Genetic Influences on Outcomes of Psychotherapy in Borderline Personality Disorder: A Narrative Review of Implications for Personalized Treatment.

Borderline personality disorder (BPD) manifests as instability in mood, relationships, self-image, and behavior, representing a challenging mental health issue. This review scrutinizes genetic factors influencing BPD and the corresponding treatment outcomes. The primary objective of this narrative review is to illuminate the association between genetic factors and BPD treatment outcomes, discussing the potential of genetic testing for personalized therapy. The review is derived from observational and experimental studies on BPD, genetic factors, and psychotherapy from 2000 to 2023, sourced primarily through PubMed. Reviews and meta-analyses were excluded. Our review suggests that genetic factors account for 40-60% of BPD variation, with significant roles played by epigenetic alterations like DNA methylation and microRNAs, particularly in the context of childhood trauma. Gene-environment interactions are also vital for BPD's development. Treatments such as dialectical behavior therapy, mentalization-based therapy, and schema therapy have shown efficacy, with success variability possibly linked to genetic factors. However, existing research is constrained by recall bias, diverse methodologies, and limited sample sizes. Future research necessitates long-term follow-up, diverse populations, and controlled variables to enhance our comprehension of BPD treatment outcomes' genetic foundations. The review underlines the promise of personalized medicine in BPD treatment, driven by genetic insights.

[Initiation of long-term non-invasive ventilation at home: current practices and expected issues. Surveys from the CasaVNI working party]. / Mise en route d'une ventilation non invasive : pratiques actuelles et évolutions attendues. Enquêtes du groupe de travail CasaVNI.

INTRODUCTION: At the initiative of the Antadir Federation, the expert group CasaVNI has undertaken a study of the current situation and the medium term outlook of the initiation of long term non-invasive ventilation (NIV) in France and other countries. METHODS: Three surveys have been undertaken: (1) the first concerning the modalities of installation and surveillance of long-term NIV in France, (2) a second concerning the same modalities in other countries, (3) a third concerning the current prevalence and expected incidence of long-term NIV over the next few years. RESULTS: The initiation of long-term NIV takes place in hospital in the majority of cases (France 76%, elsewhere 79%) and the surveillance mainly at a day hospital (France 59%, elsewhere 43%). Despite the interrogation of many sources, the working party has been unable to determine the exact incidence and prevalence of patients receiving long-term NIV in France. CONCLUSION: With regard to the initiation of long-term NIV, clinical studies and guidelines are still necessary to validate the alternatives that will permit a response to the increasing demand while maintaining high standards.

[Relative depletion in native vitamin D: a potential risk factor in Algerian hemodialysis patients with radiological evidence of hyperparathyroidism and osteomalacia independent of calcitriolemia]. / La déplétion relative en vitamine D native: un facteur de risque potentiel chez l'hémodialysé algérien de lésions radiologiques d'hyperparathyroïdie et d'ostéomalacie indépendant de la calcitriolémie.

Looser striae on the ischio-pubian branches and subperiosteal resorption of the phalanges were looked for in 113 chronic hemodialysis patients at the University Hospital of Annaba (Algeria) and were found in respectively 14 and 48 patients. Comparison of patients with and without radiological complications showed no significant difference in their age, sex ratio, nature of initial kidney disease and duration on dialysis. The patients with Looser striae had lower plasma levels of 25OHD3 than those without striae, whereas all other plasma parameters were similar. The plasma concentrations of intact PTH were higher in patients with resorption; these patients had lower plasma concentrations of calcium, bicarbonate, aluminum and 25OHD3 but similar plasma concentrations of phosphate and 1,25(OH)2D3. Multivariate analysis showed that PTH concentrations were independently linked only to plasma 25OHD3 (negatively) and duration on dialysis (positively). The results of this transversal study are in agreement with the well established pathophysiological roles of PTH hypersecretion, hypocalcemia and acidosis in the appearance of radiological hyperparathyroidism in hemodialysis patients. Furthermore they suggest that a relative native vitamin D deficiency may have a calcitriol independent role in favoring the occurrence of both osteitis fibrosa and osteomalacia.

Multiplane transoesophageal echocardiographic absence of thoracic aortic plaque is a powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly. A large prospective study.

AIMS: This study was conducted to examine whether detection of atherosclerotic aortic plaque by multiplane transoesophageal echocardiography could predict the absence or presence of significant coronary artery disease in young and elderly valvular patients. METHODS AND RESULTS: Clinical and angiographic features and transoesophageal echocardiography findings were prospectively analysed in 278 consecutive valvular patients. In 93 patients with significant coronary artery disease, 85 had thoracic aortic plaque on transoesophageal echocardiography studies. In contrast, aortic plaque existed in only 33 of the remaining 185 patients with normal or mildly abnormal coronary arteries. Therefore, the presence of aortic plaque on transoesophageal echocardiography studies had a sensitivity of 91%, a specificity of 82%, and positive and negative predictive values of 72% and 95%, respectively, for significant coronary artery disease. In the 109 patients aged > or = 70 years, these sensitivity, specificity, and positive and negative predictive values were 96%, 78%, 79%, and 96%, respectively. The above high negative predictive value was the major finding of this study and indicated that the absence of thoracic plaque is a strong predictor for absence of significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (P < 0.0001). Multivariate logistic regression analysis revealed that aortic plaque, angina, hypercholesterolaemia and age were significant predictors of coronary artery disease: aortic plaque was the most significant independent predictor, even in patients > or = to 70 years. CONCLUSION: This large prospective study indicates that examination of thoracic atherosclerotic plaque, by multiplane transoesophageal echocardiography, is a marker for coronary artery disease, and is a particularly powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly.

Clinical significance of intracavitary spontaneous echo contrast in patients with dilated cardiomyopathy.

To assess the occurrence rate and major determinants of spontaneous echo contrast and to examine its impact on thromboembolic events and mortality in patients with dilated cardiomyopathy, 86 hospitalized patients (73 men and 13 women, mean age 63 +/- 11 years) with dilated cardiomyopathy who underwent transthoracic and transesophageal echocardiographic examinations were followed up for a mean of 20 +/- 13 months. Spontaneous echo contrast was observed in 36 patients (42%) and was detected only with the transesophageal approach. It was seen in the left atrium in 33 patients, in both right and left atria in 1 patient, in both left atrium and left ventricle in 1 patient, and in the descending aorta in 1 patient. Spontaneous echo contrast was more frequent in the presence of atrial fibrillation (p < 0.05), left atrial enlargement (p < 0.02) and severely depressed left ventricular function (p < 0.01), but was less common in patients with moderate to severe mitral regurgitation (p < 0.05). This imaging phenomenon was the only significant independent predictor of intracardiac thrombus formation and previous and subsequent thromboembolic events. During follow-up, there were 26 deaths, and survival in patients with spontaneous echo contrast was significantly lower than in those without it (p < 0.02). A spontaneous echo contrast is commonly detected with transesophageal echocardiography in patients with dilated cardiomyopathy especially in the presence of atrial fibrillation, left atrial enlargement and severe left ventricular dysfunction. This imaging phenomenon represents an important marker for thromboembolic risk and may influence the treatment and clinical outcome of these patients.

Survival in COPD patients with a daytime PaO2 greater than 60 mm Hg with and without nocturnal oxyhemoglobin desaturation.

There have been few studies examining the relationship between NOD and mortality in patients with COPD and none examining this relationship in those patients with a daytime PaO2 greater than 60 mm Hg. Is NOD related to early death, and if so, should nocturnal supplemental oxygen be considered as therapy for altering survival? We examined survival in 169 COPD subjects. Two definitions were used to classify subjects as NOD and non-NOD, one considering episodic desaturation associated mainly with REM sleep (definition 1) and one considering greater than 30 percent of time in bed spent below an SaO2 of 90 percent (definition 2) to be significant. Survival corrected for age was significantly better in non-NOD subjects. However, when stratified for supplemental oxygen use, survival remained better only in subjects separated by definition 1. There was a trend toward increased survival in 35 oxygen-treated vs 38 non-oxygen-treated NOD subjects (definition 1), but this difference was not statistically significant.

Sleep-related oxygen desaturation and daytime pulmonary haemodynamics in COPD patients.

It has been hypothesized that in chronic obstructive pulmonary disease (COPD), sleep-related hypoxaemia could lead to pulmonary hypertension (PH) and cor pulmonale, even in patients with only mild daytime hypoxaemia. We investigated the relationships between sleep variables and daytime pulmonary haemodynamics in 40 COPD patients with daytime arterial oxygen tension (PaO2) between 60-70 mmHg (8-9.3 kPa). Patients were considered as desaturators if they spent at least 30% of the sleep recording time with a transcutaneous O2 saturation (StcO2) less than 90%. Daytime arterial blood gases and pulmonary volumes could not discriminate desaturators "D" (n = 18) from non-desaturators "ND" (n = 22), but awake baseline StcO2, measured just prior to the onset of sleep, was lower in group D. Pulmonary artery mean pressure was significantly higher in group D (19.1 +/- 4.7 vs 16.8 +/- 1.9 mmHg, p less than 0.05) and all patients with PH (6 out of 40) belonged to group D. PH was observed in 6 of the 15 patients whose mean nocturnal StcO2 was less than 90% but in none of the 25 with a mean nocturnal StcO2 greater than 90%. The PH patients (n = 6), all desaturators, differed from the desaturators with no PH (n = 12), and from ND (n = 22) in having higher numbers of desaturation dips, longer durations of dips, and lower mean nocturnal arterial oxygen saturation (SaO2). We conclude that a causal relation between nocturnal desaturation and permanent PH is very likely. Further studies are needed to see whether oxygen therapy can prevent PH in these patients.

Nocturnal hypoxemia and long-term oxygen therapy in COPD patients with daytime PaO2 60-70 mmHg.

Six European treatment centers contributed to a controlled trial to study nocturnal hypoxemia in COPD patients having daytime PaO2 of 60-70 mmHg. The trial is composed of two parts: first, patients inclusion, taking men aged under 70 years, excluding sleep apnea syndrome and all other concomitant pathologies leading to nocturnal desaturation. We described this population and determined the frequency and degree of nocturnal desaturation. Correlations between different daytime and sleep parameters have also been established. The second part concerns the study of the two sub-populations of nocturnal desaturators and nondesaturators. This is followed by random allocation of the desaturators to oxygen or no oxygen treatment. We defined significant nocturnal desaturation as cumulated unsaturation period, exceeding 30% of total time, in bed spent under SaO2 lower than 90%. Twenty out of 46 patients were desaturators (43%). Only the first part is dealt with in this article.

Selection of patients for long-term oxygen therapy (LTO).

Serial blood gas measurement must be made for at least three months following an acute exacerbation of chronic obstructive pulmonary disease, to secure stable arterial oxygen tension (PaO2) values. The borderline indications of oxygen therapy concern the patients who have PaO2 over 8 kPa (60 mmHg), but have nocturnal hypoxaemia and/or pulmonary hypertension. The indications of specific drugs such as almitrine are still subject to discussion. The presence of obstructive sleep apnoeas together with ventilatory troubles related to chronic obstructive lung disease (overlap syndrome), is associated with many diagnostic and therapeutic problems.