Cognitive variability in psychotic disorders: a cross-diagnostic cluster analysis.

BACKGROUND: Cognitive dysfunction is a core feature of psychotic disorders; however, substantial variability exists both within and between subjects in terms of cognitive domains of dysfunction, and a clear 'profile' of cognitive strengths and weaknesses characteristic of any diagnosis or psychosis as a whole has not emerged. Cluster analysis provides an opportunity to group individuals using a data-driven approach rather than predetermined grouping criteria. While several studies have identified meaningful cognitive clusters in schizophrenia, no study to date has examined cognition in a cross-diagnostic sample of patients with psychotic disorders using a cluster approach. We aimed to examine cognitive variables in a sample of 167 patients with psychosis using cluster methods. METHOD: Subjects with schizophrenia (n = 41), schizo-affective disorder (n = 53) or bipolar disorder with psychosis (n = 73) were assessed using a battery of cognitive and clinical measures. Cognitive data were analysed using Ward's method, followed by a K-means cluster approach. Clusters were then compared on diagnosis and measures of clinical symptoms, demographic variables and community functioning. RESULTS: A four-cluster solution was selected, including a 'neuropsychologically normal' cluster, a globally and significantly impaired cluster, and two clusters of mixed cognitive profiles. Clusters differed on several clinical variables; diagnoses were distributed amongst all clusters, although not evenly. CONCLUSIONS: Identification of groups of patients who share similar neurocognitive profiles may help pinpoint relevant neural abnormalities underlying these traits. Such groupings may also hasten the development of individualized treatment approaches, including cognitive remediation tailored to patients' specific cognitive profiles.

Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization.

Esophageal foreign body impaction (EFBI) often requires urgent evaluation and treatment, but characteristics of emergency department (ED) care such as timing of presentation and therapeutic procedures and costs of care are unknown. We aimed to study health-care utilization for patients with EFBI presenting to the ED. Cases of EFBI from 2002 to 2009 were identified by querying three different databases from the University of North Carolina Hospitals for all records with ICD-9 CM code 935.1: 'foreign body in the esophagus.' Charts were reviewed to confirm EFBI and extract pertinent data related to the ED visit, including time of presentation, length of ED stay, medications administered, type of procedure performed, characteristics of procedures, and time to therapeutic procedure. Hospital charges for EFBI encounters and consult fees were determined from the Physicians' Fee Reference 2010, and were compiled to estimate costs. Of the 548 cases of EFBI identified, 351 subjects (64%) presented to the ED. A total of 118 (34%) patients received a medication to treat EFBI, which was only effective in 8% of those patients. Two hundred ninety (83%) subjects underwent a procedure including esophagogastroduodenoscopy (EGD) (n=206) or ear, nose, and throat surgery (ENT)-performed laryngoscopy/esophagoscopy (n=138). Admission to the hospital occurred in 162 (46%) of cases. There was no relationship between ED arrival time and time-to-procedure or total time in ED. There was also no significant relationship between delivery of ED medications and likelihood of undergoing a procedure, or between ED arrival time and delivery of medications. The charges associated with a typical EFBI episode ranged from $2284-$6218. In conclusion, the majority of patients with EFBI at our institution presented to the ED. Medical management was largely ineffective. A therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time-to-procedure, indicating that gastroenterology and ENT specialists recognize the urgency of treating EFBI regardless of time of day.

Abordaje laparoscópico en cáncer de endometrio / Laparoscopic approach for endometrial cancer

El cáncer de endometrio es una neoplasia ginecológica relevante en todo el mundo, con cambios acelerados en su manejo. La cirugía es el tratamiento de elección, pero puede llegar a tener una alta tasa de complicaciones y retraso en el inicio de terapias adyuvantes por el trauma quirúrgico que provoca. Este artículo revisa el rol de la laparoscopia en el manejo de las pacientes con cáncer endometrial, haciendo hincapié en su seguridad oncológica, beneficios y complicaciones. Al comparar la vía clásica por laparotomía, la laparoscopia, en manos experimentadas, tiene similares resultados respecto de sobrevida, recurrencia y etapificación completa, pero con una menor tasa de complicaciones. La vía endoscópica podría ser la herramienta del futuro en el manejo del cáncer de endometrio.

Endometrial cancer is a relevant gynecologic neoplasm, with accelerated changes in its management. Surgery is the treatment of choice, but it can have a high rate of complications and delay in adjuvant therapies due to the surgical trauma that it inflicts. This article reviews the role of laparoscopy in the management of women with endometrial cancer, highlighting the oncologic safety, benefits and complications. Comparing laparotomy with laparoscopy, in experienced hands, it has the same results concerning to survival, recurrence and complete staging, with a lower rate of complications. Celioscopy could be the tool of the future in the management of endometrial cancer.

Apathy in Alzheimer's disease.

Apathy, or loss of motivation, is arguably the most common change in behavior in Alzheimer's disease (AD) but is underrecognized. Apathy represents a form of executive cognitive dysfunction. Patients with apathy suffer from decreased daily function and specific cognitive deficits and rely on families to provide more care, which results in increased stress for families. Apathy is one of the primary syndromes associated with frontal and subcortical pathology, and apathy in AD appears to have multiple neuroanatomical correlates that implicate components of frontal subcortical networks. Despite the profound effects of this common syndrome, only a few instruments have been designed to specifically assess apathy, and these instruments have not been directly compared. Assessment of apathy in AD requires clinicians to distinguish loss of motivation from loss of ability due to cognitive decline. Although apathy may be misdiagnosed as depression because of an overlap in symptoms, current research has shown apathy to be a discrete syndrome. Distinguishing apathy from depression has important treatment implications, because these disorders respond to different interventions. Further research is required to clarify the specific neuroanatomical and neuropsychological correlates of apathy and to determine how correct diagnosis and treatment of apathy may improve patient functioning and ease caregiver burden.

Deoxynortrichoharzin, a new polyketide from the saltwater culture of a sponge-derived Paecilomyces fungus.

The saltwater culture of a Paecilomyces cf. javanica isolated from the marine sponge Jaspis cf. coriacea has yielded a new polyketide, deoxynortrichoharzin (1), and two known diketopiperazines (2 and 3).

The psychological refractory period: evidence for age differences in attentional time-sharing.

The authors report 2 psychological refractory period (PRP) experiments in which the stimulus onset asynchrony (SOA) between Task 1 and Task 2 was 150 ms, 250 ms, 600 ms, and 1,100 ms for both younger and older adults. H. Pashler's (1994a) response-selection bottleneck theory predicts that SOA manipulations should not affect Task 1 performance, but that reaction time (RT) for Task 2 should increase as the SOA between the 2 tasks decreases (i.e., the classical PRP effect). In Experiment 1 (Task 1 = tone discrimination, Task 2 = dot location), older adults showed a larger PRP effect than younger adults did, although Task 1 RT was affected by SOA, suggesting that participants were grouping their responses on some trials. That is, participants were holding their response for Task 1 until they had completed processing Task 2, and then they responded to both tasks almost simultaneously. However, a subset of participants (11 younger adults and 11 older adults) who showed no evidence of response grouping on Task 1 continued to show a larger PRP effect for older adults on Task 2. In Experiment 2 (Task 1 = dot location, Task 2 = simultaneous letter matching), older adults continued to show a larger PRP effect than younger adults for Task 2, and Task 1 performance was unaffected by SOA. Consequently, these experiments provide evidence that older adults (relative to younger adults) exhibit a decrement in time-sharing at the response-selection stage of processing. These results suggest that attentional time-sharing needs to be added to the list of topics examined in aging research on varieties of attention.

Dihydrotubastrines: phenethylguanidine analogues from the Indo-Pacific marine sponge Petrosia cf. contignata.

Two phenethylguanidine derivatives, 7,8-dihydrotubastrine (1) and 4-deoxy-7,8-dihydrotubastrine (2), along with the sterol xestobergsterol A (3), were isolated from the marine sponge Petrosia cf. contignata. The structures of the new natural products 1 and 2 were based on spectroscopic data and comparison to the literature properties for semisynthetic 1. This is the first example from this compound class with a saturated acyclic C2 unit.

Isolation and cytotoxic evaluation of marine sponge-derived norterpene peroxides.

The marine sponge Diacarnus cf. spinopoculum has provided a series of norterpenes, including five new compounds (7-11), two new ent-compounds [(-)-1a and (+)-1b], and three known compounds (2a, 2b, and 12). Eight of these compounds represent additional examples of the muqubilin/sigmosceptrellin classes (norsesterterpene peroxides) or the nuapapuin class (norditerpene peroxides). Also isolated were dinorditerpenones 11 and 12, which are biosynthetically related to the muqubilin/sigmosceptrellin structure classes. In all, 11 compounds were evaluated for their cytotoxic properties using a soft agar assay system and the NCI's 60 cell-line screen. Compounds without peroxide functionality were inactive. Overall, the norsesterterpene peroxides were less selective as cytotoxins than norditerpene peroxide analogues. Two compounds, nuapapuin A methyl ester (3) and nuapapuin B (7), which were somewhat selective in their cytotoxic behavior, were selected for further in vivo evaluation.

Haliclostanone sulfate and halistanol sulfate from an Indo-Pacific Haliclona sponge.

Two steroids, haliclostanone sulfate (1) and halistanol sulfate (3), were isolated from a Haliclona sp. marine sponge. The structure of the new compound 1 was established based on its spectroscopic data and the properties of a pentaacetate derivative 2. Compound 1 is unique in that it possesses the rare cis C/D ring junction precedented only in marine sterols, contignasterol (4) and xestobergsterols A (5), B (6), and C (7).

Outcomes of a pneumonia critical path.

Research outcomes of a pneumonia critical path for 73 patients in a metropolitan New York City hospital were analyzed. The positive outcomes included a decreased length of stay, decreased hospital charges, and improved multidisciplinary documentation.

The National Survey of Family Growth, Cycle IV, evaluation of linked design.

Research was undertaken to quantify the effects of costs of alternative methods for selecting sample women for the National Survey of Family Growth (NSFG) from the National Health Interview Survey (NHIS). This report presents estimates of the effects of alternative design options, obtained by statistical modeling techniques, for linking the NSFG with the NHIS; the cost data and the statistical precision of estimates were based on data from the NSFG, Cycle IV. The estimated survey costs and projected response rates for alternative linked design options and for the unlinked design are compared for fixed precision. The findings confirm that substantial gains in the NSFG design efficiency were obtained by linking the NSFG sample design to that of the NHIS.

PIP: This article describes the research methodology used in Cycle IV of the National Survey of Family Growth (NSFG). The NSFG used a subsample of women living in households that participated in the National Health Interview Survey (NHIS), which is a continuous survey in 198 metropolitan areas and clusters of nonmetropolitan counties in the United States. Chapter 1 is devoted to a description of the sampling design and subsampling design, respectively, of the NHIS and NSFG. An intensive follow-up was conducted among a 50% subsample of nonresponse cases. Chapter 2 covers a discussion of the application of "balanced repeated replications," which was the technique used to estimate within-unit variance and within-segment variance. In general the between-segment variance was small for most estimates. There was a 7% between-primary-sampling-unit (PSU) variance for all races combined and an 11% between-PSU variance for Black women. Chapter 3 includes a presentation of a theoretical model of the variance of a ratio-adjusted estimate. The effects of variation in weights is discussed. A fitted model for design effects was compared to a direct design effects model. The aim of examining design effects was to provide a comparison of NSFG and NHIS linked and unlinked designs. Chapter 4 considers four designs which vary in the number of PSUs, the number of segments, the number of designated households, the number of designated women from those households, and the number of interviewed women. The design effect of oversampling of strata with a high proportion of Blacks was calculated. The number of women that would have to be interviewed was calculated in an unlinked design in order to attain the same precision comparable to a linked Cycle IV design. Chapter 5 gives the direct costs for each of the four design options for 10 activities in data collection.

Cancer incidence and survival among American Indians registered for Indian health service care in Montana, 1982-1987.

BACKGROUND: Cancer incidence and cancer survival estimates in American Indians are quite limited. PURPOSE: Our purpose was to estimate cancer incidence and survival in American Indians who were registered for Indian Health Service (IHS) care in Montana. METHODS: We linked databases from the IHS and the Montana Central Tumor Registry (MCTR) to ascertain cases for the time period from January 1, 1982, through December 31, 1987. To calculate survival rates, we used a relative survival method that incorporated age-specific risks for noncancer deaths among American Indians. RESULTS: We identified 344 cases that were compatible with the National Cancer Institute (Surveillance, Epidemiology, and End Results Program) surveillance definition of cancer. Of these cases, 249 (72%) were listed in both the MCTR and the IHS databases; 56 (16%) and 39 (11%) were listed in only the MCTR or the IHS database, respectively. Compared with the overall cancer incidence in U.S. White men, the overall cancer incidence in Montana American Indian men was markedly lower, as was the incidence for colorectal and bladder cancers and for non-Hodgkin's lymphoma. The overall cancer incidence for Montana American Indian women differed less markedly, however, from the overall incidence in U.S. White women. Compared with the cancer incidence in U.S. White women, the incidence in Montana American Indian women was significantly higher for cervical cancer but was significantly lower for colorectal, breast, and uterine cancers. Survival rates from cancer were also examined for the first time in this population. For those sites examined, the survival rates were much lower in Montana American Indians than in U.S. Whites. CONCLUSIONS: We conclude that it is feasible to develop state-specific cancer incidence and survival estimates for American Indians in at least some states in different regions of the United States. Collaboration between the IHS and a state tumor registry is likely to improve the case ascertainment achieved by either agency alone.

The CSF-FTA test and the significance of blood contamination.

Although the fluorescent treponemal antibody absorption (FTA-ABS) test has found wide application in the diagnosis of syphilis, the cerebrospinal fluid fluorescent treponemal antibody (CSF-FTA) test is still controversial in the diagnosis of neurosyphilis. We found the CSF-FTA test extremely sensitive to contamination with FTA-ABS-reactive blood at concentrations in CSF that could not be detected by visual inspection. Interpretation of a reactive test should be made with caution if red cells are present in CSF.

Bell's palsy and secondary syphilis: CSF spirochetes detected by immunofluorescence.

Although Bell's palsy is usually idiopathic, occasional cases may have an identifiable infectious cause. When facial paralysis results from syphilis, it usually develops during the tertiary meningovascular stage. We report a 30-year-old man with secondary syphilis who developed facial paralysis associated with acute syphilitic meningitis. Spirochetes were identified in the cerebrospinal fluid by immunofluorescence using standard reagents from the fluorescent treponemal antibody absorption (FTA-ABS) test. Patients with Bell's palsy should be screened for syphilis with a blood FTA-ABS test, and treatment with corticosteroids should be considered only after an infectious cause has been excluded.