From neurological soft signs to functional outcome in young individuals in treatment with secondary services for non-psychotic disorders: a path analysis.

BACKGROUND: Functional decline among patients with mental illness is not unique to individuals with psychotic disorders. Despite this, research on early predictors of functional outcome mainly focused on individuals thought to have an 'at risk mental state' (ARMS) for psychosis. There is evidence suggesting that certain early vulnerability markers, such as neurological soft signs (NSS), may explain variability in functional outcomes independent of the level of psychosis risk and the traditional diagnostic classification. METHOD: Structural equation modeling was applied to baseline data from a prospective longitudinal study of 138 young individuals in treatment with secondary services for non-psychotic disorders. We evaluated theoretically based models of pathways to functional outcome starting from NSS. The intervening variables were established according to previous evidence and drawn from two general categories: cognition (neuro- and social-) and negative symptoms (expressive and experiential). RESULTS: A final trimmed model was a single path running from NSS to neurocognition to experiential negative symptoms to outcome. It could not be improved by adding or dropping connections that would change the single path to multiple paths. The indirect effect from NSS to outcome was significant. The validity of the model was independent of the ARMS status and the psychiatric diagnosis. CONCLUSIONS: Our results provide evidence for a single pathway model in which the starting and intervening variables represent modifiable trans-diagnostic therapeutic targets to improve functional trajectories in young individuals with a recent-onset psychiatric diagnosis and different levels of psychosis risk.

Psychosis prediction in secondary mental health services. A broad, comprehensive approach to the "at risk mental state" syndrome.

BACKGROUND: Accuracy of risk algorithms for psychosis prediction in "at risk mental state" (ARMS) samples may differ according to the recruitment setting. Standardized criteria used to detect ARMS individuals may lack specificity if the recruitment setting is a secondary mental health service. The authors tested a modified strategy to predict psychosis conversion in this setting by using a systematic selection of trait-markers of the psychosis prodrome in a sample with a heterogeneous ARMS status. METHODS: 138 non-psychotic outpatients (aged 17-31) were consecutively recruited in secondary mental health services and followed-up for up to 3 years (mean follow-up time, 2.2 years; SD=0.9). Baseline ARMS status, clinical, demographic, cognitive, and neurological soft signs measures were collected. Cox regression was used to derive a risk index. RESULTS: 48% individuals met ARMS criteria (ARMS-Positive, ARMS+). Conversion rate to psychosis was 21% for the overall sample, 34% for ARMS+, and 9% for ARMS-Negative (ARMS-). The final predictor model with a positive predictive validity of 80% consisted of four variables: Disorder of Thought Content, visuospatial/constructional deficits, sensory-integration, and theory-of-mind abnormalities. Removing Disorder of Thought Content from the model only slightly modified the predictive accuracy (-6.2%), but increased the sensitivity (+9.5%). CONCLUSIONS: These results suggest that in a secondary mental health setting the use of trait-markers of the psychosis prodrome may predict psychosis conversion with great accuracy despite the heterogeneity of the ARMS status. The use of the proposed predictive algorithm may enable a selective recruitment, potentially reducing duration of untreated psychosis and improving prognostic outcomes.

Studies on mobility and degradation pathways of terbuthylazine using lysimeters on a field scale.

Terbuthylazine [N2-tert-butyl-6-chloro-N4-ethyl-1,3,5-triazine-2,4-diamine] degradation pathways in agricultural soils were evaluated by following the appearance and mobility of its main transformation products: dealkylated and hydroxylated derivatives. Three experimental degradation studies in open field were performed in different hydraulic conditions: constant hydraulic head on topsoil, achieved to simulate the highest-risk situation for the aquifer, intermittent artificial precipitation to simulate a medium-risk situation; and natural precipitation to reproduce the lowest-risk condition. Concentrations of terbuthylazine transformation products derived from dealkylation and hydroxylation reactions were measured in leachates and soil samples collected during the three experiments. Desethylterbuthylazine (DET) and deethylterbuthylazine-2-hydroxide [DETH; 4-amino-6-terbutylamino-(1,3,5)-triazine-2-OH] were found to be the highest-leaching compounds and therefore can be considered as potential pollutants for aquifer contamination.

Anaerobic removal of linear alcohol ethoxylates.

The present paper deals with a laboratory-scale study of anaerobic treatment of two commercial mixtures (LS2, LT7) of alcohol ethoxylates with 8-14 carbon atoms and 2 and 7 ethoxy groups. Tests were carried out in batch, with a 2 g l(-1) single dose, and in semibatch, with daily 0.2 g l(-1) doses. The behaviour of the tested mixtures was different: anaerobic sludge adsorption was the main removal process for LS2, while adsorption was less significant and biodegradation was more important for LT7. These differences appeared to be mainly related to the ethoxy portion length determining the extent of biodegradability and adsorption.

Broad ligament abscess after operative hysteroscopy.

Delayed complications in hysteroscopic surgery are very rare. This report describes an abscess of the left parametrium which occurred in a young woman after an operative hysteroscopy in which uterine perforation occurred.

How safe is hysteroscopic surgery? Our experience in the first 78 cases.

In this report we have considered the effectiveness of operative hysteroscopy for the treatment of endouterine pathologies in 78 patients admitted in our department from June 1991 to April 1994.

Pre-operative staging of endometrial carcinoma: magnetic resonance imaging versus ultrasounds and hysteroscopy.

Ultrasound, hysteroscopy and magnetic resonance imaging has been considerated to assess the loco-regional or extrapelvic extension of the endometrial carcinoma. Sonography has demonstrated a certain inaccuracy in predicting myometrial invasion or the involvement of the canal. Hysteroscopy allows us to characterize neoplasia and to assess its extension in the cervical canal. MR imaging is more helpful in the diagnosis of channel invasion. The assessment of ovarian metastasis requires ultrasonography or coronal planes RM imaging. As regards the involvement of the pelvic and extrapelvic lymph nodes MR is more accurate than ultrasound scan.

Uterine changes during tamoxifen therapy.

Tamoxifen used for adjuvant therapy in breast cancer, has a complex and unclear action on endometrium and myometrium. Many authors demonstrated endometrial proliferous changes in peri and post menopausal women. Our study shows the development of myomas in three patients without uterine pathology before tamoxifen therapy, and the increase of a polip and a myoma after tamoxifen therapy. Moreover, we observed the development of a myoma in a patient after one year tamoxifen in association with LH-RH analogue therapy. It is necessary to continue our study with a larger number of patients to assess the hyperplasic effect of tamoxifen.

Sonographic, hysteroscopic, histological correlation in the early diagnosis of endometrial carcinoma.

The authors evaluate the diagnostic role of hysteroscopy and sonography in the early detection of endometrial cancer. In their experience diagnostic accuracy of transabdominal ultrasound was 87.5%; the introduction of transvaginal sonography increased it up to 95.8%, whereas hysteroscopy had diagnostic accuracy of 100%. The hysteroscopy allowed us to establish cervical canal involvement in 100% of cases. Since sonography is well accepted by patients, the authors propose to perform it in high risk patients once a year as a first level exam to show abnormal endometrial echoes. Therefore patients can be selected to undergo hysteroscopy and, if necessary, biopsy.