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Age-related cognitive slowing: the role of spontaneous tempo and processing speed.

This research studied the relationships between two types of slowing observed in aging-loss of general processing speed and slowing of spontaneous tempo-in an attempt to test the assumption that there is an internal timing mechanism responsible for cognitive age-related decrease. Processing speed has been evaluated as a mediator of the relationship between age and working memory, concurrently with spontaneous tempo measures. The authors compared the performance of young and older adults on tasks involving spontaneous motor tempo, processing speed, and working memory. The findings confirmed the agerelated slowing of spontaneous motor tempo but did not indicate superiority of tempo mediation in the decline in working memory. Processing speed appeared to be a major mediator of working memory, but also of spontaneous tempo slowing.

Adult↗

Aortic stiffness in patients undergoing hemodialysis is positively related to antigen presenting cell-dependent T-lymphocyte reactivity.

BACKGROUND: Aortic stiffness is increased in patients undergoing hemodialysis (HD), and it is associated with an increased cardiovascular mortality. Among others, aortic stiffness has been correlated with serum markers of inflammation, indicating a role of the immune system in its pathogenesis. The aim of this study was to evaluate the impact of antigen-presenting cell-dependent T-lymphocyte reactivity on aortic stiffness in HD patients. PATIENTS AND METHODS: Twenty patients were enrolled in the study. Exclusion criteria were medications or conditions, other than HD, that are known to influence the immune response or aortic stiffness. Antigen-presenting cell-dependent T-lymphocyte reactivity was assessed by cell proliferation of peripheral blood mononuclear cells cultured with or without stimulation with Staphylococcal enterotoxin B (SEB). Cell proliferation was estimated by immunoenzymatic measurement of bromodeoxyuridine uptake. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (PWV) measurement. RESULTS: Linear regression analysis revealed a strong positive relation between carotid-femoral PWV and antigen-presenting cell-dependent T-lymphocyte reactivity, when SEB at concentrations of 1 ng/mL or 10 ng/mL was used as stimulant. CONCLUSION: The present study confirms that aortic stiffness in HD patients is positively related to antigen-presenting cell-dependent T-lymphocyte reactivity. The greater the ability of the immune system to react to a monocyte-dependent stimulant and, consequently, to provoke an inflammatory response, the greater the stiffness of the aorta. This is in agreement with the observation that aortic stiffness in HD patients is positively related to various serum inflammation markers.

Adult↗

Mixed depressive states: nosologic and therapeutic issues.

This paper focuses on the clinical importance of affective mixed states with special attention given to agitated depression, which has lost its status as a mixed state in the DSM and ICD systems. Following a historical review of the topic, the psychopathological elements are examined. Psychic and motor agitation are considered equally important for the definition of agitated depression and the concept of latent agitated depression is introduced for those major depressive episodes that become agitated following antidepressant treatment. The thesis is advanced that the erroneous nosologic position of agitated depression and its treatment as simple, unipolar depression is at least partly responsible for the problematic issues of the unfavourable treatment outcome and high suicide rates among depressive patients.

Anxiety Disorders↗

Renin expression in hematological malignancies and its role in the regulation of hematopoiesis.

It has been demonstrated that some myeloid blasts express renin, but normal bone marrow (BM) does not display this expression. The aim of the present work was to analyze the renin expression in different hematological malignancies and different myeloid cell lines. We investigated the expression of renin by RT-PCR in BM from patients with hematological malignancies (106 patients), in nine normal BM from healthy donors and in leukemic cell lines (K562, KU812, MEG-01, U-937 and HL60), as well in K562 cell line subjected to differentiation treatments. We have observed renin expression in cells from acute myeloid leukemia (AML), chronic myelogenous leukemia (CML) and acute lymphoblastic leukemia (ALL) cases. The highest frequency was observed in AML-non acute promyelocytic leukemia(APL) cases (47.2% of the cases). The disappearance of this expression was associated with the status of complete remission of AML. Renin is expressed in some myeloid human leukemia cell lines such as K562, KU812 and MEG-01. However, when K562 cells were treated with inducers of growth inhibition and/or differentiation, the expression did not disappear, indicating that renin expression is associated with a blastic phenotype rather than with cell proliferation. The obtained findings suggest that the renin expression could have a role on the disease development and could be used as an aberrant marker of leukemia.

Antineoplastic Agents↗

Is theory-of-mind impaired in Parkinson's disease?

INTRODUCTION: Theory-of-mind (ToM) refers to the ability to understand and predict the behaviour of others based on their mental states. Research from brain imaging and lesion studies indicate that the frontal lobes are both involved and necessary to understand mental states. METHODS: A total of 13 people with Parkinson's disease were compared with 11 age-matched controls on tasks involving ToM, based on the hypothesis that the frontal lobes are affected by Parkinson's disease. The four tasks included both ToM and non-ToM components, such as memory, to investigate the specific nature of the deficit. RESULTS: The group with Parkinson's disease scored significantly lower on three out of four of the ToM components of the tasks, relative to controls, but were not impaired on any of the non-ToM components of the four tasks. CONCLUSION: The results suggest the impairment was specific to ToM and thus have implications for a dedicated specific ToM module.

Journal Article↗

Manual skill, hand skill asymmetry, and cognitive performances in young children.

A total of 1022 children aged 3 to 6 years were examined in their preschools and 27% of them were followed up for 2 years. A computerised version of the peg-moving task was used repeatedly to assess hand skill of the dominant and the nondominant hand. Cognitive performance was repeatedly evaluated by tasks involving speech, vocabulary, phonological memory, and visual-spatial skills. Results showed that: (i) age, sex, and handedness effects on hand skill asymmetry generally confirmed previous reports, especially by Annett (2002); (ii) visual-spatial and vocabulary tasks were significantly related to hand skill but speech and phonological memory tasks were not, and the role of the dominant and nondominant hand were similar; (iii) overall, manual laterality indexes were only weakly associated to some cognitive abilities; (iv) early manual skill was more strongly associated to cognitive tasks than later manual skill. These results fit the assumption of a significant role of early manual behaviour in aspects of cognitive development not relying exclusively on phonology, and raise questions about cognitive development and rehabilitation of children with early occurring manual deficiencies.

Journal Article↗

A nonparametric comparison of the effectiveness of treatments: a multivariate toxicity-penalized approach.

In cancer clinical trials, the amount of treatment dose actually received by a patient may be limited by severe toxicity or lack of efficacy. A nonparametric approach is proposed for comparing the effectiveness of treatments based on the bivariate relationship defined by the doses at which efficacy and toxicity are observed to occur. Simulation studies are used to contrast the performance of the new procedure with the usual method of comparing percentages of patients who have effective results. Data from a randomized clinical trial of patients with metastatic nonseminomatous germ cell tumors are used to illustrate the method.

Antineoplastic Agents↗

"Waste not, want not": determining the optimal priming volume for intravenous insulin infusions.

BACKGROUND: Insulin adsorbs to plastics used for intravenous (IV) tubing. As a result, clinical IV insulin infusion procotols advise an initial priming volume of up to 50 mL, which may be wasteful-especially since most institutions use 100-mL IV solution bags. In this brief report, we sought to determine the optimal priming volume required for clinical IV insulin infusions. METHODS: One hundred units of regular human insulin was dissolved into 100 mL of 0.9% NaCl. Employing a standard polypropylene infusion set, a priming infusion was started. At 10- mL intervals, from 0 to 50 mL, effluent was collected directly into glass vials. After dilution (1:10,000) using a proprietary buffer, insulin concentrations were then measured using a double antibody radioimmunoassay. Twenty individually prepared insulin bags were tested in this manner. RESULTS: Insulin levels without prime were 15.8% [95% confidence interval (CI), 9.1-22.6%] lower than insulin levels following 50 mL of prime (designated as "maximal values"). After a priming volume of 10 mL, insulin adsorption losses fell to a marginally significant 6.6% (95% CI, 0.1-13.1%). Following 20 mL of prime, insulin concentrations were indistinguishable from maximal values (3.4% loss, 95% CI, -0.2% to 7.1%). CONCLUSIONS: For standard IV insulin infusions, a priming volume of 20 mL is sufficient to minimize the effect of insulin adsorption losses to IV lines. Priming volumes exceeding 20 mL are wasteful, increase costs, and generate unnecessary work for nurses and pharmacists.

Adsorption↗

Medical care at the end of life: views of African American patients in an urban hospital.

BACKGROUND: Although one goal of end-of-life care is to honor the wishes and needs of patients, little research has been done to characterize what is important to seriously ill African American patients at the end of life. OBJECTIVE: To characterize the views of seriously ill African American patients toward end-of- life care. DESIGN: A qualitative study using semistructured, in-depth interviews. SETTING AND PARTICIPANTS: Patients in a large, urban, public hospital who are facing a serious illness. RESULTS: Twenty-three African American patients were interviewed. Although most acknowledged a point at which they would want to cease aggressive care, some equated this with giving up. Most subjects expressed that the end of life was in God's hands. Many expressed a concern to be free of pain and suffering. Few saw a significant role for the physician at the end of life. Some had expressed their wishes for care to a family member. Others thought such discussions were unnecessary because a family member would make decisions or because death was not imminent. Subjects raised concerns about trust in the physician and the burden of end-of-life discussions. CONCLUSIONS: African Americans in an urban, public hospital who are facing a severe illness have clear desires for care at the end of life and are willing to discuss their views at length. Such discussions should explore patients' desire for aggressive care, consider spiritual views and the importance of family in end-of-life decisions, and consider that some patients will not believe such discussions are necessary.

Adult↗

Adjusting body cell mass for size in women of differing nutritional status.

BACKGROUND: Body cell mass (BCM) may be estimated in clinical practice to assess functional nutritional status, eg, in patients with anorexia nervosa. Interpretation of the data, especially in younger patients who are still growing, requires appropriate adjustment for size. Previous investigations of this general issue have addressed chemical rather than functional components of body composition and have not considered patients at the extremes of nutritional status, in whom the ability to make longitudinal comparisons is of particular importance. OBJECTIVE: Our objective was to determine the power by which height should be raised to adjust BCM for height in women of differing nutritional status. DESIGN: BCM was estimated by (40)K counting in 58 healthy women, 33 healthy female adolescents, and 75 female adolescents with anorexia nervosa. The relation between BCM and height was explored in each group by using log-log regression analysis. RESULTS: The powers by which height should be raised to adjust BCM were 1.73, 1.73, and 2.07 in the women, healthy female adolescents, and anorexic female adolescents, respectively. A simplified version of the index, BCM/height(2), was appropriate for all 3 categories and was negligibly correlated with height. CONCLUSIONS: In normal-weight women, the relation between height and BCM is consistent with that reported previously between height and fat-free mass. Although the consistency of the relation between BCM and fat-free mass decreases with increasing weight loss, the relation between height and BCM is not significantly different between normal-weight and underweight women. The index BCM/height(2) is easy to calculate and applicable to both healthy and underweight women. This information may be helpful in interpreting body-composition data in clinical practice.

Adolescent↗

Body composition in children in remission from acute lymphoblastic leukemia.

BACKGROUND: Changes in body composition are commonly reported in pediatric survivors of acute lymphoblastic leukemia (ALL). However, the effect of ALL and of its treatment on body composition in children in remission from ALL has not been fully examined with the use of a reference method. OBJECTIVES: We aimed to determine the body composition and composition of fat-free mass (FFM) in children in remission from ALL. We also aimed to compare the effects that prednisolone and dexamethasone had on the body composition of an ALL survivor population. DESIGN: This cross-sectional study measured height, weight, body volume, total body water, and bone mineral content in 24 children in remission from ALL and 24 age-matched, healthy control subjects. Body composition and FFM composition were evaluated by using the 4-component model. RESULTS: The mean body mass index and fat mass index were significantly (P = 0.05 for both) higher in the ALL survivors than in age-matched control subjects. The composition of the FFM in the 2 treatment groups was not observed to differ significantly. Examination of the composition of FFM made it evident that children in remission from ALL had both significantly greater hydration (P = 0.001) and lower density (P = 0.0001) of FFM than did the control children. CONCLUSIONS: Children in remission from ALL may develop excess body fat. To measure body composition accurately in an ALL population, the high hydration and low density of FFM in this population should be taken into consideration.

Absorptiometry, Photon↗

The rises and falls of disconnection syndromes.

In a brain composed of localized but connected specialized areas, disconnection leads to dysfunction. This simple formulation underlay a range of 19th century neurological disorders, referred to collectively as disconnection syndromes. Although disconnectionism fell out of favour with the move against localized brain theories in the early 20th century, in 1965, an American neurologist brought disconnection to the fore once more in a paper entitled, 'Disconnexion syndromes in animals and man'. In what was to become the manifesto of behavioural neurology, Norman Geschwind outlined a pure disconnectionist framework which revolutionized both clinical neurology and the neurosciences in general. For him, disconnection syndromes were higher function deficits that resulted from white matter lesions or lesions of the association cortices, the latter acting as relay stations between primary motor, sensory and limbic areas. From a clinical perspective, the work reawakened interest in single case studies by providing a useful framework for correlating lesion locations with clinical deficits. In the neurosciences, it helped develop contemporary distributed network and connectionist theories of brain function. Geschwind's general disconnectionist paradigm ruled clinical neurology for 20 years but in the late 1980s, with the re-emergence of specialized functional roles for association cortex, the orbit of its remit began to diminish and it became incorporated into more general models of higher dysfunction. By the 1990s, textbooks of neurology were devoting only a few pages to classical disconnection theory. Today, new techniques to study connections in the living human brain allow us, for the first time, to test the classical formulation directly and broaden it beyond disconnections to include disorders of hyperconnectivity. In this review, on the 40th anniversary of Geschwind's publication, we describe the changing fortunes of disconnection theory and adapt the general framework that evolved from it to encompass the entire spectrum of higher function disorders in neurology and psychiatry.

Agnosia↗

Collecting genetic information in primary care: evaluating a new family history tool.

BACKGROUND: The family history is a time-honoured method for identifying genetic predisposition. In specialist practice the standard approach is to draw up a family tree based on a genetic pedigree interview, but this is too time-consuming and focused on single gene disorders to be applicable in primary care. OBJECTIVES: To assess the ability of a brief self-administered Family History Questionnaire (FHQ), given to patients when they register with a GP, to identify genetic risk. METHODS: A comparative study. Informants completed an FHQ at registration, and later participated in a genetic pedigree interview. Two clinical geneticists independently scored results obtained with each instrument. Discrepancies were agreed by consensus. The genetic risks identified by the two instruments were compared. RESULTS: 326 new registrants completed the FHQ, and 121 also completed the genetic interview. 24% of FHQs and 36% of genetic interviews resulted in a score 'higher than population risk'. There was 77% agreement in the scores obtained with the two instruments, with a moderate kappa of 0.52. (95% CI 0.40-0.64). There was 90% agreement in the scores for a family history of premature coronary heart disease (Kappa 0.67; 95% CI 0.49 to 0.85). The instruments were equally effective in identifying ethnicity-related risk of common recessive disorders. CONCLUSIONS: The FHQ identified most informants with genetic risks that are appropriately addressed in primary care-those with a family history of premature coronary heart disease, those warranting specialist referral, and those who might appropriately be offered carrier testing. However, it was less effective in identifying those with a possible Mendelian disorder for whom more information was required.

Adult↗

Phototropic response induced by wind loading in Maritime pine seedlings (Pinus pinaster Aït.).

Both woody and herbaceous plant species are known to respond to wind loading, with consequences for growth and morphology. Wind has usually been classified as a mechanical stress which is detrimental to plant growth. Few experiments exist whereby plants and, in particular, woody species are exposed to wind, as opposed to mechanical perturbation by touching, flexing or shaking. Such experiments have always been short term and often carried out in wind tunnels in a controlled greenhouse environment. This study introduces an experiment to test the responses of Maritime pine (Pinus pinaster Aït.) seedlings to recurrent and short wind loading in the field, over two growing seasons. These experiments provide evidence that periodic short-term exposure to wind can induce phototropic responses in the early stage of pine seedlings' development. An interpretation is proposed in terms of efficiency to light tracking and hypotheses are discussed concerning the underlying physiological process.

Phototropism↗

Genetic Susceptibility to the Environment Moderates the Impact of Childhood Experiences on Psychotic, Depressive, and Anxiety Dimensions.

BACKGROUND AND HYPOTHESIS: Gene-by-environment (GxE) studies in psychosis have exclusively focused on negative exposures. However, evidence supports the resilience-enhancing effect of positive factors on psychosis outcome. The Differential Susceptibility (DS) model proposes that common genetic variants may confer not only disproportionate responsiveness to negative environments, but also greater sensitivity to positive, resilience-enhancing conditions. This study is the first to apply the DS model to the expression of subclinical psychosis, employing polygenic risk scores of environmental sensitivity (PRS-ES). PRS-ES were hypothesized to moderate, in a DS manner, associations between childhood adversity and psychosis, affective, and anxiety dimensions in young adults. An exploratory goal examined whether PRS for psychotic-like experiences (PRS-PLE) also showed DS patterns. STUDY DESIGN: PRS, schizotypy, PLE, depression, anxiety, and childhood adversity ratings were obtained for 197 nonclinical young adults. LEGIT software for testing competitive-confirmatory GxE models was employed. STUDY RESULTS: Results largely supported DS: Individuals high on PRS-ES showed increased subclinical psychosis, depression, and anxiety if they had experienced elevated childhood adversity, and lower symptoms if exposed to low levels of adversity as compared with those with low PRS-ES. Similarly, PRS-PLE moderated the effect of adversity on PLE, positive schizotypy, and depression following the DS model, but only PRS-ES moderation on PLE survived statistical correction. CONCLUSIONS: Our results suggest that genetic DS to the environment is relevant to psychosis, depression, and anxiety. Current debates on reconceptualization of genetic "risk" and resilience may benefit from this insight that support optimistic views on preventative efforts for early detection and intervention.

Humans↗

Righting response of artificially inclined maritime pine (Pinus pinaster) saplings to wind loading.

To determine if trees respond to dynamic and static loading in the same manner, 2-year-old maritime pine (Pinus pinaster Ait.) trees were subjected to different types of mechanical loading in the field. One block of trees (the control) were kept in pots and planted in the field at an angle of 0 or 45 degrees to the vertical. A similar block of leaning potted trees was planted nearby and subjected to frequent, unilateral wind loading for a period of 1 s every 2 min. Half the leaning trees were oriented toward the direction of wind loading and half were oriented along the axis of wind loading. The stem profile was measured three times during the growing season to quantify the rate of stem straightening. Compression wood formation and stem shape were measured in all plants. No differences in mean height or diameter were observed between blocks and all leaning trees straightened, but not at the same rate. Although no difference in the rate of apical straightening occurred between control and wind-treated trees, the righting response of the basal part of the stem of leaning trees subjected to wind was four times greater than that of leaning trees without wind. No differences in the righting response were observed between leaning trees growing toward and trees growing away from the source of wind. No significant differences in compression wood formation were found between control trees and wind-treated trees, indicating that other factors must determine the reorientation rate of leaning trees. Results are discussed with reference to the quality of compression wood in conifers and the mechanotransductive pathway in plants.

Pinus↗