Mortality rates and cause of mortality in patients with mildly elevated pulmonary pressures versus PH: insights from the retrospective EVIDENCE-PAH study

Background

Normal mean pulmonary artery pressure (mPAP) does not exceed 20 mmHg and normal pulmonary vascular resistance (PVR) does not exceed 2 Wood Units (WU). The thresholds used to define pre-capillary pulmonary hypertension (PH) – mPAP ≥25 mmHg and PVR >3 WU – are being evaluated. It is unclear if treatment would benefit patients with mildly elevated mPAP (≥21–<25 mmHg).

Purpose

The EVIDENCE-PAH study aims to describe mortality and hospitalisation outcomes, clinical characteristics, therapies, and quality of life during long-term follow-up of a national cohort of patients with different levels of mPAP and PVR. We report preliminary analyses focusing on mortality and its cause in patients stratified by their baseline (BL) mPAP.

Methods

This retrospective analysis included PAH-treatment-naïve patients with suspected PH who received a first right heart catheterisation (RHC) between 2009 and 2017 at any of the 7 UK tertiary PH centres, which assess all PH patients in the UK. A sample of patients with BL mPAP ≥25 mmHg (stratified by PVR and treatable versus non-treatable PH) was used as a control in this analysis. Baseline characteristics, mortality and cause of mortality were stratified by mPAP (<21, ≥21–<25, ≥25 mmHg) at BL (first RHC). Mortality was also stratified by BL PVR (<1, 1–<2, 2–<3, 3–<6, ≥6 WU). Mortality analysis was done without matching cohorts. Mortality data were obtained from the Office for National Statistics, NHS Digital.

Results

In total, 2926 patients were analysed (968, 689 and 1269 with mPAP <21, ≥21–<25, ≥25 mmHg, respectively). Mean observation was 6.1 years. BL characteristics are in Table. Survival worsened with increasing mPAP (p<0.0001) and increasing PVR (p<0.01) (Figure). After 5 years of follow-up, 187 (27.1%) patients with mPAP ≥21–<25 mmHg had died, compared with 162 (16.7%) and 595 (46.9%) patients in the lower and higher mPAP groups, respectively. In patients with mPAP ≥21–<25 mmHg, the most common main cause of death was respiratory disease (36.4%) – with scleroderma lung disease and interstitial lung disease accounting for 69.1% of these deaths – followed by cardiac disease (16.6%) and malignancy (15.0%) (Table). PH was the main cause of death for only 1.6% of patients with mildly elevated mPAP and it was a contributor to death in 6.8% (BL mPAP <21 mmHg), 10.2% (≥21–<25 mmHg), and 40.2% (≥25 mmHg) of cases.

Conclusion

Long-term survival in patients with mPAP ≥21–<25 mmHg was worse than in those with normal mPAP, and better than in those with the current definition of PH. While the main cause of death was mostly unrelated to PH and further analysis is needed to understand the impact of underlying disease, mildly elevated mPAP appears to confer a worse prognosis and should be closely monitored. These data show the relevant disease burden in patients with mPAP ≥21–<25 mmHg and the need to understand if they could benefit from treatment. PVR may be key in determining patients who might benefit.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Actelion Pharmaceuticals Ltd., a Janssen pharmaceutical company of Johnson & Johnson.

Perception of otherness - the role of personality and demographic variables

Introduction

The idea that personality can influence our perception of ‘otherness’ is widely accepted within the literature of social sciences. Undoubtedly, the principle of dehumanization played an important role in genocides during the 20th and 21st centuries. In totalitarian or post-totalitarian regimes ‘otherness’ may present a challenge to the absolute power. Recent studies showed that negative attitudes toward ‘otherness’ – also known as xenophobia – are on a rise in the Czech Republic.A deeper analysis of the personality in relation with perception of otherness is still missing.

Objectives

The presentation analyse the personality variables associated with the perception of otherness and compare the differences between various age groups, genders, individuals with different levels of education, and above all, the differences between various groups. Several contrast groups are compared - general population, high neuroticism sample, personality disorder sample, xenophobic and xenophilic sample.

Methods

Bogardus Scale of Social Distance as a measure of perception of otherness is compared with in-depth analysis of personality functioning (Semi-Structured Interview for Personality Functioning DSM–5, STiP-5.1).

Results

We analyze the results of five samples with respect to demographic variables, variables of personality functioning and try to point out the relationship between more attitudes and underlying personality functioning. The importance of some demographic variables (as age) and connections between personality functioning (Self and Interpersonal) and social distance is emphasized and discussed.

Conclusions

The project help us to understand perception of otherness in light of demographic and relative power of personality factors.

How neuroticism affects prejudical attitudes and social distance

Introduction

Previous studies didn’t find any connection between Neuroticism and authoritarian personality or social dominance orientation, but xenophobic attitudes might be hold even apart from these constructs.

Objectives

In our study we compared subjects with high Neurtoticism score with controls with a focus on racism and social distance.

Methods

The Bogardus Social Distance Scale (BSDS) is a measure of perceived social distance of a subject towards concrete outgroups. Modern Racism Scale (MRS) and The Blatant and Subtle Prejudice Scales (BSRS) are scales measuring racism. For our study we used the Neuroticism scale of the Eysenck Personality Questionnaire (EPQ). Also, we asked about personal conflicts with outgroup members and how subjects perceived their unpleasantness and importance. We measured the attitudes towards Romani, Vietnamese, foreigners, homeless people, migrants, people with mental disease and people with a physical disability.

Results

People with the high neuroticism score (SD≥1; N=48) showed significantly higher scores in racism. In comparison to control group (CG; N=96), their social distance differed significantly towards Romani, Vietnamese and migrants. Effect sizes were however on the threshold between weak and moderate. After Bonferroni correction, only the social distance towards migrants remained significant. People with the high neuroticism score didn’t report higher rate in conflict with outgroup members than HC.

Conclusions

People with the high neuroticism score showed different pattern in attitudes towards outgroup members, but not in conflict with them, which might point at higher need of internalization of negative attitudes.

Moral disengagement and social distancing of people with a personality disorder

Introduction

People with personality disorders (PD) share some impairments in personality functioning (e.g. identity, intimacy, empathy) that are also associated with inner or interpersonal conflicts, and sometimes also with different strategies of moral disengagement (MD). It is unclear whether MD strategies are related to individuals with/without PD and their willingness to have social contacts with representatives of otherness (like minorities, physically handicapped, etc.).

Objectives

Comparison of the differences in MD strategies and social distance to the otherness of healthy controls and people with PD, and the influence of personality functioning.

Methods

Moral Disengagement Scale which measures eight MD strategies, the Semi-Structured Interview for Personality Functioning DSM-5 assessing the Self and Interpersonal functioning, and Bogardus Social Distance Scale measuring perceived social distance toward various representatives of otherness are applied in two samples (general population and personality disorders).

Results

People with PD showed a significantly higher propensity to use various MD strategies than healthy controls with moderate effect size (.34–.49). Moral disengagement is facilitated by different aspects of personality functioning in both samples, sharing the impairments in maintaining close relationships. Both samples differed in MD strategies connected with higher social distancing.

Conclusions

People with PD are more prone to moral disengagement than healthy adults. MD appears to be facilitated by different aspects of personality functioning in both samples. Some representants of otherness are more related to specific MD strategies. We hypothesize that understanding of specific MD strategies used by people with PD can provide insight and explain some of their behavior.

Attentional networks in euthymic patients with unipolar depression

Background

The capacity to focus and concentrate or to direct attention supports many aspects of cognitive functioning including short-term memory and higher-level cognitive functions. The purpose was to assess attentional networks in euthymic patients with unipolar depression using the Attentional Network Test (ANT).

Materials and methods

We investigated performance of attention by virtue of ANT during remission from unipolar depressive disorder and tested a hypothesis that there are no differences between outpatient group (euthymic patients, N = 32) and matched controls in attentional variables, the relationship of attentional networks and everyday cognitive failures.

Results

No differences between the groups in attentional networks were found and no relationship between attentional networks and cognitive failures was found.

Limitations

One assessment during remission could be insufficient to recognize long-term pattern of cognitive functions.

Conclusions

These data show non-impaired attentional networks possibly explained by sufficient level of remission and ameliorated influence of high education on cognition.

Effects of different types of instruction on the Scores of PID-5 profile

Introduction

Section III of 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a hybrid model of personality pathology, in which dimensional personality traits (PTs) are used to derive one of six categorical Personality Disorder (PD) diagnoses. The Personality Inventory for DSM-5 (PID-5) has been developed to assess PTs within this new system.

Objectives

PT is a tendency to feel, perceive, behave, and think in relatively consistent ways across time and situations. PD diagnosis is generally stated if a pattern of maladaptive PTs persists at least 5 years. Nevertheless, the PID-5 instruction does not cover duration of symptoms.

Aims

We have explored the effect of two different types of instructions, in which duration of symptoms is or is not explicitly mentioned, on the PID-5 scores. Moreover, we have asked whether the scores differ in psychiatric patients and healthy individuals.

Methods

Differences between original and modified instructions of the Czech PID-5 version have been evaluated in a group of 62 psychiatric patients and 38 healthy controls; each respondent has been administered both instruction types in random sequence. ANOVA mixed design has been used to test the relation between groups and different sequence of administration.

Results

We have found no consistent differences in PID-5 scores using the different types of instruction described above.

Conclusions

In our sample, PID-5 seems to reflect strong beliefs of a subject regardless of symptoms’ duration and could be reliably used with both types of instruction. The PID-5 represents an appropriate instrument for the assessment of maladaptive PTs.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Treating with an implant: BMS or DES?

As the minimal invasive procedures for the treatment of peripheral arterial disease grow at exponential rates, interventional radiologists and vascular surgeons are more often faced with the difficult decision of which devices are the most appropriate to bring the desired results. Under the light of the newest studies and always having in mind the concept of "leaving no metal behind", when focusing on the lesions within the superficial femoral artery and popliteal arteries, we try to answer the question: treating with an implant, bare metal stents or drug eluting stents?

Differences in onset of disease and severity of psychopathology between toxoplasmosis-related and toxoplasmosis-unrelated schizophrenia

OBJECTIVE

Toxoplasmosis is a lifelong parasitic disease that appears to be associated to schizophrenia. However, no distinguishing attributes in Toxoplasma-infected schizophrenia patients have been described as yet.

METHOD

We searched for differences in symptom profile, cognitive performance and treatment response between 194 Toxoplasma-free and 57 (22.7%) Toxoplasma-infected schizophrenia patients treated in Prague Psychiatric Centre between 2000 and 2010.

RESULTS

Infected and non-infected patients differed in severity of symptoms (P = 0.032) measured with the Positive and Negative Symptom Scale (PANSS). Infected patients scored higher in positive subscale of PANSS, but not in the general and negative subscales. Infected men scored higher also in Total PANSS score, and negative, reality distortion, disorganisation and cognitive scores. Higher PANSS scores of positive, negative and disorganised psychopathology were associated with the lower titres of anti-Toxoplasma antibodies suggesting that psychopathology deteriorates with duration of parasitic infection. Infected patients remained about 33 days longer in hospital during their last admission than uninfected ones (P = 0.003). Schizophrenia started approximately 1 year earlier in infected men and about 3 years later in infected women, no such difference was observed in uninfected subjects.

CONCLUSION

Latent toxoplasmosis in schizophrenia may lead to more severe positive psychopathology and perhaps less favourable course of schizophrenia.

[The significance of biological intracranial meningioma behaviour for their long-term management]

INTRODUCTION

From the histological point of view, most meningiomas are benign tumours. Nevertheless, their recurrence is quite frequent, and identifying the risk factors for recurrent disease is of utmost importance.

MATERIAL AND METHODS

Prospective study, patients operated on in the period 2/2008-9/2009. Inclusion criteria for enrolment into the study: age 18-70 years, good health status, and previously untreated solitary intracranial meningioma. Evaluation of clinical, surgical, MRI findings and vascular endothelial growth factor serum levels (prior to procedure, 3 months after, 12 months after, 24 months after procedure and at the time of the last follow-up in 11/2011) was performed. Immunohistochemical analysis of histological samples was carried out. Further treatment (wait and see, redo surgery, treatment with radiation using the Leksell Gamma Knife, external radiotherapy) was recorded in case of a positive follow-up MRI finding (recurrent disease, progression of residual tumour).

RESULTS

A total of 50 consecutive patients (34 women and 16 men) were included into the study. Average age at the time of surgery was 59.2 years (range 27-75 years). Radical resection with no residual tumour left was achieved in 35 cases. Histological analysis showed grade I meningioma in 45 cases and grade II (atypical) meningioma in 5 cases. Correlation between E-cadherin expression and recurrent meningioma was proved by immunohistochemical examinations; in the remaining investigations, however, such a correlation was not found. No correlation was detected between the serum vascular endothelial growth factor level and the expression of vascular endothelial growth factor in immunohistochemical investigation. A correlation was found between the expression of vascular endothelial growth factor in immunohistochemical investigation and peritumoural oedema. The tumour recurred in 5 cases.

CONCLUSIONS

On the basis of our results as well as literature findings we can conclude that all the patients after meningioma surgery need to be carefully followed for the rest of their life by repeated MRI invetigations.

The influence of low-frequency left prefrontal repetitive transcranial magnetic stimulation on memory for words but not faces

Brain imaging studies suggest localization of verbal working memory in the left dorsolateral prefrontal cortex (DLPFC) while face processing and memory is localized in the inferior temporal cortex and other brain areas. The goal of this study was to assess the effect of left DLPFC low-frequency repetitive transcranial magnetic stimulation (rTMS) on verbal recall and face recognition. The study revealed a significant decrease of free recall in word encoding under rTMS (110% of motor threshold, 0.9 Hz) in comparison with sham stimulation (p=0.03), while no significant difference was found with facial memory tests. Our findings support the essential role of the left DLPFC in word but not facial memory and confirm the content specific arrangement of cortical areas involved in semantic memory. As a non-invasive tool, rTMS is useful for cognitive brain mapping and the functional localization of the category specific memory system.

Invasive pulmonary aspergillosis: effects of early resection in a neutropenic rat model

OBJECTIVE

Invasive pulmonary aspergillosis is frequent in neutropenic patients. Usually localized in the beginning, the disease spreads and mortality is high despite antifungal treatment. The role of early adjuvant surgery is not clear. Surgery may help to confirm fungal disease, may control fungal disease locally and may prevent systemic spreading. This study examines effects of early resection on survival and dissemination in a rat model of localized invasive pulmonary aspergillosis.

METHODS

Forty persistently neutropenic male albino rats were challenged with standardized conidial aspergillus inoculum injected into peripheral lung tissue of the right upper lobe under direct vision. Animals were divided into four groups. Twenty animals were treated with amphotericin B at 1 mg/kg per day beginning 48 h after inoculation, 20 animals were left untreated. In each group half the animals underwent early resection of localized invasive aspergillosis by lobectomy. Animals were checked daily and mortality was recorded up to 28 days after which surviving animals were sacrificed.

RESULTS

Significantly higher survival was observed in resected animals in the non-Am B groups (survival: 10 +/- 19% without early resection and 50 +/- 32% with early resection; P = 0.044). However, early resection did not lead to improved survival in animals treated with amphotericin B (survival 70 +/- 29% without early resection and 50 +/- 32% with early resection; P = 0.316).

CONCLUSIONS

In this rat model of localized invasive pulmonary aspergillosis effects of early resection on survival could be demonstrated only in animals not receiving amphotericin B treatment.

[Multiple heart valve diseases: differential therapeutic considerations]

After more than 40 years of heart valve surgery, the indication for double valve procedures still represents a problem in the presence of an obviously leading single valve disease. If the isolated valves do not already represent a clear indication for surgery then this situation is the best example for a good deal of thought in cardiac surgery and discussion with competent cardiologists.

[Aortic dissection in pregnancy in Marfan syndrome--case report and treatment concept]

PATIENTS AND METHODS

Herein we report the case of a 37 year old pregnant women with Marfan syndrome with dilatation of the aorta ascendens of 42 mm preconceptionAl. The dilatation remained stable until 34 weeks of gestation when a aortic dissection (De Bakey type I) occurRed rapidly. The patient underwent a cesarean section and hysterectomy, followed by surgery of the aorta asc. by means of implantation of a valved graft immediately.

CONCLUSIONS

The criteria of a dilatation of the aorta ascendens < 40 mm does not identify reliably those patients who are at risk of dissection during pregnancy. A interdisciplinary approach together with obstetricians, cardiologists and cardiac surgeons is mandatory in all cases of Marfan syndrome and pregnancy.

Aneurysmal and partially thrombosed orifice of a coronary artery fistula into the right atrium combined with patent foramen ovale

We report a case of a right atrial sessile tumor combined with a patent foramen ovale and the characteristics of fat containing tumor in magnetic resonance imaging. Histologic study revealed this to be an aneurysmal and partially thrombosed formation of a coronary artery fistula.

Huntington's disease: the relationship between clinical signs, CAG repeats and the atrophy of the caudate nucleus in CT scans

We compared clinical data from 45 patients with Huntington's Disease (HD) with CAG triplet repeats and the planimetric measurement of the caudate nucleus head area (CNHA) in CT scans. The mean age of patients was 50.4 yrs (SD +/- 10.2), the mean duration of HD 7.4 yrs (4.6), the mean age at the onset of HD 43.1 yrs (11.1). HD started with motor symptoms in 28 patients, with psychiatric symptoms in 14 patients, the history was unknown in 3 patients. The paternal transmission was observed in 29 patients, the maternal one in 12 patients, unknown in 4 patients. The mean number of CAG repeats was 46.6 (6.1). The mean CNHA was 0.4 cm2 (0.1). We found statistically significant reversed correlation between CAG repeats and the age at the onset of HD (p < 0.0001, r -0.6). The earlier onset of HD in patients with the paternal transmission compared to the maternal one was found statistically significant (p < 0.05). This phenomenon was not related to the larger number of CAG triplets in patients with the paternal transmission. No differences either of the age at the onset of HD or numbers of CAG repeats were found between subgroups of HD patients starting with motor or psychiatric symptoms. We also observed the significant reversed correlation between the duration of HD and CNHA measurement (p < 0.001, r -0.5). Even in the earliest stage of HD patients showed the marked atrophy of CNHA.

Nitric oxide inhibits isoprenaline-induced positive inotropic effects in normal, but not in hypertrophied rat heart

Evidence has accumulated that, in the rat heart, nitric oxide (NO) inhibits beta-adrenoceptor-mediated positive inotropic effects. The aim of this study was to investigate whether this effect of NO may be altered in cardiac hypertrophy. For this purpose we studied the effects of the NO-donor SNAP (S-nitroso-N-acetyl-D,L-penicillamine) on isoprenaline-induced positive inotropic effects in left ventricular strips from three models of cardiac hypertrophy: a) 12-16 weeks old male spontaneously hypertensive rats (SHR) vs. age-matched normotensive Wistar-Kyoto (WKY) rats, b) six weeks old male Wistar WKY-rats sub-totally nephrectomized (SNX) 7 weeks after SNX vs. sham-operated rats (SOP) and c) four weeks old male Wistar WKY-rats supra-renal aortic-banded (AOB, band diameter 1.0 mm) 8 weeks after AOB vs. SOP. In all three models of cardiac hypertrophy the heart weight/body weight ratio was significantly higher than in their respective controls. On isolated electrically driven ventricular strips isoprenaline (10(-10)-10(-5) M) caused concentration-dependent increases in force of contraction. Maximal increases (Emax) were similar in SHR vs. WKY-rats, but reduced in SNX- (2.9+/-0.29 vs. 5.1+/-0.34 mN, p<0.01) and AOB-rats (2.3+/-0.37 vs. 4.2+/-0.33 mN, p<0.01). In control rats (WKY and the respective SOP) the NO-donor SNAP (10(-5) M) caused a significant rightward-shift of the concentration-response curve for isoprenalinel; this rightward-shift could be inhibited by methylene blue (10(-5) M). In ventricular strips of SHR, SNX- and AOB-rats, however, 10(-5) M SNAP failed to significantly affect isoprenaline-induced positive inotropic effect. We conclude that in cardiac hypertrophy effects of NO are attenuated. Such an impairement of the NO-system could contribute to the development and/or maintenance of cardiac hypertrophy.

Time course of high-intensity transient signals in patients undergoing elective heart valve replacement: a prospective study

BACKGROUND AND AIMS OF THE STUDY

This study was performed to evaluate the time course of intracranial high-intensity transient signals (HITS) in patients undergoing elective heart valve replacement.

METHODS

Thirty-three patients were enrolled in this study. The examination protocol included serial (before and at one, five, 90 and 180 days after surgery) monitoring sessions with transcranial Doppler and detailed neurological examination. Monitoring was performed bilaterally over the middle cerebral arteries for one hour per session using 2 MHz probes. Microembolic signals were recognized according to standard criteria and stored on a computer for later evaluation.

RESULTS

HITS prevalence increased from 3% preoperatively to 41% on the first postoperative day and remained unchanged during the postoperative period. No influence of the intensity of anticoagulation or valve type on HITS counts was evident. Unilateral monitoring provided adequate results in 83.9% of cases.

CONCLUSIONS

The causative role of the valve implant in the pathogenesis of HITS appears certain, since their prevalence dramatically increases following valve implantation. Valve type, duration of valve implant or intensity of anticoagulation did not influence HITS counts. Bilateral monitoring is warranted for accurate evaluation of HITS counts in this patient group.

Doppler microembolic signals in children with prosthetic cardiac valves

BACKGROUND AND PURPOSE

The aim of this study was the evaluation of the prevalence and counts of Doppler microembolic signals (MES) in children with prosthetic cardiac valves and their comparison to those obtained in corresponding adult patients.

PATIENTS AND METHODS

Nine children and 43 adults with ATS valves implanted in the aortic position were monitored over both middle cerebral arteries with transcranial Doppler ultrasound. MES were identified on-line according to standard criteria. Heart rate and rhythm, valve type, size and duration, patients' height, International Normalized Ratio, and prevalence of neurological complications were obtained from all study participants.

RESULTS

MES prevalence and counts were significantly higher in children compared with adult patients (100% versus 25.5% and 58 [18.5 to 115.5] versus 55 [2 to 10.5], median, 95% CI, respectively). No corresponding differences in valve duration of valve implant were evident, but children has heart rates and were significantly smaller compared with adults. A positive correlation between patients' size, heart rate, and MES counts was noted.

CONCLUSIONS

MES counts in children with mechanical prosthetic valves are significantly higher compared with those in corresponding adults. We hypothesize that this is due to (1) the shorter distance between aortic valve and middle cerebral artery, since cavitation bubbles have a short life span and are bound to dissolve with time, and (2) the faster heart rate in children, resulting in a higher number of valve closures per minute.

[Neuropsychologic rehabilitation of mental functions using computers]

The authors draws attention to the problem of neuropsychological rehabilitation. He emphasizes the problem of exploiting the patient's experience during rehabilitation into practical life. He provides data on rehabilitation in vivo and in vitro. He reflects on the development of computer rehabilitation of cognitive functions from neuropsychological tests and presents some examples based on Scandinavian experience. The author also draws attention to his own experience with the neuropsychological computer programme TRAIN THE BRAIN and gives an account of the work with this programme. He recommends the use of computer programmes in psychological and neuropsychological practice. He emphasizes their possibilities in patients with traumatic brain damage and the possibility to follow up systematically changes during recovery which are difficult to record in written tests. Changes in recovery which were recorded by the computer programme frequently did not correspond with changes of the mental state of the patient. Rehabilitation computer programmes also enable to activate of psychiatric patients with performance disorders. The author emphasizes possibilities of neuropsychological rehabilitation and recommends its further development in the Czech Republic.

[Neuropsychologic examinations and rehabilitation]

The presented paper is focused on substantial features of neuropsychological examinations. The author emphasizes the application of different tests focused on the relationship between the brain and behaviour, but in particular the neuropsychological battery. He describes the Halstead--Reitan battery and possibilities of its application in children. He emphasizes the importance of neuropsychological rehabilitation and differentiates it from mere recording of the process of spontaneous recovery. He characterizes the main neuropsychological factors which affect recovery after traumatic brain damage. He mentions some of his own examples where he used these factors in clinical practice. The author describes also his own experience with computer rehabilitation using the SERMION--Train the Brain programme.

[Neuropsychology of traumatic brain damage in children]

The author deals with the neuropsychology of traumatic brain damage in children. He mentions briefly the development of neuropsychology with regard to problems encountered in children. Based on an analysis of the literature he assesses four basic factors when establishing the diagnosis. These factors are: age, type and extent of damage, duration of coma and posttraumatic amnesia and premorbid personality. The author finds discrepancies between assessment of coma in different experimental publications and emphasizes the practical aspect of these basic factors in clinical reflections. He presents results of studies concerning mild, medium and severe cerebral affections in children. He emphasizes the importance of psychotherapy, neuropsychological rehabilitation and crisis intervention.

Enhancement of specific nitrogenase activity in Azospirillum brasilense and Klebsiella pneumoniae, inhibition in Rhizobium japonicum under air by phenol

Specific nitrogenase activity in Azospirillum brasilense ATCC 29145 in surface cultures under air is enhanced from about 50 nmol C2H4 X mg protein -1 X h-1 to 400 nmol C2H4 by the addition of 1 mM phenol. 0.5 and 2 mM phenol added increase the rate 5-fold and 4-fold. This enhancement effect is observed only between 2 and 3 days after inoculation, with only a small reduction of the growth of the cells by the phenol added. In surface cultures under 1% O2, nitrogenase activity is slightly reduced by the addition of 1-0.01 mM phenol. Utilization of succinate is enhanced during the period of maximum enhancement of nitrogenase activity by 60% by addition of 1 mM phenol. The cells did not produce 14CO2 from [U-14C] phenol, neither in surface cultures nor in liquid cultures and less than 0.1% of the phenol was incorporated into the cells. A smaller but significant enhancement of nitrogenase activity by about 100% in surface cultures under air was found with Klebsiella pneumoniae K 11 after addition of 1 mM phenol. However, in Rhizobium japonicum 61-A-101 all phenol concentrations above 0.01 mM reduced nitrogenase activity. With 1 mM phenol added activity was reduced to less than 10% with no effect on the growth in the same cultivation system. With this Rhizobium japonicum strain significant quantities of phenol (25 mumol in 24 h by 2 X 10(12) cells) were metabolized to 14CO2, with phenol as sole carbon source. With Azospirillum brasilense in liquid culture under 1% and 2% O2 in the gas phase, no enhancement of nitrogenase activity by phenol was noticed.