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PubMedDate not supplied

Insight and illness in chronic schizophrenia.

The role of insight in relation to the diagnosis and treatment of psychotic disorders has received renewed attention in psychiatric and psychological literature. Degree of insight has been found to generally associate with social and occupational functioning, prognosis, and treatment outcome. However, the relationship between insight and symptoms of illness is not known due to previous studies that yielded conflicting results. This study tested the association between general insight and symptomatology in a sample of 66 patients with chronic schizophrenia. Degree of insight was significantly related to positive symptomatology; however, it was not related to demographics, negative symptoms, general psychopathology, or global functioning. These results are supported by several other investigations in this area.

Adult↗

PubMed1992

Evaluation of changes in myocardial function on exercise in patients with coronary artery disease using gated MIBI scintigraphy.

Technetium-99m-methoxy-isobutyl-isonitrile (MIBI) is a myocardial perfusion agent which allows simultaneous assessment of left ventricular function. We evaluated left ventricular (LV) function with exercise using a new method of myocardial profiling in 43 patients with chest pain. Twenty-eight had significant coronary artery disease and 15 were normal on coronary angiography. Results were compared to equilibrium radionuclide ventriculography. MIBI fractional shortening (FS) correlated well with ejection fraction (EF) on exercise (r = 0.79, P = less than 0.001). There was also a good correlation between changes in global function from rest to exercise (r = 0.82, P = less than 0.001) with a sensitivity of diagnosing CAD of 71% and specificity of 80%. New regional wall abnormalities were detected in 25/28 with CAD with a sensitivity of 89% and specificity of 60%. There was also a close correlation between mean diameters measured with gated MIBI scans and volumes measured with RNV, end-diastolic diameter (EDD) versus end-diastolic volume (EDV) r = 0.78 (P = less than 0.001) at rest and r = 0.74 (P = less than 0.001) on exercise and end-systolic diameter (ESD) versus end-systolic volume (ESV) r = 0.72 (P = less than 0.001) at rest and r = 0.72 (P = less than 0.001) on exercise. This produced a sensitivity for detecting CAD of 79% and a specificity of 73%. These results show that gated MIBI scanning on exercise provides information comparable to RNV so enhancing the diagnostic usefulness of MIBI.

Adult↗

PubMedDate not supplied

Diagnosis and management of Alzheimer disease.

BACKGROUND: Alzheimer disease afflicts millions of older Americans, with an estimated cost to society approaching $100 million annually. Family physicians will care for an increasing number of patients with Alzheimer disease as well as their caregivers and families. METHODS: A comprehensive and systematic review of the literature published between 1985 and 1998 about diagnosing and treating Alzheimer disease was conducted, using "dementia," "Alzheimer's disease," and "treatment" as search strategy key words. Data and information that reported significant conclusions were critically reviewed. Potentially important new data about new agents that might be of benefit when caring for patients with Alzheimer disease are discussed. RESULTS AND CONCLUSIONS: The primary goals when treating Alzheimer disease patients are enhancing autonomy and functional abilities and maintaining quality of life for patients and caregivers. In addition to diagnostic and pharmacologic treatment, primary care physicians will be called upon to provide nonpharmacologic support to assist with behavioral, social, and living environment problems faced by these patients and their families. The most common pharmacologic treatment is cholinesterase inhibition. Two cholinesterase inhibitors, tacrine and donepezil, are effective in treating cognitive and global function. Newer cholinesterase inhibitors should soon be available that might offer safety advantages as well as efficacy in treating behavioral and psychiatric symptoms related to Alzheimer disease. Other agents, including vitamin E, nonsteroidal anti-inflammatory drugs, estrogen, and Ginkgo biloba, are under investigation. Nonpharmacologic measures are important components in the management of Alzheimer disease. Support groups can help to diminish behavioral problems, maintain the patient's independence, and provide relief for caregivers and families.

Alzheimer Disease↗

PubMed2004

[Reliability of cardiac magnetic resonance imaging indicators of myocardial viability for predicting the recovery of systolic function after a first acute myocardial infarction with a patent culprit artery].

INTRODUCTION AND OBJECTIVE: To assess the reliability of early analysis of the most frequently used cardiac magnetic resonance (CMR)-derived indexes for predicting systolic function recovery and ventricular remodeling in patients after a first acute myocardial infarction with a patent culprit artery. PATIENTS AND METHOD: 17 patients were studied with an initial CMR protocol that included regional assessment of wall thickness and wall thickening, low-dose dobutamine response, first-pass gadolinium myocardial perfusion imaging and delayed enhancement. These results were compared with those obtained for segmental and global function in a second CMR study 6 months later. RESULTS: Of the 272 myocardial segments evaluated in the initial study, 73 showed severe systolic dysfunction. The findings were used to calculate sensitivity and specificity of each of the indexes mentioned above for predicting myocardial viability. The sensitivities and specificities for each index were wall thickness > or =5.5 mm, 100% and 12%; low-dose dobutamine response, 41% and 93%; normal myocardial perfusion, 78% and 68%; delayed enhancement, 81% and 95%. Multivariate analysis showed that delayed enhancement was the only independent predictor of contractility (r=-0.83, P=.0001), ventricular volumes (end-diastolic: r=0.61, P=.009, end-systolic: r=0.67, P=.003) and ejection fraction (r=-0.73, P=.001) at 6 months. CONCLUSIONS: Delayed enhancement seen in CMR is a reliable, quantifiable index for predicting recovery of systolic function and ventricular remodeling in patients after a first infarction with a patent culprit artery.

Female↗

PubMedDate not supplied

[Vascular hemichorea: clinical-radiological correlation].

INTRODUCTION: Hemichorea is uncommon in acute cerebrovascular accidents. Its appearance is in relation to the contralateral involvement of the basal ganglia, particularly the striate ganglion. With current neuroimaging techniques it is possible to identify the lesions responsible for these abnormal movements. Magnetic resonance (MR) is the technique of choice for detection of small sized lesions. OBJECTIVE: We have analysed our series of patients to try to relate the site of the lesion to the appearance of chorea. PATIENTS AND METHODS: We made a retrospective study of the cases of hemichorea of vascular origin admitted between January 1993 and April 1999. In all cases, cerebral CAT and/or MR had been done to find the site of the lesion. RESULTS: A total of 10 patients with an average age of 72.5 years (range: 55-85) was found. In eight of them (80%) lesions were found in the basal ganglia, half of which were of ischemic type and the other half hemorrhagic. The sites were: caudate nucleus in one case (10%), thalamus in two cases (20%) and capsulo-lenticular lesions in five cases (50%). All lesions were contralateral to the side of the body affected except in one case with a left thalamic haematoma and homolateral hemichorea. CONCLUSIONS: The lesions found were very varied in site. In 20% of the cases they were not detected by conventional neuroimaging techniques. This fact supports the concept of a functional global network of the basal ganglia which may be interrupted at several points and lead to the same clinical findings.

Aged↗

PubMed2006

Incarceration and hospital care.

Risk for jail or prison recidivism is well documented among incarcerated individuals with schizophrenia. However, it is less clear that risk is also high for psychiatric hospital readmission after accounting for mediating influences such as psychopathology severity, functioning level, substance misuse, and demographic characteristics. Relative to counterparts without prior time in jail, this study therefore assessed whether formerly incarcerated individuals with schizophrenia were more likely to repeatedly use hospital care after controlling for level of functioning and symptomatology. Among 315 inpatients, former inmates had a greater mean number of previous hospital stays than other patients (t = -2.13; df = 305; p = 0.03) and were more likely to visit the emergency room or be rehospitalized within 3 months of discharge (chi2 = 8.83; df = 1; p = 0.003). They were twice as likely to be readmitted, moreover, even after accounting in logistic regression for age, sex, race, global functioning, psychopathology severity, alcohol abuse or dependence, and drug abuse or dependence (OR = .49; CI = .26-.95). Implications for community care are discussed, and the suggestion is made that jail diversion programs should be renamed and refocused as "jail and hospital diversion."

Adolescent↗

PubMed2025

kMermaid: Ultrafast metagenomic read assignment to protein clusters by hashing of amino acid k-mer frequencies.

Shotgun metagenomic sequencing can determine both the taxonomic and functional content of microbiomes. However, functional classification for metagenomic reads remains highly challenging as protein mapping tools require substantial computational resources and yield ambiguous classifications when short reads map to homologous proteins originating from different bacteria. Here we introduce kMermaid for the purpose of uniquely mapping bacterial short reads to taxa-agnostic clusters of homologous proteins, which can then be used for downstream analysis tasks such as read quantification and pathway or global functional analysis. Using a nested hash map containing amino acid k-mer profiles as a model for protein assignment, kMermaid achieves the sensitivity of popular existing protein mapping tools while remaining highly resource efficient. We evaluate kMermaid on simulated data and data from human fecal samples as well as demonstrate the utility of kMermaid for classifying reads originating from new, unseen proteins. kMermaid allows for highly accurate, unambiguous and ultrafast metagenomic read assignment into protein clusters, with a fixed memory usage, and can easily be employed on a typical computer.

Metagenomics↗

PubMedDate not supplied

On the descriptive validity of ICD-10 schizophrenia: empirical analyses in the spectrum of non-affective functional psychoses.

In order to examine the descriptive validity of ICD-10 schizophrenia, 1,476 consecutively admitted in-patients were included in the present study. ICD-10 schizophrenia (n=951) was compared with other non-affective psychotic disorders [persistent delusional disorders (n=51), acute and transient psychotic disorders (n=116) and schizoaffective disorders (n=354)] with respect to sociodemographic, symptomatological and other clinical parameters. Analyses revealed that it is possible to distinguish schizophrenia from other non-affective psychotic disorders according to ICD-10 criteria: schizophrenic patients were characterised by more pronounced negative symptoms and a lower global functioning. They were younger than patients with persistent delusional disorders and schizoaffective disorders but older than patients with acute and transient psychotic disorders. The results are in line with a high descriptive validity of ICD-10 schizophrenia and highlight the importance of negative symptoms for this diagnosis.

Activities of Daily Living↗

PubMed1999

Reduced subendocardial ryanodine receptors and consequent effects on cardiac function in conscious dogs with left ventricular hypertrophy.

The goal of this study was to examine the transmural distribution of ryanodine receptors in left ventricular (LV) hypertrophy (LVH) and its in vivo consequences. Dogs were chronically instrumented with an LV pressure gauge, ultrasonic crystals for measurement of LV internal diameter and wall thickness, and a left circumflex coronary blood flow velocity transducer. Severe LVH was induced by chronic banding of the aorta (12+/-1 months), which resulted in a 78% increase in LV/body weight. When ryanodine was infused directly into the circumflex coronary artery, it did not affect LV global function or systemic hemodynamics; however, it reduced LV wall thickening and delayed relaxation in the posterior wall in control dogs but was relatively ineffective in dogs with LVH. In LV sarcolemmal preparations, [3H]ryanodine ligand binding revealed a subendocardial/subepicardial gradient in normal dogs. In LVH there was a 45% decrease in ryanodine receptor binding and a loss in the natural subendocardial/subepicardial gradient, which roughly correlated inversely with the extent of LVH and directly with regional wall motion. Both mRNA and Western analyses revealed similar findings, with a reduction of the transmural mRNA levels and a loss in the natural gradient between subendocardial and subepicardial layers in LVH. Thus, ryanodine receptor message and binding in LVH is reduced preferentially in the subendocardium with consequent attenuation of the action of ryanodine in vivo. The selectively altered ryanodine regulation subendocardially in LVH could reconcile some of the controversy in this field and may play a role in mediating decompensation from stable LVH.

Animals↗

PubMed2003

Social characteristics of seasonal affective disorder patients: comparison with suicide attempters with non-seasonal major depression and other mood disorder patients.

Although it is evident from numerous studies that patients with mood disorders generally have a deficient social functioning and a weak social network, little is known about these aspects of seasonal affective disorder (SAD) patients. We studied the social situation, the social network and the social functioning of SAD (n = 20) patients in comparison with matched suicide attempters (SA) with non-seasonal major depression, and with findings from other major depressive disorder (MDD) studies and community samples. The social situation and the clinical background of both the SAD and the SA groups were almost similar and the social networks were equally disadvantageous and weaker than those observed in some community/healthy populations. Furthermore, the data on global functioning and social adjustment of the SAD group were well comparable to those of other MDD patients and significantly worse than that of a community sample. Thus, the results indicate a considerable social impairment in SAD.

Adult↗

PubMed2005

Visuospatial learning and executive function are independently impaired in first-episode psychosis.

BACKGROUND: Demonstrating specific cognitive impairments in psychotic disorders is difficult. However, specific deficits in memory and executive functions have often been claimed. The Cambridge Neuropsychological Test Automated Battery (CANTAB) tasks of IDED attention-shifting (an executive task) and visuospatial paired associates learning (PAL, a memory task) require intact frontal and temporo-hippocampal functioning, respectively; both have been suggested as markers of disease progress in psychosis. METHOD: Seventy-one subjects with a first-episode psychosis or at-risk mental state were assessed on these two tasks during referral to a specialist service, the Cambridge-based CAMEO early intervention team. RESULTS: Performance on the two tasks was dissociated. Poor performance on the PAL test was associated with increased symptom levels and poorer global function, while failure on the IDED executive test was not found to have significant clinical associations. Duration of illness was not associated with performance on either task. CONCLUSIONS: Visuospatial PAL failure may be a marker of clinical severity at the onset of psychosis while IDED performance may reflect a more stable, trait-like impairment. Dissociated performance on the executive and associative learning tasks may reflect independent, neurally dissociated impairments that do not arise in a fixed order. This may explain some of the heterogeneity of cognitive function seen in early psychosis.

Adult↗

PubMed1996

Maximal blood lactate level acts as a major discriminant variable in exercise testing for coronary artery disease detection in men.

BACKGROUND: The interpretation of exercise stress testing for coronary artery disease detection is affected by the many differences in chosen variables and mathematical methods. We conducted a prospective trial to evaluate a global muscle fatigue parameter--the blood lactate level achieved at maximal exercise--as a method of distinguishing between diseased and nondiseased coronary status. METHODS AND RESULTS: We evaluated 236 consecutive male patients without previous myocardial infarction who had been referred for the diagnosis of coronary artery disease. None of the patients had cardiomyopathy, severe cardiac heart failure, or valvular heart disease. Blood lactate concentration at maximal exercise was measured as well as other classic variables. Correlations between variables and coronary status as assessed by coronary arteriography were described using receiver operating characteristic (ROC) curves and logistic regression analysis. The first four most powerful variables (lactate level, maximal power output, exercise duration, and percentage of maximal predicted heart rate), which are directly representative of the global functional capacity, showed values of 0.777, 0.775, 0.760, and 0.740, respectively, by ROC curve analysis. Mean +/- SD blood lactate level at peak exercise reached 7.68 +/- 2.70 mmol/L in the 153 diseased and 10.56 +/- 2.75 mmol/L in the 83 nondiseased patients (P < .0001). After adjustment for other variables, blood lactate level remained a significant predictor of coronary artery disease by logistic regression analysis (adjusted odds ratio, 1.2; confidence interval, 1.04 to 1.4). CONCLUSIONS: Global muscle fatigue as assessed by lactate levels in the blood at maximal exercise appears to be a powerful distinguisher of diseased and nondiseased coronary status.

Adult↗

PubMed2001

Manganese-enhanced MRI of mouse heart during changes in inotropy.

Recently the dual properties of manganese ion (Mn(2+)) as an MRI contrast agent and a calcium analogue to enter excitable cells has been used to mark specific cells in brain and as a potential intracellular cardiac contrast agent. Here the hypothesis that in vivo manganese-enhanced MRI (MEMRI) can detect changes in inotropy in the mouse heart has been tested. T(1)-weighted images were acquired every minute during an experimental time course of 75 min. Varying doses of Mn(2+) (3.3-14.0 nmoles/min/g BW) were infused during control and altered inotropy with dobutamine (positive inotropy due to increased calcium influx) and the calcium channel blocker diltiazem (negative inotropy). Infusion of MnCl(2) led to a significant increase in signal enhancement in mouse heart that saturated above 3.3 +/- 0.1 nmoles/min/g BW Mn(2+) infusion. At the highest Mn(2+) dose infused there was a 41-47% increase in signal intensity with no alteration in cardiac function as measured by MRI-determined ejection fractions. Dobutamine increased both the steady-state level of enhancement and the rate of MRI signal enhancement. Diltiazem decreased both the steady-state level of enhancement and the rate of MRI signal enhancement. These results are consistent with the model that Mn(2+)-induced enhancement of cardiac signal is indicative of the rate of calcium influx into the heart. Thus, the simultaneous measurement of global function and calcium influx using MEMRI may provide a useful method of evaluating in vivo responses to inotropic therapy.

Animals↗

PubMed2004

Caged phosphopeptides reveal a temporal role for 14-3-3 in G1 arrest and S-phase checkpoint function.

Using classical genetics to study modular phosphopeptide-binding domains within a family of proteins that are functionally redundant is difficult when other members of the domain family compensate for the product of the knocked-out gene. Here we describe a chemical genetics approach that overcomes this limitation by using UV-activatable caged phosphopeptides. By incorporating a caged phosphoserine residue within a consensus motif, these reagents simultaneously and synchronously inactivate all phosphoserine/phosphothreonine-binding domain family members in a rapid and temporally regulated manner. We applied this approach to study the global function of 14-3-3 proteins in cell cycle control. Activation of the caged phosphopeptides by UV irradiation displaced endogenous proteins from 14-3-3-binding, causing premature cell cycle entry, release of G1 cells from interphase arrest and loss of the S-phase checkpoint after DNA damage, accompanied by high levels of cell death. This class of reagents will greatly facilitate molecular dissection of kinase-dependent signaling pathways when applied to other phosphopeptide-binding domains including SH2, Polo-box and tandem BRCT domains.

14-3-3 Proteins↗

PubMedDate not supplied

[Regulation of cardiac output;an approximation at 3 levels: organic, cellular, and protein].

The heart is the central point for adaptation of the organism to physical exercise because it is the center of the energy support system. Its activity is regulated at three levels; organ, cells and molecular and genetic components. During the development of the heart, the organ adapts in response to chronic and acute overloads by instantaneous functional and chronic changes, leading to a variable degree of cardiac growth. Physical exercise (acute and chronic) is the main example of physiologic overload. The acute response of the heart means a mechanical-hemodynamical and energetic modulation, driving to a final point where oxygen supply fits the increased need. Training, as response to chronic exercise, promotes an increase in energetic capacity (heart rate and stroke volume), structurally reflected in the physiological cardiac hypertrophy. Global functional and structural changes express what is happening at the cellular level. Different stimuli signal through specific receptors and second messengers to the nucleus, regulating gene expression and conditioning structural (size) and functional (contractile) changes. Changes in cellular size explain, by Starling mechanism, the increase in individual contractile strength and in reduction of the ventricular cavity in the systolic period. Other structural changes refer to the interstitium, myocardial vasculature and vascular reactivity. Changes in contractility affect the composition of the contractile elements (isoforms of heavy myosin, light myosin and/or modulatory proteins) and sarcoplasmic Ca2+ regulation, through the increase in Ca2+ flow. Many of the adaptations to chronic exercise studied in vivo in intact heart, isolated heart (Langendorf) or papillary muscle (multicellular preparation), are retained in the cardiomyocyte. Isolated cardiomyocytes can be precisely through the medium, temperature, ionic composition, active substances, etc. Shortening speed without load (Vmax), considered an inotropic index (Sonnenblick) can be measured independently of the initial length. Myocytes shorten against an internal load (restoration force) with viscous and elastic components, although they cannot be loaded externally (stretching is difficult). Cardiomyocyte isolation and maintenance requires strict and controlled conditions. This model offers many possibilities for studying dimensions, contraction-relaxation mechanics, Ca2+ and pH dynamics, beta-adrenergic receptors, electrophysiology, pharmacology, genetics, etc. This kind of studies can deal with normal myocytes or myocytes from trained animals, cardiomyopathies, etc.

Adaptation, Physiological↗

PubMed1999

Transmyocardial laser revascularization. Early clinical experience.

OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR) in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor), University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG). All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score) unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA). Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months), with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15% of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

Aged↗

PubMedDate not supplied

[Symptoms and social functioning features in chronic schizophrenia are aggregate in a tripartite structure].

OBJECTIVE: To verify the association between schizophrenic symptoms and multidimensional variables of social functioning and to look for a possible classification based on an empirical classification outcome oriented. DESIGN: Forty chronic schizophrenic patients, with a diagnosis ascertained through clinical interview and diagnostic criteria were enrolled in the study. SETTING: All patients were followed in a State Mental Health center and were assessed in a stabilized phase of illness. PRINCIPAL OUTCOME MEASURES: Psychopathological assessment was made with PANSS and CGI. Psychosocial assessment was made with Life Skills Profile and Global Functioning Scale. RESULTS: A pervasive correlation among symptoms and psychosocial variables emerged suggesting a unitary concept of behavior related to diagnosis. Factor analysis revealed 2 main components able to explain the 79% of variance. Cluster analysis separated the patients in 3 different groups showing that clinical symptoms are aggregated with specific variables of social functioning. CONCLUSION: Schizophrenic symptoms and social functioning are organized in a tripartite structure. It suggests the existence of three different syndromes that are outcome oriented, and compatible with an unitary concept of schizophrenia.

Adult↗

PubMed1989

[Serial changes in left ventricular global and regional function during exercise after percutaneous transluminal coronary angioplasty; effect of complete coronary revascularization].

In order to evaluate the effect of complete coronary revascularization (CR) with PTCA on global LV function at rest and during exercise, EF, LV volumes and systolic blood pressure/end-systolic volume index (SP/ESVI) were assessed in 23 patients with CR before, 14 days after (early FU) and 4 to 12 months after PTCA (late FU) by first-pass radionuclide angiography (FRNA). The subjects were divided into 3 groups in this study, G-I which consisted of 14 patients with continued CR, G-II, 9 patients with discontinued CR due to restenosis and G-C, 7 normal subjects. To further assess anterior (Ant) and apical (Ap) regional EFs, 15 patients with dilatation of left anterior descending artery were subdivided into 9 patients with continued success (G-I LAD) and 6 patients with restenosis (G-II LAD). Exercise-induced global LV dysfunction improved significantly both at early FU and late FU in G-I, however improved insignificantly at early FU and did not change at late FU in G-II. Even response to exercise (delta EF, % delta SP/ESVI) at late FU in G-I was significantly (p less than 0.05) less than those in G-C. Regional dysfunction during exercise already improved significantly (Ant: p less than 0.05, Ap: p less than 0.01) at early FU in G-I LAD, but did not improve sufficiently in G-II LAD. In conclusion, FRNA may be useful for the assessment of completeness of coronary revascularization by PTCA and may give guidelines for repeat angiography.

Adult↗