Maladaptive personality traits in patients with epilepsy and psychogenic non-epileptic seizures

OBJECTIVE

We aimed to evaluate the sociodemographic, clinical, and psychological characteristics associated with psychogenic non-epileptic seizures (PNES) in patients with epilepsy, with particular emphasis on the personality profile assessed from a dimensional perspective.

METHODS

The cohort study included 77 consecutive inpatients with active epilepsy aged 36-55 years; 52 (67.5%) were female. The presence of PNES was confirmed by video-EEG monitoring. All patients underwent the Mini-International Neuropsychiatric Interview to diagnose psychiatric disorders. All participants completed the Neurological Disorders Depression Inventory in Epilepsy, the Epilepsy Anxiety Survey Instrument - brief version, and the Personality Inventory for DSM-5 and ICD-11 Brief Form Plus Modified. Chi-square and Fisher's exact tests were used to compare categorical variables, and the Brunner-Munzel test was used for quantitative variables.

RESULTS

Twenty-four patients (31.2%) had both epilepsy and PNES. There were no significant differences in social, demographic or clinical characteristics, psychiatric diagnoses or depression severity. Compared to patients with epilepsy alone, patients with epilepsy and PNES had higher anxiety scores and more pronounced maladaptive personality traits such as disinhibition and psychoticism.

SIGNIFICANCE

The main novelty of our study is that using the recently proposed dimensional approach to personality disorders and an appropriate instrument we assessed all personality domains listed in two of the most widely used classifications of mental disorders (DSM-5 and ICD-11) in PWE with and without PNES. To our knowledge, this is the first study to demonstrate the association of the maladaptive traits of psychoticism and disinhibition with the development of PNES in PWE.

Adverse childhood experience referring to parental relationship is associated with the risk of alcohol dependence and with COMT Val158Met polymorphism, but out of gene-environment interactions

Introduction

Gene-environment interactions (GxE) are considered to make a substantial impact on the risk of alcohol dependence (AD).

Objectives

The aim of the study: to test the associations between the functional polymorphism Val158Met (rs6265) in the catechol-O-methyl transferase (COMT) gene, affecting dopamine neurotransmission, and adverse childhood experiences (ACE) and their GxE interactions with AD risk.

Methods

The study included 149 AD inpatients (mean age 29.9 (SD=3.91), 16.1% females) and 201 healthy volunteers (23.3 (2.48), 30.1% females). The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used for assessing ACE. COMT Val158Met polymorphism was detected by RT-PCR.

Results

First, COMT Val158Met polymorphism was associated only with adverse childhood experience referring o parental relationship (ACE-IQ), but differently in two groups. Healthy minor Met158 carriers have lower scores on the subscale “relationship with parents/guardians” (P) (p=0.025) and “physical neglect” (PN) (p=0.059) vs. homozygous Val158 carriers. However, AD patients - Met158carriers have a tendency to a higher score on the subscale “one or no parents, parental separation or divorce” (PSD) (p=0.078). Then logistic regression revealed associations of these ACE scores with increased AD risk: P (p=0.001, OR=1.186, 95%CI [1.069-1.315]), PN (p=0.024, OR=1.254, 95%CI [1.030-1.526]), and PSD (p=0.016, OR=1.499, 95%CI [1.080-2.082]). No associations of COMT Val158Met alone or in interactions with these ACE-IQ scores with the AD risk were found.

Conclusions

Adverse childhood experience referring to parental relationship is associated with alcohol dependence risk and separately with COMT Val158Met, but no clear interactions in frame of GxE has been supported.

Disclosure

No significant relationships.

Childhood violence experience interacts with BDNF Val158Met polymorphism and modify internet addiction risk

Introduction

Internet-addiction (IA) is one of the most common non-chemical (or behavioral) addictions with genetic impact and substantial effects of psychological and personality characteristics, taking into account the childhood traumatic experience. Gene-environment interactions (GxE) may substantially impact on the risk of Internet-addiction (IA).

Objectives

Aim: to test the associations between the functional polymorphism rs6265 (Val66Met) in brain-derived neurotrophic factor (BDNF) gene, affecting BDNF function, and childhood traumatic experience and their GxE interactions with IA risk.

Methods

In total 456 participants were screened with Chinese Internet Addiction Scale (CIAS) to cut a cohort on two groups: IA (CIAS total score ≥ 65, n=100) and controls (CIAS total score less 64, n=356). The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess childhood traumatic experience using its main domains: parents (P), family (F), abuse (A) and violence (V). BDNF Val158Met polymorphism was detected by RT-PCR.

Results

Logistic regression revealed associations of P scores with increased IA risk only after adjustment for sex and age (p=0.01, OR=1.166, 95%CI[1.038-1.309]) and V scores with decreased IA risk (p=0.000, OR=0.799, 95%CI [0,233;0,744] only before adjustment. No associations of F and A with IA risk were found. BDNF Val158Met per se was not associated with IA risk, but significant effect of interaction V score*BDNF rs6265 CC on IA risk in “protective” manner was revealed (р=0.039, OR=0.873, 95%CI[0.768-0.993]) in a model adjusted for sex and age.

Conclusions

Childhood violence experience interacts with BDNF Val158Met polymorphism and CC (ValVal) genotype may be possibly protective factor decreasing the internet addiction risk

Disclosure

This work was carried out with the financial support of the Russian Foundation for Basic Research: RFBR grant # 18-29-22079

Internet addiction: Gender-associated differences in psychological characteristics

Introduction

Internet addiction (IA) is reported to cause significant negative psychosocial consequences. The gender specificity of psychological characteristics that are potentially significant for the formation of IA remains understudied.

Objectives

To identify gender-related differences in the psychological characteristics of people with IA.

Methods

100 subjects aged 16-34 years who scored 65 points or more on the Chinese Internet Addiction Scale (CIAS) were identified and divided into 2 groups by gender: group 1 (54 men) and group 2 (46 women). The individual psychological characteristics were assessed with: the Liebowitz Social Anxiety Scale (LSAS); the Bass-Perry Aggression Questionnaire (BPAQ); the Emotional Regulation Questionnaire (ERQ); the Adverse Childhood Experiences International Questionnaire (ACE-IQ); a short version of the Five-factor Personality Questionnaire (TIPI-RU) and the Cloninger Temperament and Character Inventory (TCI-125).

Results

Women were significantly more likely to experience fear of situations of interpersonal contact and action in public places (p=0.027). They experienced significantly more sexual violence in childhood (p=0.032) and were more likely to have personality traits such as “reward dependence” (p=0.002), “persistence” (p = 0.046), and “self-transcendence” (p=0.002). Men demonstrated physical aggression (p=0.009), suppressed emotions (p=0.019) significantly more often than women and characterized themselves as emotionally stable (p=0.048).

Conclusions

The gender differences identified in the cohort of individuals with IA can potentially be considered specific for this contingent, although such gender relationships can be observed in other forms of addiction and in the general population. The specificity of gender differences may reflect individual psychological markers of increased vulnerability to developing IA.

Disclosure

The study was financially supported by Russian Foundation for Basic Research within the framework of scientific project No 18-29-22079.

Evaluation of the factor structure of the Russian version of PID-5-BF

Introduction

Traditional categorical classifications of personality disorders (PD) have been criticized for insufficient structural and cross-cultural validity. In the DSM-5 Section III, alternative model of the PDs (AMPD), the maladaptive personality traits are divided into five domains: negative affect, detachment, antagonism, disinhibition and psychoticism. The Personality Inventory for DSM-5 Brief Form (PID-5-BF) is a 25-item self-report questionnaire that measures the severity of each of these five domains. To date, no questionnaires assessing pathological personality traits following the AMPD have been validated in Russia.

Objectives

This study aimed to investigate the factor structure of the Russian version of PID-5-BF.

Methods

Five hundred and 86 (female - 505 (86,2%), age - 18–77 years (M - 28.2, SD - 11.5)) consecutive inpatients with non-psychotic mental disorders were assessed with the Russian language version of the PID-5-BF. Exploratory structural equation modelling (ESEM) with Robust Diagonally Weighted Least Squares method of extraction and Robust Equamax rotation was performed in Factor v 11.04.02.

Results

The results of the ESEM analysis showed good fit of the five-factor model (CFI - 0.982; TLI - 0.971; RMSEA (95% CI) - 0.036 (0.01-0.05). Most of the items had the highest factor loadings on their mother domains. However, two items showed weak loadings on their designated factors (<0.4), and attention seeking item had a primary load to (low) detachment instead of antagonism.

Conclusions

The PID-5-BF was found to be a valid and reliable tool for the evaluation of the AMPD trait domain

Disclosure

No significant relationships.

Possible association between high social anxiety level and genetic markers in young adult Internet addicts

Introduction

Internet addiction (IA) is a rapidly growing disorder especially among adolescents and young adults. Social anxiety is one of the risk factors for IA. Also, genes involved in dopaminergic and serotoninergic systems are among the candidate genes most frequently associated with IA.

Objectives

The study aimed to investigate the association between social anxiety level and genetic markers in young adult Internet addicts.

Methods

IA group included 44 people (Chen/Chinese Internet Addiction Scale (CIAS) score ≥ 65), 75,0% males), the average age 22,0 [18,0;25,0] y.o. (Md [Q1; Q3]). Healthy control group (CIAS score was less 65) included 120 people, (73,3% males), the average age 23,0 [22,0;24,0] y.o. Psychometric measures: Liebowitz Social Anxiety Scale (LSAS). Genetic markers: rs2072450 in GRIN2A, rs2832407 in GRiK-GluR5, HUMTH01 in TH01(S<9, L>=9 repeats). The impact of genotypes on social anxiety scores was identified using Proportional Odd Logit modeling taking into account group affiliation.

Results

Group of IA reported significantly higher levels in almost all LSAS measures including total score. We found that carriers of the genotypes rs2072450 CC (p=0.004 vs.CA/AA), rs2832407 CC (p=0.023 vs AA), and TH01 SS (p=0.013 vs. LL) scored significantly higher of LSAS total in the IA group. There were no significant differences in the healthy controls group.

Conclusions

The rs2072450(CC) in GRIN2A, rs2832407(CC) in GRiK-GluR5, and HUMTH01 in TH01(SS) genotypes may be possibly associated with higher social anxiety levels in Internet addicts.

Disclosure

The study was supported by the Russian Foundation for Basic Research (RFBR), project #18-29-22079.

Public attitudes to Sputnik V vaccination against the novel COVID 19 infection the role of the social-demographic characteristics and pandemic COVID-19 individual experience issues and their implementation as the targets for brief psychosocial intervention

Introduction

Vaccination has proved to be an effective tool in decreasing infectious diseases incidence and their mortality rate. Negative public vaccine attitude can significantly undermine efforts to combat the pandemic that makes vaccine hesitancy one of the WHO main concerns

Objectives

Examination of the relationships in population between vaccine attributes and COVID-19 personal experience, social and demographic characteristics

Methods

Cohort cross-sectional study of the population attitude to vaccination against coronavirus infection COVID-19 was performed online during the first 2 months of mass vaccination in Russia, using the special designed questionnaire assessing social demographic variables, COVID-19 related factors, and preferable sources of information about COVID-19 vaccines. 4977 participants in the age from 18 to 81 years were enrolled in the study to vaccination against coronavirus infection COVID-19 was performed online during the first 2 months of mass vaccination in Russia, using the special designed questionnaire assessing social demographic variables, COVID-19 related factors, and preferable sources of information about COVID-19 vaccines .

Results

34.2% of respondents consider vaccination useful. 31.1% ‑ doubt its effectiveness. 9.9% ‑ consider vaccination unnecessary. 12.2% ‑ dangerous. indifference to vaccination was formed in 7.4% of respondents. They indicated that they do not plan to be vaccinated. 32.3%. postpones their decision until more remote data on the results and effectiveness of vaccination are obtained ‑ 34.0%. were vaccinated at the time of the study ‑ 11.6%.

Conclusions

Attitude towards vaccination depends on age, gender, education, fear of possible complications, coronaphobia. Young people are less focused on vaccination than middle-aged and older people.

Disclosure

No significant relationships.

[THE COMBINATION OF HIGH-FREQUENCY ELECTRICAL STIMULATION AND FIBRIN GLUE IN THE TREATMENT OF DECUBITAL ULCERS IN PATIENTS AFTER BRAIN DAMAGE: A PILOT STUDY]

Aim - to improve the results of treatment of decubital ulcers (DU) in combination therapy of high-frequency electrical stimulation (HFS) and fibrin glue (FG). The authors carried out a comparative analysis of the effectiveness of the combined method of treatment of decubital ulcers using high-frequency electrical stimulation (HFS) and fibrin glue (FG). All patients included in the pilot project, 22 people with a stage III pressure ulcer and who are in chronic critical condition after various brain damage. During the dressings, high-frequency stimulation was carried out with an EHVCh-250 "KiK Medimaster" electrosurgical apparatus, which generates alternating currents of the radio frequency (RF) range (0.3-3.0 MHz) for 28 days, and then (the main group), cryoprecipitate (fibrin glue) within 21 days. For comparison, the results obtained were compared with those in 25 people with DU treated according to the generally accepted method with the use of standard drugs (levomekol, levosin). HFS has a beneficial effect on all stages of a complicated wound process, promotes wound cleansing, activation of early granulation growth and marginal epithelialization. And the subsequent use of fibrin glue causes an even greater prevalence of proliferative processes over inflammatory processes in the tissues, which also contributes to a decrease in exudation, further growth of granulation tissue and an increase in epithelization processes. The use of this combination in the treatment of decubital ulcers can be used in complex conservative therapy in the treatment of pressure ulcers.

Stress load and neurodegeneration after gastrostomy tube placement in amyotrophic lateral sclerosis patients

Dysphagia and progressive swallowing problems due to motoneuron death is one of amyotrophic lateral sclerosis (ALS) symptoms. Malnutrition and body weight loss result in immunological disturbances, fatigability and increase risk of secondary complications in ALS patients, percutaneous endoscopic gastrostomy tube (PEG) placement representing a well-recognized method for malnutrition correction and potentially increasing life expectancy. However, despite nutritional correction, occasional rapid neurological deterioration may develop after PEG placement. We have hypothesized that this decline can be a result of exteroceptive stress during PEG placement and promote neurodegeneration in ALS patients. Intravenous sedation may decrease stress during invasive procedures and it is safe during PEG placement in ALS patients. The aim of the study was comparing different PEG placement protocols of anesthesia (local anesthesia or local anesthesia plus intravenous sedation) in ALS from perspectives of stress load and neurological deterioration profile. During 1.5 years 94 ALS patients were admitted; gastrostomy was performed in 79 patients. After screening according to inclusion and exclusion criteria, 30 patients were included in the prospective consecutive study. All patients were divided in two groups, with local anesthesia and with combination of local anesthesia and intravenous sedation. Routine biochemical indices, neurodegeneration and stress markers were measured. The age of ALS patients was 61 ± 10 years; 20 patients were included at stage 4A and 10 at stage 4B (King's College staging). PEG was placed at average14 months after the diagnosis and 2.2 years after first symptoms. Mean ALS Functional Rating Scale-Revised was 27.8, mean forced vital capacity of lung 46.3% (19-91%). After one year of observation only 8 patients survived. Mean life duration after PEG was 5 months (5 days-20 months). Comparison of two PEG placement protocols did not reveal differences in survival time, stress load and inflammation level. Higher saliva cortisol levels, serum cortisol, glucose, C-reactive protein and interleukin-6 were detected after PEG placement, confirming considerable stress response. PEG is a stressful factor for ALS patients, PEG placement representing a natural model of exteroceptive stress. Stress response was detected as increased cortisol, C-reactive protein, interleukin-6, and glucose levels. Intravenous sedation did not increase the risk of PEG placement procedure, however, sedation protocol did not affect stress load.

Tobacco smoking in non-psychotic patients with suicidal ideation

Introduction

Tobacco smoking (TS) is a major public health concern worldwide because of its association with a number of unfavorable health-related outcomes. According to recent studies TS negatively affects both physical and mental health. Suicidal ideation (SI) is more prevalent in people with mental disorders than in the general population. Factors associated with the transition from SI to suicide attempt (SA) should be detected to prevent suicide in this high-risk population.

Objectives

The aim of the study is to evaluate the influence of tobacco smoking on risk of lifetime suicide plan (SP), SA and nonsuicidal self-injury (NSSI) in patients with nonpsychotic mental disorders (NPMD) and SI.

Methods

Four hundred and 78 consecutive patients with NPMD and SI were included into the study. All patients were evaluated by a psychiatrist, underwent Self-Injurious Thoughts and Behavior Interview as well as semi-structured interview designed to gather information on demographic and biographical features. Mann-Whitney, Fishers exact test, chi-square test and stepwise logistic regression were used as statistical methods.

Results

Three hundred and 24 (67.8%) patients have smoked at least 100 cigarettes in their entire life. No differences were found between smokers and non-smokers in terms of age, gender, educational and occupational statuses as well as age at onset of self-injurious thoughts and behavior, and total number of SP, SA and NSSI (all: p>0.05). The lifetime smokers were at higher risk of SA (OR=2.379; 95% CI 1.58-3.581: p<0.001) and NSSI (OR=1.591; 95% CI 1.064-2.38: p=0.024).

Conclusions

Lifetime smoking in patients with NPMD and SI is associated with SA and NSSI.

[LOW-ENERGY LASER TECHNOLOGY IN THE COMPLEX TREATMENT OF PRESSURE SORES IN PATIENTS WITH SEVERE BRAIN DAMAGE]

Aim - to improve the results of treatment of pressure sores using low-energy laser technology. The authors performed a comparative analysis of the effectiveness of the use of low-energy laser irradiation in the complex treatment of pressure ulcers of 2-3 degrees in 35 patients with severe brain damage for the period from 2017-2019. The contact laser was used with the following parameters: wave length - 904 nm, frequency - 5000 Hz, irradiation mode - pulsed, power - 13.5mWt/cm2, exposure - on average 2 minutes per zone. The results were compared with those in 41 people treated according to the traditional methodology. The demographic criteria, localization and length of the process did not have significant intergroup differences. The use of low-energy laser technology in combination with other conservative methods made it possible to accelerate the healing of pressure sores by 1.3-1.4 times, and to reduce the degree of microbial contamination of the focus in earlier periods (p<0.05). At the same time, both the duration of the inpatient rehabilitation phase and the overall treatment costs are reduced. An integrated approach using low-energy laser technology as an additional physical factor can significantly improve the results of the treatment of pressure sores in people with severe brain damage.

Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials

Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.

Neuronal damage and neuroinflammation markers in patients with autoimmune encephalitis and multiple sclerosis

Inflammatory diseases of the central nervous system (CNS) are a diagnostic challenge to clinicians. Autoimmune encephalitis (AE) is an important diagnostic consideration in patients with CNS inflammatory disorders; despite of a wide range of neuropsychiatric symptoms it should be diagnosed as soon as possible and the patient transferred to the neurologist. We studied a group of AE patients (n = 24) as compared to multiple sclerosis (MS, n = 61) and control (n = 19) groups. Detailed clinical pictures of patients are presented. We focused on relevant cerebrospinal fluid (CSF) tests like protein levels, cytosis and oligoclonal bands, neuroinflammation indices (interleukin-6, soluble receptor of IL-6, neopterin, anti-ribosomal proteins antibodies) and markers of neurodegeneration (phosphorylated neurofilament heavy chain, pNfh). Elevated neopterin level was found in AE group as compared to the MS and control groups, while protein and pNfh were increased in both AE and MS groups. In the MS group, the cytosis and soluble receptor of IL-6 were higher as compared to the control group. Anti-ribosomal proteins antibodies were increased in a single patient with AE. High levels of protein were predictive of mortality in AE patients, while IL-6 and pNfh were elevated in severe AE patients. AE patients with paraneoplastic etiology demonstrated oligoclonal bands positivity. Taken together, our results suggest the neopterin as an additional marker of autoimmune brain inflammation. Though higher levels of protein, IL-6 and pNfh were found in patients with severe disease progression and death, prognostic values of these markers should be validated in larger cohorts of patients.

The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Establishing a hepatitis C continuum of care among HIV/hepatitis C virus-coinfected individuals in EuroSIDA

OBJECTIVES

The aim of the study was to establish a methodology for evaluating the hepatitis C continuum of care in HIV/hepatitis C virus (HCV)-coinfected individuals and to characterize the continuum in Europe on 1 January 2015, prior to widespread access to direct-acting antiviral (DAA) therapy.

METHODS

Stages included in the continuum were as follows: anti-HCV antibody positive, HCV RNA tested, currently HCV RNA positive, ever HCV RNA positive, ever received HCV treatment, completed HCV treatment, follow-up HCV RNA test, and cure. Sustained virological response (SVR) could only be assessed for those with a follow-up HCV RNA test and was defined as a negative HCV RNA result measured > 12 or 24 weeks after stopping treatment.

RESULTS

Numbers and percentages for the stages of the HCV continuum of care were as follows: anti-HCV positive (n = 5173), HCV RNA tested (4207 of 5173; 81.3%), currently HCV RNA positive (3179 of 5173; 61.5%), ever HCV RNA positive (n = 3876), initiated HCV treatment (1693 of 3876; 43.7%), completed HCV treatment (1598 of 3876; 41.2%), follow-up HCV RNA test to allow SVR assessment (1195 of 3876; 30.8%), and cure (629 of 3876; 16.2%). The proportion that achieved SVR was 52.6% (629 of 1195). There were significant differences between regions at each stage of the continuum (P < 0.0001).

CONCLUSIONS

In the proposed HCV continuum of care for HIV/HCV-coinfected individuals, we found major gaps at all stages, with almost 20% of anti-HCV-positive individuals having no documented HCV RNA test and a low proportion achieving SVR, in the pre-DAA era.

Mechanisms of hydrogen sulfide (H2S) action on synaptic transmission at the mouse neuromuscular junction

Hydrogen sulfide (H2S) is a widespread gasotransmitter also known as a powerful neuroprotective agent in the central nervous system. However, the action of H2S in peripheral synapses is much less studied. In the current project we studied the modulatory effects of the H2S donor sodium hydrosulfide (NaHS) on synaptic transmission in the mouse neuromuscular junction using microelectrode technique. Using focal recordings of presynaptic response and evoked transmitter release we have shown that NaHS (300 μM) increased evoked end-plate currents (EPCs) without changes of presynaptic waveforms which indicated the absence of NaHS effects on sodium and potassium currents of motor nerve endings. Using intracellular recordings it was shown that NaHS increased the frequency of miniature end-plate potentials (MEPPs) without changing their amplitudes indicating a pure presynaptic effect. Furthermore, NaHS increased the amplitude of end-plate potentials (EPPs) without influencing the resting membrane potential of muscle fibers. L-cysteine, a substrate of H2S synthesis induced, similar to NaHS, an increase of EPC amplitudes whereas inhibitors of H2S synthesis (β-cyano-L-alanine and aminooxyacetic acid) had the opposite effect. Inhibition of adenylate cyclase using MDL 12,330A hydrochloride (MDL 12,330A) or elevation of cAMP level with 8-(4-chlorophenylthio)-adenosine 3',5'-cyclic monophosphate (pCPT-cAMP) completely prevented the facilitatory action of NaHS indicating involvement of the cAMP signaling cascade. The facilitatory effect of NaHS was significantly diminished when intracellular calcium (Ca(2+)) was buffered by 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid tetrakis acetoxymethyl ester (BAPTA-AM) and ethylene glycol-bis(2-aminoethylether)-N,N,N',N'-tetraacetic acid acetoxymethyl ester (EGTA-AM). Activation of ryanodine receptors by caffeine or ryanodine increased acetylcholine release and prevented further action of NaHS on transmitter release, likely due to an occlusion effect. Inhibition of ryanodine receptors by ryanodine or dantrolene also reduced the action of NaHS on EPC amplitudes. Our results indicate that in mammalian neuromuscular synapses endogenously produced H2S increases spontaneously and evoked quantal transmitter release from motor nerve endings without changing the response of nerve endings. The presynaptic effect of H2S appears mediated by intracellular Ca(2+) and cAMP signaling and involves presynaptic ryanodine receptors.

HIV-1 seroprevalence rates in women and relinquishment of infants to the state in St Petersburg, Russia, 2002

The effectiveness of rapid HIV-1 testing and nevirapine prophylaxis for HIV-infected mothers without prenatal care has been shown. We found that from 1998 to 2002, HIV-1 seroprevalence in women giving birth in St Petersburg, Russia increased 100-fold: from 0.013% to 1.3% (p<0.0001). HIV-1 seroprevalence was 8% (114 of 1466) in women without prenatal care and 1% (376 of 37645) in those with prenatal care (p<0.0001). All 376 HIV-1-infected women with, and 41% (47 of 114) of HIV-1-infected women without prenatal care received intrapartum antiretroviral therapy (p<0.0001). In women who were HIV-1 positive, 26% (30 of 114) of those without prenatal care and 4% (13 of 371) of those with prenatal care relinquished their infants to the custody of the state, compared with 1% (354 of 37 621) of HIV-1-negative women (p<0.0001).

Roles of DNA fragmentation factor and poly(ADP-ribose) polymerase in an amplification phase of tumor necrosis factor-induced apoptosis

During apoptosis, endonucleases cleave DNA into 50-300-kb fragments and subsequently into internucleosomal fragments. DNA fragmentation factor (DFF) is implicated in apoptotic DNA cleavage; this factor comprises DFF45 and DFF40 subunits, the former of which acts as a chaperone and inhibitor of the catalytic subunit and whose cleavage by caspase-3 results in DFF activation. Disruption of the DFF45 gene blocks internucleosomal DNA fragmentation and confers resistance to apoptosis in primary thymocytes. The role of DFF-mediated DNA fragmentation in apoptosis was investigated in primary fibroblasts from DFF45(-/-) and control (DFF45(+/+)) mice. DFF45 deficiency rendered fibroblasts resistant to apoptosis induced by tumor necrosis factor (TNF). TNF induced rapid cleavage of DNA into approximately 50-kb fragments in DFF45(+/+) fibroblasts but not in DFF45(-/-) cells, indicating that DFF mediates this initial step in DNA processing. The TNF-induced activation of poly(ADP-ribose) polymerase (PARP), which requires PARP binding to DNA strand breaks, and the consequent depletion of the PARP substrate NAD were markedly delayed in DFF45(-/-) cells, suggesting a role for DFF in PARP activation. The activation of caspase-3 and mitochondrial events important in apoptotic signaling, including the loss of mitochondrial membrane potential and the release of cytochrome c, induced by TNF were similarly delayed in DFF45(-/-) fibroblasts. DFF45(-/-) and DFF45(+/+) cells were equally sensitive to the DNA-damaging agent and PARP activator N-methyl-N'-nitro-N-nitrosoguanidine. Inhibition of PARP by 3-aminobenzamide partially protected DFF45(+/+) cells against TNF-induced death and inhibited the associated release of cytochrome c and activation of caspase-3. These results suggest that the generation of 50-kb DNA fragments by DFF, together with the activation of PARP, mitochondrial dysfunction, and caspase-3 activation, contributes to an amplification loop in the death process.

Early detection and treatment of postoperative pharyngocutaneous fistula

Fever during the early postoperative period traditionally has not been considered an indication of a postoperative wound infection or breakdown. Atelectasis is considered the most likely source for these early fevers. We studied 200 consecutive patients who underwent major head and neck surgery that involved reconstruction with a pharyngeal suture line. Patients were divided into 2 groups: those who had preoperative irradiation and those who did not. All patients had prophylactic antibiotic coverage, and all patients had identical suture material for closure. We showed a high correlation between fever (>101.5 degrees F) that developed in the first 48 hours and eventual fistula formation and wound infection. We also studied length of hospitalization and number of days until decannulation and resumption of oral feedings. Our data indicate that in those patients in whom fistulas developed, early detection led to earlier healing and rehabilitation.

A random walk model of oligodendrocyte generation in vitro and associated estimation problems

A branching stochastic process proposed earlier to model oligodendrocyte generation by O-2A progenitor cells under in vitro conditions does not allow invoking the maximum likelihood techniques for estimation purposes. To overcome this difficulty, we propose a partial likelihood function based on an embedded random walk model of clonal growth and differentiation of O-2A progenitor cells. Under certain conditions, the partial likelihood function yields consistent estimates of model parameters. The usefulness of this approach is illustrated with computer simulations and data analyses.

Modeling insight into spontaneous regression of tumors

The phenomenon of spontaneous regression of benign and malignant tumors is well documented in the literature and is commonly attributed to the induction of apoptosis or activation of the immune system. We attempt at evaluating the role of random effects in this phenomenon. To this end, we consider a stochastic model of tumor growth which is descriptive of the fact that tumors are inherently prone to spontaneous regression due to the random nature of their development. The model describes a population of actively proliferating cells which may give rise to differentiated cells. The process of cell differentiation is irreversible and terminates in cell death. We formulate the model in terms of temporally inhomogeneous Markov branching processes with two types of cells so that the expected total number of neoplastic cells is consistent with the observed mean growth kinetics. Within the framework of this model, the extinction probability for proliferating cells tends to one as time tends to infinity. Given the event of nonextinction, the distribution of tumor size is asymptotically exponential. The limiting conditional distribution of tumor size is in good agreement with epidemiologic data on advanced lung cancer.

Irreversible binding of poly(ADP)ribose polymerase cleavage product to DNA ends revealed by atomic force microscopy: possible role in apoptosis

During apoptosis, DNA undergoes fragmentation and caspase-3 cleaves poly(ADP-ribose) polymerase (PARP) into both a 24-kDa fragment containing the DNA binding domain and an 89-kDa fragment containing the catalytic and automodification domains. Atomic force microscopy revealed that recombinant full-length PARP bound to plasmid DNA fragments and linked them into chainlike structures. Automodification of PARP in the presence of NAD+ resulted in its dissociation from the DNA fragments, which, nevertheless, remained physically aligned. A recombinant 28-kDa fragment of PARP containing the DNA binding domain but lacking the automodification domain irreversibly bound to and linked DNA fragments in the absence or presence of NAD+. Identical results were obtained on incubation of internucleosomal DNA fragments from apoptotic cells with the products of cleavage of recombinant PARP by purified caspase-3. The 24-kDa product of PARP cleavage by caspase-3 may contribute to the irreversibility of apoptosis by blocking the access of DNA repair enzymes to DNA strand breaks.

A cure model with time-changing risk factor: an application to the analysis of secondary leukaemia. A report from the International Database on Hodgkin's Disease

A parametric model is used to investigate the latency time of leukaemia observed in patients treated for Hodgkin's disease. In specifying the treatment effect on leukaemia-free survival, account was taken of a fraction of long-term survivors and of time-changing risk associated with the relapse of the primary disease. The model is applied to data collected in the International Database on Hodgkin's Disease. It permits estimation of the contributions of primary and of relapse treatment to the overall risk of induced leukaemia. Baseline hazards appear to be identical after primary and relapse treatments supporting the concept that induced leukaemia have common origin. The probability to induce leukaemia by MOPP chemotherapy is the same, regardless whether used as primary or relapse treatment.

Do cells repair precancerous lesions induced by radiation?

The most widely accepted point of view is that cells are endowed with the capacity to repair the primary lesions responsible for cancer induction. In radiobiology, this popular belief evolved from experiments of the same type as those that suggested the existence of sublethal radiation damage repair. The central problem with such data is that the cell-killing component of radiation damage may mask the effects associated with repair of precancerous lesions. The challenge is to separate the two processes that contribute to the observed tumor incidence after irradiation. using a recently developed stochastic model of radiation carcinogenesis allowing for cell death, we provide evidence that precancerous lesions are not subject to repair under certain experimental conditions.

A diversity of responses displayed by a stochastic model of radiation carcinogenesis allowing for cell death

A stochastic model is presented of carcinogenesis induced by irradiation with arbitrary time-dependent dose rate. The key feature of the model is that it allows for radiation-induced cell killing to compete with the process of tumor promotion. Two versions of the model arise when considering target tissues with slow and rapid replacement of damaged cells. These versions show dissimilar shapes of the dose-response curves in the case of short-term exposure. The model provides a natural explanation of the basic experimental findings documented in the radiobiological literature.