Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011)

OBJECTIVE

To describe the case-mix of patients admitted to intensive care units (ICUs) in Spain during the period 2006-2011 and to assess changes in ICU mortality according to severity level.

DESIGN

Secondary analysis of data obtained from the ENVN-HELICS registry. Observational prospective study.

SETTING

Spanish ICU.

PATIENTS

Patients admitted for over 24h.

INTERVENTIONS

None.

VARIABLES

Data for each of the participating hospitals and ICUs were recorded, as well as data that allowed to knowing the case-mix and the individual outcome of each patient. The study period was divided into two intervals, from 2006 to 2008 (period 1) and from 2009 to 2011 (period 2). Multilevel and multivariate models were used for the analysis of mortality and were performed in each stratum of severity level.

RESULTS

The study population included 142,859 patients admitted to 188 adult ICUs. There was an increase in the mean age of the patients and in the percentage of patients >79 years (11.2% vs. 12.7%, P<0.001). Also, the mean APACHE II score increased from 14.35±8.29 to 14.72±8.43 (P<0.001). The crude overall intra-UCI mortality remained unchanged (11.4%) but adjusted mortality rate in patients with APACHE II score between 11 and 25 decreased modestly in recent years (12.3% vs. 11.6%, odds ratio=0.931, 95% CI 0.883-0.982; P=0.008).

CONCLUSION

This study provides observational longitudinal data on case-mix of patients admitted to Spanish ICUs. A slight reduction in ICU mortality rate was observed among patients with intermediate severity level.

The relationship of the parotid duct to the buccal and zygomatic branches of the facial nerve; an anatomical study with parameters of clinical interest

There have been studies concerning the protection of the facial nerve during plastic surgery intended for the parotid gland. The close relationship between the parotid duct and the buccal and zygomatic branches of the facial nerve is studied here. The dissections were performed on 10 fixed cadavers at the Anatomy Dissection Laboratory of Ankara University in 2004. The reference points used for surgery of this region were taken into consideration as the landmarks for morphometric measurements. In 7 of the cases the zygomatic branch was double and in 3 it was single. In 4 of the 7 cases with a double zygomatic branch both superior and inferior branches crossed the parotid duct. In the remaining 3 cases the superior branches of the zygomatic nerve coursed through the zygomatic major and minor muscles. In 9 of all the cases the zygomatic branch of the facial nerve crossed the duct anteriorly and in one it did so posteriorly (case 10). The buccal branch was single in 4 of the cases and double in 6. Among these one of the most precise measurements was the distance between the lateral canthus and the intersection point of the zygomatic branch and the duct with a coefficient of variation of 9.9%. With the use of this reliable measurement the intersection point of the zygomatic branch and the duct may be estimated to be within 5.16+/-1.01 centimetres of the lateral canthus. Facial nerve paralysis is the most important complication of superficial face surgery and the anatomy of this region must thus be taken into detailed consideration by surgeons.

An unusual course of the radial artery

Radial artery variations are of importance for clinicians, whether in angiographic examinations or surgical approaches. The high origin radial artery is the most frequent arterial variation observed in the upper limb, showing an incidence of 14.27% in dissection material and 9.75% in angiographic examination. In the present study an unusual course of the radial artery and its relation with the median nerve has been evaluated. During embryological development the radial artery sprouts from two arterial buds arising from the lateral side of the brachial artery and coalescing with each other. The artery lies in the forearm and is overlapped by the brachioradial muscle. In this particular case the radial artery originated from the medial side of the brachial artery and crossed the median nerve twice in an unusual manner 8 cm below the point at which the deep brachial artery arose and 12 cm above the intercondylar line. These results will enhance anatomical knowledge of the region and reduce complication in surgical approaches.

Feasibility and reproducibility of an image-scoring method for quality control of fetal biometry in the second trimester

OBJECTIVES

The need for training programs and certification processes in fetal ultrasound has become obvious. The purpose of this study was to evaluate the feasibility of a score-based quality control system for fetal biometry in the second trimester.

METHODS

Standard measurements of biparietal diameter and head circumference, abdominal circumference, and femur length at 20-24 weeks had been made by four operators using the same ultrasound machine. Twenty-five of each of the cephalic, abdominal and femoral images with the calipers in place were selected arbitrarily from each operator's ultrasound database and anonymized. These 300 images were analyzed by three experienced reviewers blinded to the operator's identity. Each image was first evaluated subjectively and then scored according to six criteria for abdominal and cephalic measurements and four criteria for femur length making a six-point score for abdominal and cephalic biometry and a four-point score for femur length. For subjective evaluation, inter-reviewer differences were analyzed using percentage agreement and adjusted kappa. For objective evaluation, a difference in scoring of one point or less among reviewers was considered good agreement. Intrareviewer variability was assessed using 40 images of each type of examination selected arbitrarily.

RESULTS

The distribution of scores was similar between reviewers. One operator obtained significantly lower scores whereas the other three had good and comparable results. There was no statistical difference in the mean score attributed by each reviewer and agreement was good in 84-90% of the cases. Intrareviewer agreement was good in 90-100% of the cases, with similar scores for each reviewer.

CONCLUSION

A quality control policy based on image scoring is feasible and allows for fair to good inter- and intrareviewer reproducibility. The potential contribution of this approach to assess the quality of routine ultrasound examinations should be tested on a larger scale.

Quantitative analysis of myelinated axons of commissural fibers in the rat brain

In this study, the myelinated axons of the rostrum, genu, truncus and splenium parts of the corpus callosum and of the anterior, posterior and habenular commissures were counted in the rat brain by using a camera lucida. The numerical densities of these axons were compared with each other by means of quantitative analytical statistical methods. In parts of the corpus callosum, a statistically significant difference was found between the rostrum and genu, rostrum and truncus, rostrum and the splenium, genu and truncus, and the genu and splenium. However, no statistically significant difference was found between the truncus and splenium. When comparing the number of myelinated axons of the anterior, posterior and habenular commissures, statistically significant differences were found between the anterior and posterior commissures, and between the anterior and habenular commissures. No statistically significant difference was found between the posterior and habenular commissures. Small sized myelinated axons were present in all parts of the corpus callosum and in the anterior commissure. However, a heterogeneous distribution of myelinated axons was present in the posterior and habenular commissures.

Effects of cimetidine on broiler fattening and on stress-induced gizzard erosion in chicken

The work describes the effects of cimetidine on stress-induced gizzard erosions (Experiment A) and the influence of the long-term application (42 days) of the same drug on weight gain and feed consumption during broiler fattening (Experiment B). For Experiment A, 60 male, three-day-old chicks were divided into two groups: C (n = 30)--control chicks treated with 0.5 ml saline; CIM (n = 30)--chicks treated with cimetidine in a dose of 5 mg/kg body weight (b. w.) intragastrically. All chicks were stressed using a modified water-immersion stress method according to which the chicks, after 24 h of feed deprivation, were immersed in tap water (17 degrees C) for a few seconds. Under chloroform anaesthesia ten chicks from each group were killed 1, 2 and 3 h after the stressing. The morphometric analysis of gizzard erosion (GE) and histopathological examinations of gizzards were performed for each chick. In Experiment B, 32 one-day-old broilers of both sexes were used. The control group was untreated (n = 16) while the CIM group (n = 16) was fed the same diet supplemented with 10 mg of cimetidine per kilogram of feed throughout the fattening period (42 days). The results of Experiment A showed decreased mean length of the GE in the cimetidine-treated birds as compared with the GE lesions of the controls. In Experiment B, the treated chicks had reduced liveweight (1835.1 g), carcass weight (1474.6 g) and increased feed consumption (2115 g of feed per kilogram of weight gain) compared to the controls in which the same parameters were 1898.5 g, 1574.2 g and 1797 g, respectively. The results show that while stress-induced GE of chicks can be medicated pharmacologically, long-term application of the same substance impairs the results of fattening.

Balance between opposite effects of short day stimulation and testicular steroid feedback inhibition on pituitary pulsatile LH release in male mink, Mustela vison

This study explores changes in pituitary pulsatile Luteinizing Hormone (LH) secretion in intact and castrated male mink, either previously photogonadostimulated by short day treatment (LD 4:20), or maintained in a state of sexual quiescence by long day treatment (LD 20:4). Artificial photoperiodic treatment of intact mink significantly increases plasma LH level and pulse frequency, following transfer from inhibiting long-to stimulating short-days. This photoperiodic control mimics two important phases of the annual reproductive cycle: seasonal maximum gonadal activity and sexual quiescence. Furthermore, pulsatile secretion of LH is investigated 48 hours after castration. When mink castrated during long day treatment are compared against control intact mink, no change in their low LH secretion parameters are observed. This result indicates that gonadal steroids on long days are not suppressing LH secretion, which is controlled by photoperiodic inhibition alone. When mink are castrated at the onset of short day induced gonadal growth, mean plasma LH level and amplitude of LH pulses are increased over that found in stimulated intact mink. This result indicates that, during the phase of resumption of gonadal activity on short days, testicular steroid feedback partially controls the pituitary activity.

Differential photoperiodic control of seasonal variations in pulsatile luteinizing hormone release in long-day (ferret) and short-day (mink) mammals

The aim of this study was to elucidate the pituitary adjustments implicated in photoperiodic control of reproduction in two mammalian species, the ferret and the mink. In the ferret, which displays renewed testicular activity when the days lengthen, we observed a stimulation of the pulsatile liberation of luteinizing hormone (LH) reflecting the pulsatile activity of the gonadotropin-releasing hormone (GnRH) system when daylight was equal to or in excess of LD 8:16. This photoperiod coincides precisely with the phase of photosensitivity known to be essential for gonadal stimulation in this species. In the mink, which displays renewed testicular activity when the days shorten, pituitary stimulation was activated when daylight was reduced to LD 11:13, and gonadal stimulation occurred only when daylight was further reduced to LD 10:14. In addition to requiring different photoperiodic stimuli to trigger the seasonal reproductive process, the two species display variations in the "timing" of pituitary control of renewed gonadal activity.

Seasonal variations of pulsatile luteinizing hormone release in the mink (Mustela vison)

The pulsatile secretion of the hypophyseal luteinizing hormone (LH) is induced by the pulsatile secretion of the hypothalamic neurons secreting gonadotrophin-releasing hormone (GnRH). Seasonal variations in the pulsatility of LH were studied in the adult male mink (Mustela vison), reared under natural environmental conditions. Twenty-one animals were studied according to five critical phases in the breeding season: (1) the terminal phase of sexual quiescence, which precedes renewal of gonadal activity (October-November); (2) renewal of gonadal activity (December); (3) maximum gonadal activity at the height of the breeding season (February); (4) reduction of testicular activity (April); and (5) the initial phase of testicular quiescence (June). Levels of gonadal growth and activity were used to define each phase. A second animal group was studied after being reared for 2 months in an experimental gonado-inhibitory photoperiod, which, necessarily for the mink, was of the "long-day" type: 20L:4D regimen in the present study. Results, obtained with fully conscious animals, provide evidence for the pulsatile secretion of gonadotrophic hormone in this species. In spite of inter-individual differences in pulse patterns, particularly in phases 1 and 2, the pulsatile character of LH secretion is seen to vary markedly as a function of gonadal activity. The variations reflect an increase of hypophyseal activity as early as the preparative phase to the breeding season, and a decrease of activity during the testicular regression phase, which is followed by the onset of gonadotrophic quiescence in June. The main parameter affected statistically by these seasonal fluctuations is pulse frequency; variations in pulse frequency correlated with variations in mean plasma concentrations of LH. In the experimental gonado-inhibitory photoperiod, which led to a severe reduction in gonadal activity, all hormonal pulsatility parameters were statistically reduced; this confirms the importance of photoperiodic control of reproduction in Mustela vison. Several possible mechanisms are proposed for photoperiodic control.

Effects of bilateral superior cervical ganglionectomy on thyroid and gonadal functions in the edible dormouse Glis glis

1. The annual profiles of plasma thyroid-stimulating hormone (TSH), thyroxine (T4), luteinizing hormone (LH) and testosterone (T) concentrations in control and ganglionectomized (SCGx) dormice were analyzed to determine whether the pineal gland affects thyroid-gonadal interactions in response to the seasonal influence of environmental factors. 2. Dormice ganglionectomized in September, around the time of prehibernation when hormonal activity is minimal had significantly disturbed annual cycles of plasma T4, LH and T, while the TSH cycle was unchanged. 3. SCGx performed after breeding season (June), only affected the T4 variations, while the T and LH titers were similar to those of controls. 4. We conclude that the annual cycles of T4 and testosterone are controlled by the sympathetic nervous system via the superior cervical ganglion which innervates both the pineal gland and the thyroid. 5. During the start of seasonal gonadal activity, which is strongly dependent on thyroid-gonadal interactions, the inhibitory action of the pineal gland on the neuroendocrine thyroid axis, or most probably a direct inhibition of the thyroid by the sympathetic innervation from SCG, might influence the timing of the reproduction cycle. 6. The lack of thyroid-gonadal interaction at the end of the breeding season suggests that the thyroid disturbance caused by ganglionectomy in June does not cause gonadal perturbation at this time.

Diurnal variations of urinary 6-sulphatoxymelatonin in male intact or ganglionectomized mink

The existence of the major urinary metabolite of melatonin, 6-sulphatoxymelatonin (aMT6s), was validated for mink and the 24 hr urinary excretion pattern was determined in intact and superior cervical ganglionectomized animals under different photoperiodic conditions. Within- and between-assay variations, parallelism between serially mid-night pooled urine dilutions and standard curves in aMT6s free urine of mink at 1:125 dilution and recovery of aMT6s in mid-day pooled urine at 1:125 dilution provided a good validation for the mink urinary a MT6s assay. In natural photoperiods (January, LD 9:15; April, LD 13:11) the diurnal rhythm was characterized by low aMT6s values during the day and high values at night. There were no differences in the nocturnal values measured under long- (April, 4.11 +/- 0.40 ng/hr) or short-day (January, 4.74 +/- 0.36 ng/hr) conditions. In an experimental long photoperiod (LD 15:9), the same result was obtained on the 24 hr rhythm in intact animals, but in ganglionectomized mink the nocturnal rise in aMT6s was abolished and the nocturnal values were always low (0.88 +/- 0.09 ng/hr). Our results agree with those obtained in other species concerning plasma melatonin rhythm and urinary aMT6s excretion; we thus conclude that this is an effective assay for measuring pineal activity in mink.

Seasonal changes in thyroid-gonadal interactions in the edible dormouse, Glis glis

This study was conducted to determine changes in thyroid-gonadal interaction in the edible dormouse during the phase of the annual cycle that corresponds to the end of the breeding season (from June to September). We evaluated intra-hypothalamic luteinizing hormone-releasing hormone (LHRH) content, and plasma concentrations of luteinizing hormone (LH), testosterone, thyroid-stimulating hormone (TSH) and thyroxine (T4) in three groups of dormice: (1) controls; (2) dormice receiving sufficient T4 supplementation to maintain June levels in control animals until September, thus counteracting the seasonal reduction of T4 that normally begins in July; and (3) thyroidectomized dormice. The effect of thyroidectomy was only detectable in June, when plasma T4 concentration in the control group was maximal, and consisted of a significant decrease in plasma testosterone levels. This provides strong support for the hypothesis that thyroid function positively influences gondal function during the breeding season. The T4 supplementation resulted in a decrease in hypothalamic LHRH concentration, suggesting that an increased LHRH release led to the observed stimulated hypophyseal secretion of LH in June and September and the increased circulating testosterone levels in September. There was no detectable effect in July and August. These results show that thyroid axis activation of the hypothalamic-pituitary-gondal system is only possible during certain phases of the annual cycle, particularly evidenced here during the breeding season. They also reinforce our conclusions drawn from the thyroidectomy results. Conversely, the summer testicular regression which normally occurs after the breeding season is no longer controlled by plasma T4 levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Control of annual endocrine rhythms in the edible dormouse: nonprimary effect of photoperiod

We investigated the extent to which photoperiodic fluctuations synchronize annual thyroid and gonadal rhythmicity in edible dormice. The effects of different daylength manipulations (LD 4:20, LD 6:18, LD 18:6, LD 20:4) were examined during the two critical ascending and regressive phases of the annual plasma testosterone and thyroxine cycles that correspond to naturally increasing or decreasing photoperiod variations. The data failed to demonstrate any essential photoperiodic contribution to control systems that generate these two annual biological rhythms in dormice.

Further demonstration of the ambient temperature dependence of the annual biological cycles in the edible dormouse, Glis glis

In the male edible dormouse, it has been proposed that the annual temperature cycle is the major external factor triggering annual biological rhythms in this hibernating species. The present study was designed to explore (i) the effects of suppression of the annual thermoperiodic cycle under natural photoperiodic conditions, and (ii) the effects of acute exposure to a warm environment on basal plasma T4 levels observed during hibernation. The results of the first experiment demonstrate an absence of circannual cycles of hibernation, body weight, and endocrine thyroid and gonadal functions in the absence of annual fluctuations of temperature (constant warm environment at 24 degrees C) despite the maintenance of a normal photoperiodic cycle. On the other hand, acute exposure to 24 degrees C during the late stage of hibernation stimulated thyroid function as expressed by a consistent transitory rise in plasma T4 concentrations, which was maximal within 7 days and restored to basal levels after 14 days. These findings are in close agreement with the concept that in the edible dormouse, the annual thyroid cycle is synchronized with the annual temperature cycle. Moreover, the present study, combined with prior data indicating that the thyroid cycle induces the testis cycle, suggests that the ambient temperature cycle may be intricately involved in the control of neuroendocrine cycles in dormice, although the mechanism is still unknown.