in case of disagreement a consensus was arrived at. RESULTS: The incidence of DVT was 20%, with isolated calf vein thrombi in 63% of the cases. There were 7 false-negative and one false-positive result/s at TUS, with a sensitivity of 74%, specificity of 99% and accuracy of 97%. The kappa values ranged from 0.58 to 0.82. The false-negative results were all caused by missed calf vein thrombi in technically inadequate examinations. At sonography 2% of vein segments were noninterpretable, compared to 29% at venography. CONCLUSION: Venous US is less sensitive as a test for DVT in this study of asymptomatic patients than in earlier studies on symptomatic patients. Still, sonographic screening of high-risk patients would be both effective and cost effective. Fresh thrombi may cause a false-negative compression test.

[Are low back pain and radiological changes during puberty risk factors for low back pain in adult age? A 25-year prospective cohort study of 640 school children]. / Giver laendesmerter og radiologiske forandringer i puberteten risikofaktorer for senere laendesmerter? En 25 års prospektiv kohorteundersøgelse af 640 skoleelever.

Recent reports have stated that low back pain (LBP) among children is a common problem comparable with that in adults. This 25-year prospective cohort study confirms that 11% of the cohort have had a history of LBP in adolescence with an 84% lifetime prevalence of LBP in these subjects as adults compared with 70% in the rest of the cohort. LBP was associated with increased morbidity and decreased working capacity. Thirteen percent of the cohort had radiological abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to LBP in this period. Unlike other reports our results did not show any association between X-ray changes in the lower spine in adolescents and a higher prevalence of LBP in adults. Stepwise logistic regression analyses showed that LBP in the growth period and familial occurrence of back disease are important risk factors for LBP later in life, with an observed probability of 88% if both factors are present. Preventive measures in the school period seem to be of great importance.

Low back pain and physical exercise in leisure time in 38-year-old men and women: a 25-year prospective cohort study of 640 school children.

A cohort of 38-year-old men and women were studied for leisure time physical exercise in relation to low back pain (LBP), education, work, social class and smoking by a self-administered questionnaire. At the age of 14 years, the subjects had been interviewed by their school doctor regarding history of LBP and radiographs of the thoracic and lumbar spine were taken. The results show no positive correlation between radiographic changes and LBP in the adolescent period and decreased physical activity in adulthood. Physical activity for at least 3 h/week reduces the risk of LBP measured as lifetime, 1-year and point prevalence. Eighty-five percent of the subjects who reported taking physical exercise for at least 3 h/week had participated in sports activity almost constantly since their school days and these reported being in better condition than the rest of the cohort. Otherwise they did not have a healthier mode of life. No physical exercise during leisure time was associated with a short school education, unskilled work, unemployment and sickness, low social class, divorce, living in an apartment and smoking. Sixty percent had never or not for many years been interested in participating in sports. Badminton and tennis were the most common sports practised (36%), followed by gymnastics (32%), ball games-soccer and team handball-(25%), running (20%) and swimming (18%). Gymnastics and swimming seem to reduce LBP significantly. Our results show a falling interest in participating in sports activities over time, with 68% of the subjects being members of an athletic association previously, but only 29% currently. Women were more physically inactive during leisure time, probably because of their dual role. Logistic regression analysis indicates that physical activity is related to a long school education, high social class and regular sports activity over time.

Epidemiological aspects and risk factors for low back pain in 38-year-old men and women: a 25-year prospective cohort study of 640 school children.

This study is based on data gathered by means of a postal questionnaire from a cohort of 640 38-year-old subjects. At the age of 14 years these subjects had been interviewed by their school doctor to ascertain whether any of them had a history of low back pain (LBP), and X-rays of the thoracic and lumbar spine were taken. The questionnaire contained related groups of questions, with LBP as the main topic. We wanted to identify probable risk factors in developing LBP. The results show a cumulative life-time prevalence of LBP of 70%, a 1-year prevalence of 63% and a point prevalence of 19%, independent of gender. Women reported a higher incidence of LBP than men during the month and week before they filled out the questionnaire, they also reported a higher incidence of sciatica and greater use of the health care system and analgestics over the previous year. Heavy manual work was associated with LBP and sciatica, and smoking (more than 16 cigarettes per day) was more common among unemployed and sick-listed subjects, Severe LBP was associated with increased morbidity, reduced work capacity, deterioration in social life, mental and sexual problems, and increased smoking. A stepwise logistic regression analysis of "early" independent variables indicated that severe LBP is positively correlated with low social class for men and with menstruation and pregnancy for women.

Are radiologic changes in the thoracic and lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective cohort study of 640 school children.

STUDY DESIGN: This report was based on a 25-year prospective cohort study and designed as a self-administered questionnaire with low back pain as the main topic. OBJECTIVE: To identify whether radiologic changes in the thoracic and lumbar spine and a history of low back pain in the adolescent period represent risk factors for low back pain in adults. SUMMARY OF BACKGROUND DATA: Six-hundred-forty 14-year-old school children were examined with x-rays of the thoracic and lumbar spine and registered by the school doctor regarding a history of low back pain. METHODS: All of the x-rays and the short journals from the school doctor's registration were reviewed. This primary information was the basis of the investigation 25 years later. RESULTS: Eleven percent of the cohort had a history of low back pain in adolescence, and the results showed an 84% lifetime prevalence of low back pain in these subjects as adults and an increased frequency of low back pain the last month and week before they answered the questionnaire, compared with the rest of the cohort. These problems were associated with increased morbidity and decreased working capacity. Thirteen percent had radiologic abnormalities, mainly Scheuermann changes, in the thoracic and lumbar spine as adolescents, with no positive correlation to low back pain in this period. Unlike other reports, our results did not confirm a positive correlation between x-ray changes in the lower spine in adolescents and a higher prevalence of low back pain in adults. Stepwise logistic regression analyses showed that low back pain in the growth period and familial occurrence of back disease are important risk factors for low back pain later in life, with an observed probability of 88% if both factors are present. CONCLUSION: This study suggests that low back pain in the growth period is "a real problem," with a trend toward aggravation as time passes. Thus, implementing preventive measures in schools may be very important.

CT scan compared to tomography in suspected hip fracture.

In a prospective study the diagnostic value of CT scanning and tomography were compared in the cases of eight consecutive patients in whom initial radiographs showed a suspected hip fracture. CT scan did not contribute more to diagnosis than tomography.

Cranial computed tomography in infantile spasms. Primary findings related to long-term mental prognosis.

Out of 109 children with infantile spasms (IS), prospectively tested during the years 1976 to 1979 in Denmark, 52 children were examined by cranial computed tomography (CT). The classification of IS into cryptogenic (CR), symptomatic (SY) and doubtful (DO) was done clinically without considering the CT-findings. Sixty per cent of the scannings were abnormal. Only 6/30 (20%) of the children in ACTH treatment were found to develop cerebral atrophy which means that this finding is not an obligatory side-effect of ACTH treatment of children with IS. Normal CT-findings were found in 50% of the CR and 50% of the SY + DO-groups, and could not be used as a prognostic tool for estimating the mental development. This was also the case for children with cerebral atrophy. Abnormal CT-findings (minus atrophy) were highly correlated to the group with clinical symptoms and indicate an extremely unsatisfying long-term mental prognosis. CT-scanning is a valuable tool for the examination of clearing children with infantile spasms.

[Cerebral computed tomography in infantile spasms]. / Cerebral computertomografi ved infantile spasmer.

A prospective investigation of 52 children with infantile spasms was carried out employing computed tomography. Normal conditions were demonstrated in 21 (40%). Among the 31 children with pathological computed tomografic findings, dilatation of the ventricular system and/or subarachnoid space was found in nine cases (17%), congenital malformations in ten (19%) and cerebrovascular changes in a similar number (19%). One patient had a tumour and one had congenital toxoplasmosis. No significant differences were found in the frequencies of normal psychomotor development between children with normal and abnormal computed tomographic findings. The reason for this is probably that a good prognosis may be anticipated in the idiopathic forms provided that ACTH treatment is initiated early in the course of the disease. Computed tomography is useful to differentiate between symptomatic and idiopathic cases of infantile spasms. It may, however, be assumed that neuronal heterotopy without other malformations in the central nervous system may be difficult to diagnose with computed tomography. Magnetic resonance scanning will probably be able to demonstrate these cases.

Intravenous digital subtraction angiography in patients with cerebral ischaemia. Evaluation of extracranial carotid lesions.

Over a two-year period, 167 patients with symptoms of transient ischaemic attacks or suspected minor stroke underwent intravenous digital subtraction angiography (DSA) of the carotid arteries. There were no major complications. Ninety-six patients had abnormal angiograms, 60 normal studies, and in 11 patients (7%) the examination was not of diagnostic quality, mostly because of motion artifacts. In 86 patients no therapeutic consequences resulted from the DSA examination. Twenty-six patients were referred for vascular surgery, and 34 patients had either anticoagulation or aspirin therapy. In 10 patients a primary medical cause was found for their cerebral vascular symptoms. It is concluded that intravenous DSA of the carotid arteries in patients with transient ischaemic attack is a safe, diagnostically useful procedure, that can also be used on an outpatient basis.

[Rotatory atlanto-axial luxation in children]. / Rotatorisk atlanto-aksial luksation hos børn.

Two cases of atlanto-axial rotatory dislocation following ear and head surgery are presented. Reduction was followed by Halo bandage in one, and by wedge C1-2 arthrodesis and Halo bandage in the other. The importance of early recognition by diagnostic CT-scan is emphasized.