[Clinical, biochemical and epidemiological features of macro-AST preceding inflammatory bowel disease diagnosis by several years]. / Caractéristiques cliniques, biochimiques et épidémiologiques d'une macro-ASAT précédant le diagnostic de maladie inflammatoire chronique de l'intestin de plusieurs années.

INTRODUCTION: An isolated elevation of aspartate aminotransferase (AST) is a diagnostic issue. Macro-aspartate aminotransferase (macro-AST) corresponds to the formation of complexes between AST and immunoglobulins. CASE REPORT: We report the case of a patient with macro-AST identified several years before the onset of inflammatory bowel disease (IBD). A 6-year retrospective analysis in our laboratory identified only one case out of 42 540 adult patients. CONCLUSION: The objective of this work is to increase awareness of this benign disorder among clinicians and biologists, as well as to aid in prescribing only the required tests.

Diagnoses associated with the greatest years of potential life lost for in-hospital deaths in the United States, 1988-2010.

OBJECTIVE: Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality from in-hospital mortality can help guide hospital initiatives and resource allocation. This paper identified the diagnosis categories associated with in-hospital deaths that account for the highest YPLL and their trends over time. STUDY DESIGN: Retrospective review of the Nationwide Inpatient Sample (NIS), 1988-2010. METHODS: Using the NIS, YPLL on patients hospitalized in the United States from 1988 to 2010 was calculated. Hospitalizations were categorized by related principal diagnoses using the Healthcare Cost and Utilization Project (HCUP) single-level Clinical Classification Software (CCS) definitions. RESULTS: Between 1988 and 2010, total in-hospital estimated mortality of 20,154,186 people accounted for 198,417,257 YPLL (9.84 YPLL per in-hospital mortality; 8,626,837 estimated annual mean YPLL). The ten highest YPLL diagnosis categories accounted for 51% of the overall YPLL. The liveborn disease category (i.e., in-hospital live births) was the most common principal diagnosis and accounted for the highest YPLL at 1,070,053. The septicemia category accounted for the second highest YPLL at 548,922. The highest in-hospital mortality rate (20.8%) was associated with adult respiratory failure/insufficiency/arrest. The highest estimated in-hospital annual mean deaths occurred in patients with pneumonia at 69,134. For all in-hospital mortality, the inflation adjusted total in-hospital charges per YPLL was highest for acute myocardial infarction at $9292 per YPLL. CONCLUSIONS: Using YPLL, a framework has been provided to compare the impact of premature in-hospital mortality from dissimilar diseases. The methodology and results may be used to help guide further investigation of hospital quality initiatives and resource allocation.

Estimation of injury simulation in international men's soccer.

The aim of this study was to determine the frequency of apparent injury incidents in men's international soccer and attempt to estimate what proportion of these incidents are authentic. Broadcast recordings of 89 group stage games from 4 tournaments were reviewed to identify incidents in which a player behaved as if injured. Apparent injuries were considered definite if a player withdrew from participation within 5 min or if bleeding was visible. The remaining incidents were considered questionable. A total of 980 apparent injuries were observed at a rate of 5.63/team game. The definite injury rate was only 0.41/team game vs. 5.22/team game for questionable injuries. Definite injuries were associated with on-field treatment (P<0.001) and stretcher (P<0.001) while questionable injuries were associated with fouls (P<0.001), yellow cards (P=0.013), and the first half (P=0.001). Questionable injuries were more associated with the final 1/3 of the second half than the initial 2/3 (P=0.039). For the 24 games of the 2007 AFC Asian Cup there was an association between questionable injuries and a contact mechanism (P<0.001). The range of the rate of questionable injury was 4.17-5.4 by confederation. This information may assist soccer governing bodies in developing plans to prevent injury simulation behavior.

Bedside end-tidal CO2 tension as a screening tool to exclude pulmonary embolism.

End tidal carbon dioxide tension (P(ET,CO(2))) is a surrogate for dead space ventilation which may be useful in the evaluation of pulmonary embolism (PE). We aimed to define the optimal P(ET,CO(2)) level to exclude PE in patients evaluated for possible thromboembolism. 298 patients were enrolled over 6 months at a single academic centre. P(ET,CO(2)) was measured within 24 h of contrast-enhanced helical computed tomography, lower extremity duplex or ventilation/perfusion scan. Performance characteristics were measured by comparing test results with clinical diagnosis of PE. PE was diagnosed in 39 (13%) patients. Mean P( ET,CO(2)) in healthy volunteers did not differ from P( ET,CO(2)) in patients without PE (36.3+/-2.8 versus 35.5+/-6.8 mmHg). P(ET,CO(2 )) in patients with PE was 30.5+/-5.5 mmHg (p<0.001 versus patients without PE). A P(ET,CO(2)) of >or=36 mmHg had optimal sensitivity and specificity (87.2 and 53.0%, respectively) with a negative predictive value of 96.6% (95% CI 92.3-98.5). This increased to 97.6% (95% CI 93.2-99.) when combined with Wells score <4. A P(ET,CO(2)) of >or=36 mmHg may reliably exclude PE. Accuracy is augmented by combination with Wells score. P( ET,CO(2)) should be prospectively compared to D-dimer in accuracy and simplicity to exclude PE.

Resolution of trigeminal neuralgia after palliative embolization of a cerebellopontine angle arteriovenous malformation.

BACKGROUND: Trigeminal neuralgia (TN) is a syndrome with debilitating paroxysmal facial pain, one cause of which is thought to be vascular compression of the nerve root entry zone causing ephaptic transmission. Arteriovenous malformations (AVM) have been reported to cause TN, including AVMs in the cerebellopontine (CP) angle. These lesions have been successfully treated with endovascular coiling, ethylene-vinyl alcohol copolymer (Onyx) and surgery for decompression. CASE DESCRIPTION: We present a case of TN caused by AVM in the CP angle in a patient who was not a candidate for microsurgery and who did not want radiofrequency treatment or other destructive procedures because he would not tolerate facial numbness. The patient's symptoms were successfully treated by embolization using an ethylene-vinyl alcohol copolymer. After 17 months he had a recurrence of pain which was again treated with palliative embolization and again experienced resolution of his symptoms. CONCLUSION: This case demonstrates that palliative embolization is a safe and effective option for the treatment of trigeminal neuralgia pain in patients for whom surgery of the AVM is not an option.

Prospective investigations of the prodromal state of schizophrenia: review of studies.

OBJECTIVE: The paper presents a comprehensive overview of prospective studies monitoring or intervening in the pre-onset phase of first episode psychosis. METHOD: A systematic literature search was conducted and supplemented by a manual search. All relevant studies were ordered and intensively reviewed according to specified criteria. Methodological and conceptual issues are discussed. RESULTS: Reports of 23 prospective studies were found, some describing subsamples of larger samples. Major methodological and conceptual divergences exist. CONCLUSION: Applied criteria detect individuals with a significantly increased risk of psychosis within the schizophrenia spectrum, but these criteria are only validated on clinical populations. The significance of differences in sample-characteristics is unclear. Most study samples are small. Results are preliminary and in need of further research before they constitute a realistic knowledge base. Methodological and conceptual issues should not be underestimated.

Prospective investigations of the prodromal state of schizophrenia: assessment instruments.

OBJECTIVE: To review assessment instruments used for detection of prodromal or at-risk mental states, and discuss their role in current research. METHOD: A systematic electronic literature search was conducted and supplemented by a manual search. All relevant scales were selected for the purpose of the review. RESULTS: Six interviews and four screening instruments were found. Two main traditions are prevailing: the Attenuated Positive Symptoms approach and the Basic Symptoms approach. Reports of psychometric properties of the interviews are preliminary. CONCLUSION: The instruments detect individuals with an increased risk of psychosis in clinical populations, but predictive validity and measures of reliability is insufficiently evaluated. Studies including instruments from both traditions should be conducted, in order to obtain an empirical basis of hypothesized relations between instruments. Instruments elucidating phenomenological aspects of anomalies in self-experience may contribute with valuable data on the pre-onset phase of psychosis.

Suitability for psychoanalytic psychotherapy: validation of the Dynamic Assessment Interview (DAI).

OBJECTIVE: To examine the predictive validity of a particular interview and rating scale of patient suitability for psychoanalytic psychotherapy: The Dynamic Assessment Interview (DAI) scale. METHOD: Seventy-four psychiatric out-patients were interviewed with the DAI and the associations between DAI-scores and measures of outcome and of therapeutic alliance were investigated. RESULTS: Small to moderate correlations were found between the DAI suitability score and outcome (0.06-0.46) and between DAI suitability score and early rated alliance (0.14-0.45). The predictive value of the DAI-score was limited although on a par with the alliance measures used in the study. No other pretherapy predictor variable investigated was found significantly to predict outcome. CONCLUSION: The predictive power of the DAI measure was limited, a result, which is in agreement with results from former studies on suitability.

The dynamic assessment interview (DAI), interpersonal process measured by structural analysis of social behavior (SASB) and therapeutic outcome.

In this study we investigated the interrelationships between the Dynamic Assessment Interview (DAI), the interpersonal process of the assessment interview analyzed with Structural analysis of Social Behavior (SASB), and treatment outcome. The DAI is a semistructured interview and rating procedure designed to evaluate patient suitability for psychodynamic psychotherapy based on the patient's immediate interaction with the assessment interviewer. In the selected sample (n = 20) the DAI ratings showed no significant correlations with the SASB-coded interpersonal process of the assessment interview nor with treatment outcome. The SASB-coded interpersonal process in the assessment interview correlated significantly with interpersonal process early in therapy and was able to predict treatment outcome. It is concluded that the abstract ''inner'' patient characteristics assumed to be of major prognostic importance for psychodynamic psychotherapy might be of limited validity, whereas the patient offered interpersonal process is worth further consideration as a predictor of treatment outcome. Finally, the relatively stressful structure of the DAI interview might have facilitated the prediction of treatment outcome from the interpersonal process in the assessment interview.

Landomycin A inhibits DNA synthesis and G1/S cell cycle progression.

Landomycin A was found to inhibit the uptake of [3H]thymidine into DNA in murine smooth muscle cells indicating decreased DNA synthesis. Subsequent studies showed that landomycin A inhibits cell cycle progression.

Single unit recordings in the auditory nerve of congenitally deaf white cats: morphological correlates in the cochlea and cochlear nucleus.

It is well known that experimentally induced cochlear damage produces structural, physiological, and biochemical alterations in neurons of the cochlear nucleus. In contrast, much less is known with respect to the naturally occurring cochlear pathology presented by congenital deafness. The present study attempts to relate organ of Corti structure and auditory nerve activity to the morphology of primary synaptic endings in the cochlear nucleus of congenitally deaf white cats. Our observations reveal that the amount of sound-evoked spike activity in auditory nerve fibers influences terminal morphology and synaptic structure in the anteroventral cochlear nucleus. Some white cats had no hearing. They exhibited severely reduced spontaneous activity and no sound-evoked activity in auditory nerve fibers. They had no recognizable organ of Corti, presented >90% loss of spiral ganglion cells, and displayed marked structural abnormalities of endbulbs of Held and their synapses. Other white cats had partial hearing and possessed auditory nerve fibers with a wide range of spontaneous activity but elevated sound-evoked thresholds (60-70 dB SPL). They also exhibited obvious abnormalities in the tectorial membrane, supporting cells, and Reissner's membrane throughout the cochlear duct and had complete inner and outer hair cell loss in the base. The spatial distribution of spiral ganglion cell loss correlated with the pattern of hair cell loss. Primary neurons of hearing-impaired cats displayed structural abnormalities of their endbulbs and synapses in the cochlear nucleus which were intermediate in form compared to normal and totally deaf cats. Changes in endbulb structure appear to correspond to relative levels of deafness. These data suggest that endbulb structure is significantly influenced by sound-evoked auditory nerve activity.

Population densities of Sulawesi crested black macaques (Macaca nigra) on Bacan and Sulawesi, Indonesia: effects of habitat disturbance and hunting.

Population surveys of Sulawesi crested black macaques (Macaca nigra) were conducted on the Indonesian islands of Sulawesi and Bacan in 1992-1994 to assess the status of natural populations and determine habitat and anthropogenic factors affecting their population densities. We surveyed five sites for primates, including undisturbed and disturbed habitats. Data were collected on habitat structure and composition at two undisturbed and one disturbed forest site in which the primates were surveyed. The highest density of macaques was found in primary forest at Gunung Sibela Nature Reserve on Bacan (170.3 individuals/km2). Population density in logged forest on Bacan was high but significantly less than primary forest (133.4 individuals/km2). The high density of crested black macaques in primary forest on Bacan is best explained by the high carrying capacity found in primary forest. The lower food quantity and quality of food resources found in logged forest correlated with lower primate densities compared to primary forest. However, the large population of macaques in logged forest demonstrates the conservation value of such forest. Densities on Sulawesi at Tangkoko-Batuangas-DuaSudara Nature Reserve (TBDS) showed a continuing decline since earlier surveys. Primate densities were highest near the protected center of Tangkoko Reserve (66.7 individuals/km2). The peripheral areas of Batuangas and DuaSudara, even though adjacent and continuous, showed lower population densities of 46.4 and 23.5 individuals/km2, respectively. The best explanation for the continued decline of Macaca nigra populations at TBDS is hunting. Unless conservation measures are implemented immediately, M. nigra on Sulawesi risks extinction in the near future.

Cerebrospinal fluid free choline in movement disorders of paediatric onset.

We measured free choline in cerebrospinal fluid (CSF) of 78 patients with movement disorders of paediatric onset and various controls as a putative index of central phospholipid metabolism. Most of the disorders studied were myoclonic disorders, such as progressive myoclonus epilepsy, the opsoclonus-myoclonus syndrome, and essential myoclonus, but other movement disorders, interictal seizure disorders, and different neurological and nonneurological disorders were also included. There were no significant differences in CSF choline concentrations in myoclonic disorders or other movement disorders compared with controls. The CSF choline levels were lowest in children with seizure disorders including progressive myoclonus epilepsy. In progressive myoclonus epilepsy, the CSF choline values resembled other epileptic disorders rather than other myoclonic disorders. When all the data were analysed collectively, no significant relation of CSF choline was found to patient age, gender, aliquot of CSF measured, or the length of time the sample was stored at -70 degrees C. Separate analyses of data from children and adults showed a trend toward a biphasic relation between patient age and CSF choline which could be pursued in developmental studies of normal subjects. Reduced CSF choline may indicate increased choline incorporation into brain phospholipids, disturbances of choline metabolism, decreased choline release, or non-neural factors.

The Dynamic Assessment Interview: testing the psychodynamic assessment variables.

The Dynamic Assessment Interview (DAI) is a semi-structured interview with anchored scales to rate patients; suitability for psychodynamic psychotherapy. The DAI was inspired by the Personality Assessment Interview developed by Selzer et al. in 1987 and it introduces from the beginning of the assessment interview an explicit focus on the patient's immediate interactions with the interviewer. Seven theoretical derived variables are assessed, namely psychological mindedness, capacity for self-observation, capacity for empathy, tolerance of frustration, motivation, response to confrontation, and ability to contain and work with affect. In addition, the patient's attractiveness as a psychotherapy patient and his or her assumed confidence in the forthcoming treatment are assessed. The patient's personality organization ad modum Kernberg is measured from a global assessment of the interview. The present paper describes the DAI and presents its psychometric properties. An acceptable level of inter-rater agreement was found for the theoretically derived variables and for the personality organization diagnosis, with intra-class correlations or kappa coefficients ranging from 0.68 to 0.80.

Containers, mental space and psychodynamics.

The concept of the container has a place within cognitive science as well as within psychodynamic theories. Cognitive semantics has shown that many metaphors giving meaning to daily life-events use the container as a basic reference point. Psychoanalytic theory, most notably, Freud's psychosexual developmental model, illustrates how the container of the body results in meaning. Object relations theory in psychoanalysis has shown how patients with borderline personality disorder behave according to the dynamics of container and containment. Both the cognitive and the psychodynamic conceptions of containers are clinically relevant. The fundamental notion of the container leads to an exploration of 'container dynamics' both in cognitive semantics and in psychodynamic work. A model of the cusp may be of help in the description of the dynamics at the border of the container. Furthermore, the descriptions of the patient's communication of emotion and thoughts may involve three interacting dimensions: an effective-perceptual dimension, a phantasy dimension and a socio-interactive dimension. The interaction between these dimensions has implications for dealing with container dynamics and the process of containment.

Ex vivo evaluation of the NASA/DeBakey axial flow ventricular assist device. Results of a 2 week screening test.

The authors investigated the antithombogenicity of the NASA/DeBakey axial flow ventricular assist device in an ex vivo calf model. The device is 3 inches in length and 1 inch in largest diameter. The pump weighs 53 g and displaces 15 ml. The unit consists of three major components: a flow straightener, a spinning inducer/impeller, and a diffuser. The impeller has rod shaped permanent magnets embedded within the six blades and is activated magnetically by a motor stator that is positioned outside the flow tube. Previous 2 day screening tests demonstrated an antithrombogenic configuration in short-term implantation. Based on the results of these 2 day screening tests, five pumps with the best configuration were implanted into a calf for 2 weeks for anti thrombogenicity confirmation. Pumps were implanted paracorporeally, and heparin was used to maintain activated clotting time to approximately 250 sec. Each pump was changed every 2 weeks as planned. During the experiment, all pumps demonstrated stable pumping. The required electric power was 7 to 8 watts and pump flow was maintained at 4 L/min. The calf was in excellent condition. Liver and renal function were maintained, plasma free hemoglobin was kept at less than 4 mg/dl (3.3 +/- 0.3 mg/dl), and lactate dehydrogenase was 1043 +/- 36 units/L. In this experimental series, all five pumps passed the 2 week implantation. Two week ex vivo test results indicated very slight thrombus in the hub areas of some pumps. For the next phase of the implantation study, minor design optimization is necessary to completely eliminate thrombus formation. According to our step by step approach, the in vivo test aiming for long-term implantation is ongoing.

Characteristics of cloned cerebrovascular endothelial cells following infection with Theiler's virus. I. Acute infection.

The present study describes the replication of Theiler's virus in cloned cerebrovascular endothelial cells (CVE) isolated from strains of mice that are either susceptible or resistant to Theiler's virus-induced demyelination (TVID). CVE isolated from all strains of mice were equally permissive to Theiler's virus infection. Interferon-gamma and tumor necrosis factor-alpha were found to inhibit the replication of Theiler's virus in CVE. A correlation between susceptibility to demyelination and the ability of Theiler's virus to induce MHC Class I on CVE was demonstrated.

Characteristics of cloned cerebrovascular endothelial cells following infection with Theiler's virus. II. Persistent infection.

Cloned cerebrovascular endothelial cells (CVE) persistently infected with Theiler's virus (PI-CVE) have been established and characterized. The CVE were derived from strains of mice that are susceptible (SJL/J and CBA) and resistant (BALB/c) to Theiler's virus-induced demyelination (TVID). The cells were persistently infected with either the BeAn or GDVII strains of Theiler's virus in vitro and studied at various passage levels for infectious virus, viral antigen and the expression of major histocompatibility complex (MHC) Class I and II antigens. The virus replicated to lower titers than in acutely infected CVE and appeared to be more cell-associated. Flow cytometric analysis revealed that 18-39% of the PI-CVE contained viral antigen. Persistently infected CVE derived from SJL/J and CBA mice expressed high levels of MHC Class I, whereas BALB/c PI-CVE did not. MHC Class II was upregulated by IFN-gamma in SJL/J PI-CVE albeit at a slightly lower level than in uninfected CVE. In addition, the PI-CVE demonstrated increased levels of mRNA for IL-1 beta when compared to uninfected CVE.