Dialectical Behavior Therapy for Adolescents With Bipolar Disorder: A Randomized Clinical Trial

Importance

Early-onset bipolar disorder conveys substantial risk for suicide. No psychosocial intervention for this population expressly targets suicidal behavior.

Objective

To determine whether dialectical behavior therapy (DBT) for adolescents with bipolar spectrum disorder is more effective than standard of care (SOC) psychotherapy in decreasing suicide attempts over 1 year.

Design, Settings, and Participants

Adolescents aged 12 to 18 years diagnosed with bipolar spectrum disorder were recruited from a specialty outpatient psychiatric clinic between November 2014 and September 2019. Independent evaluators conducted quarterly assessments over 1 year with participants and parents. Data were analyzed from March 2021 to November 2022.

Interventions

Participants were randomly assigned to 1 year of DBT (36 sessions; n = 47) or SOC psychotherapy (schedule clinically determined; n = 53). All youth received medication management via a flexible algorithm.

Main Outcomes and Measures

Primary outcomes included suicide attempts over 1 year and mood symptoms and states (depression and hypomania/mania). Secondary analyses included moderation of DBT effects by history of suicide attempt and mediation through emotion dysregulation.

Results

Of 100 included participants, 85 (85%) were female, and the mean (SD) age was 16.1 (1.6) years. Participants were followed up over a mean (SD) of 47 (14) weeks. Both treatment groups demonstrated significant and similar improvement in mood symptoms and episodes over 1 year (standardized depression rating scale slope, -0.17; 95% CI, -0.31 to -0.03; standardized mania rating scale slope, -0.24; 95% CI, -0.34 to -0.14). DBT and SOC participants reported similar suicide attempt rates at intake as measured on the Adolescent Longitudinal Follow-Up Evaluation (ALIFE; mean [SD] attempts, 2.0 [4.5] vs 1.8 [3.9], respectively; P = .80). DBT participants reported slightly more suicide attempts at intake as measured on the Columbia-Suicide Severity Rating Scale Pediatric Version (C-SSRS; mean [SD] attempts, 1.4 [3.6] vs 0.6 [0.9]; P = .02). DBT participants reported significantly fewer suicide attempts over follow-up compared with SOC participants via the ALIFE (mean [SD] attempts per follow-up period, 0.2 [0.4] vs 1.1 [4.3], controlling for baseline attempts: P = .03) and the C-SSRS (mean [SD] attempts per follow-up period, 0.04 [0.2] vs 0.10 [0.3], controlling for baseline attempts; P = .03). DBT was significantly more effective than SOC psychotherapy at decreasing suicide attempts over 1 year (ALIFE: incidence rate ratio [IRR], 0.32; 95% CI, 0.11-0.96; C-SSRS: IRR, 0.13; 95% CI, 0.02-0.78). Decreased rate of suicide attempts in DBT was moderated by presence of lifetime history of suicide attempt and time (IRR, 0.23; 95% CI, 0.13-0.44) and mediated by improvement in emotion dysregulation (IRR, 0.61; 95% CI, 0.42-0.89), particularly for those with high baseline emotion dysregulation (standardized β, -0.59; 95% CI, -0.92 to -0.26).

Conclusions and Relevance

In this randomized clinical trial, DBT demonstrated efficacy in decreasing suicide attempts among the high-risk population of adolescents with bipolar spectrum disorder.

Trial Registration

ClinicalTrials.gov Identifier: NCT02003690.

Subjective and neural reactivity during savoring and rumination

Repetitive thinking about negative emotions or events is strongly associated with worse mental health, whereas repetitive positive thought is generally believed to be beneficial. This observation is at odds with the idea that all forms of repetitive thinking share underlying neural mechanisms. To resolve this apparent discrepancy, the present study examined relationships between subjective affect and neural mechanisms during periods of sustained processing of positive (savoring) and negative (rumination) emotion. We also examined potential common moderators of savoring and rumination including memory specificity and sleep quality. Results indicated that individuals who experience high positive affect during savoring also are likely to experience more intense negative affect during rumination. fMRI-derived brain activity revealed common mechanisms of rumination and savoring. Memory specificity had common effects on neural correlates of rumination and savoring; sleep quality was not associated with mechanisms of savoring or rumination. These results suggest that repetitive engagement with positive and negative affect is similar both subjectively and mechanistically. Clinical interventions for rumination may benefit from capitalizing on preserved capacity for savoring.

0247 Sleep Disturbance is Associated with Dysregulation of Positive and Negative Affect Systems

Introduction

Sleep disturbance is a risk factor for the development of mood disorders and up to 90% of mood disorder patients report sleep problems. However, the neural mechanisms by which poor sleep contributes to mood disorders are not well understood. We investigated whether sleep disturbance was associated with dysregulation of positive and negative affect systems, including passive reactivity and active emotion regulation.

Methods

Participants (n=55, Mage=24.4 years, 53% female) selected for high, medium, and low scores on the PROMIS Sleep Disturbance scale completed a cognitive reappraisal task in an fMRI scanner. Participants were presented with International Affective Picture Stimuli (30 positive, 30 negative, 15 neutral) and were instructed to either passively view or actively up- or down-regulate their emotional experience. We tested five conditions: view-positive, upregulate-positive, view-negative, downregulate-negative, view-neutral. Participants also completed objective (i.e., 7-day actigraphy) and self-report (i.e., Insomnia Severity Index [ISI]) measures of sleep prior to the scan. Analyses in AFNI were constrained within an emotion regulation network, identified using a Neurosynth mask, and treated as a single region of interest. Voxelwise (puncorr<.005) and clusterwise thresholds (p<.05) were used to correct for multiple comparisons.

Results

Actigraphy-assessed sleep duration was associated with supplementary motor area (SMA) activity when upregulating positive affect relative to passively viewing positive images (k=44 voxels, clusterwise p=.04); participants who slept less showed greater SMA activity. ISI score was marginally associated with dorsolateral prefrontal cortex (dlPFC) activity when downregulating negative affect relative to an implicit baseline (k=30 voxels, clusterwise p=.10); individuals with greater insomnia severity showed more dlPFC activity. PROMIS Sleep Disturbance showed no significant associations.

Conclusion

Markers of poor sleep (i.e., lower sleep duration, greater insomnia severity) were associated with heightened SMA and dlPFC activity during cognitive reappraisal. This may suggest inefficiency in modulating positive affect via verbal and motor processes (i.e., SMA) and negative affect via cognitive control (i.e., dlPFC). Alternatively, individuals with poor sleep may have greater emotional reactivity to modulate. Mood disorders are commonly associated with increased negative affect and blunted positive affect. Our findings suggest a plausible neural substrate for how sleep disturbance contributes to dysregulation of these systems.

Support (If Any)

NIMH R21 MH102412.

0192 Effects of emerging alcohol use on developmental trajectories of functional sleep measures in adolescents

Introduction

Adolescence is characterized by developmental changes in sleep timing and architecture as well as alcohol use initiation. While the effects of acute and chronic alcohol use on sleep in adults are well-documented, much less is known in adolescents. We used longitudinal data from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) to examine how emerging alcohol use affected sleep architecture in adolescents.

Methods

Overnight polysomnographic recordings were made each year, for 4 years, in 94 adolescents (12–21 years at baseline, 43% female) from the NCANDA cohort. All participants were no or low (youth adjusted Cahalan score of zero) alcohol users at baseline. These data were used to examine developmental trajectories of sleep macro-architecture and sleep electroencephalographic (EEG) measures using linear mixed effect models (LMMs), considering age, sex, family history of alcohol use, body mass index, ethnicity, and alcohol use class (i.e., no-to-low, moderate or heavy) at each annual assessment.

Results

There were strong developmental changes in sleep macro-structure and EEG, most notably, a decrease in slow wave sleep percentage and slow wave (delta) EEG activity with advancing age (p=0.02)​. Compared to those who remained no-to-low drinkers, participants who became moderate/heavy drinkers during the follow-up period, had different sleep trajectories, especially those older at baseline at baseline, including higher slow wave activity (p = 0.04), higher REM sleep percentage (p = 0.03), poorer sleep efficiency​ (p=0.003), and longer latency to sustained sleep (p = 0.03). The effects of alcohol use depended on sex, with male heavy drinkers having more REM sleep than female heavy drinkers (p = 0.04). Overall, a positive family history of alcohol use was associated with less NREM sleep and shorter sleep duration.

Conclusion

Our results present novel findings showing that emerging alcohol use during adolescence exerts complex effects on sleep macro- and micro-structure, over and above normal developmental changes in sleep. These effects could, in part, be alcohol effects on brain maturation processes underlying sleep regulation.

Support (If Any)

AA021696, AA021690

540 Age Trends in Sleep Across the Lifespan: Findings from the Pittsburgh Lifespan Sleep Databank

Introduction

Sleep continuously changes over the human lifespan and it does so across multiple dimensions, including duration, timing, efficiency, and variability. Although studies focused on specific developmental periods have shown age-related changes in sleep, methodological differences make it difficult to synthesize information across studies to fully understand precisely when these sleep changes occur. Our goal was to use individual-level actigraphy and self-report sleep data from a single site to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human lifespan. To accomplish this goal, we developed the Pittsburgh Lifespan Sleep Databank (PLSD), a large aggregate databank of participants from sleep research studies conducted at the University of Pittsburgh.

Methods

In the present analysis, we included N=1,070 PLSD participants from 21 studies without a major psychiatric, sleep, or medical condition. We used Generalized Additive Models to examine flexible, potentially non-linear relationships between age and sleep dimensions (actigraphy and self-report duration, efficiency, and timing; actigraphy variability) from ages 10 to 87. We also examined whether these sleep characteristics differed by sex across the lifespan.

Results

The most dramatic age-related trends were observed in sleep timing. Actigraphy and self-report sleep onset time shifted later between ages 10–18 and then shifted earlier again during the 20s. Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s. Self-report duration became shorter from approximately ages 10–20. Self-report sleep efficiency and actigraphy variability both decreased over the entire lifespan. Relative to males, females tended to have earlier self-report sleep onset, higher actigraphy sleep efficiency, and longer actigraphy duration.

Conclusion

By focusing on lifespan sleep rather than specific age segments of the samples, we can provide a unified assessment of age-related changes and sex differences from childhood through older adulthood. An understanding of age trends and sex differences in sleep in healthy individuals – and explicating the timing and nature of these difference – can be used to identify periods of sleep-related risk or resilience and guide intervention efforts.

Support (if any)

University of Pittsburgh Clinical and Translational Science Institute (UL1TR001857).

284 Cognitive Deficits due to Insufficient Sleep are Mitigated Following Strenuous Physical Exertion in Firefighters

Introduction

Insufficient sleep impairs cognitive function which results in costly errors. Firefighter shifts regularly exceed 24-hrs with little to no sleep. Nevertheless, firefighters must maintain and flexibly shift attention in high-pressure scenarios. Firefighters also engage in strenuous physical exertion during fire suppression activities. However, it is unclear whether physical exertion acts as another stressor, exasperating cognitive deficits due to insufficient sleep, or whether physical exertion enhances arousal to reduce cognitive deficits. Moreover, the effects of physical exertion may depend on the type of cognitive process and extent of sleep loss. We examined the effect of physical exertion on vigilant attention and task-switching in firefighters who underwent sleep-deprivation or sleep-disruption.

Methods

Participants were 17 healthy young adult males who participated in a within-subjects crossover design with three experimental lab visits: sleep-deprivation, sleep-disruption (woken 3 times for 60-min each), and normal sleep. The next day, participants completed a 50-min treadmill exercise task in a heated room in firefighter protective clothing. Participants completed a vigilant attention task (Psychomotor Vigilance Task, PVT) and a task-switching task five to nine times each visit. The five timepoints of interest–before and after the sleep manipulation night, before and after the treadmill exercise task, and recovery (approximately 180-min following exercise)–were examined using linear mixed effects models.

Results

We analyzed lapses (reaction times [RT]>500ms) on the PVT and switch-trial RT and accuracy on the task-switching task for sleep-deprivation and sleep-disruption conditions relative to normal sleep. Sleep-disruption, p=.001, and sleep-deprivation, p<.001, increased lapses. Sleep-disruption increased switch-trial RT, p=.01, and sleep-deprivation reduced switch-trial accuracy, p=.01. Only switch-trial accuracy improved immediately after the treadmill exercise task and only for the sleep-deprivation condition, p=.01. During recovery, lapses lessened for the sleep-deprivation condition, p=.049, and switch-trial accuracy improved for both sleep-deprivation, p=.01, and sleep-disruption conditions, p=.049.

Conclusion

Physical exertion reduced task-switching and attentional deficits caused by insufficient sleep, with more benefits observed during recovery. We found no evidence for performance decrements due to physical exertion. Physical exertion may interact with the extent of sleep loss–primarily benefitting performance under conditions of total sleep-deprivation.

Support (if any)

DSF Charitable Foundation and University of Pittsburgh Clinical and Translational Science Institute UL1TR001857.

Neutron measurements from beam-target reactions at the ELISE neutral beam test facility

Measurements of 2.5 MeV neutron emission from beam-target reactions performed at the ELISE neutral beam test facility are presented in this paper. The measurements are used to study the penetration of a deuterium beam in a copper dump, based on the observation of the time evolution of the neutron counting rate from beam-target reactions with a liquid scintillation detector. A calculation based on a local mixing model of deuterium deposition in the target up to a concentration of 20% at saturation is used to evaluate the expected neutron yield for comparison with data. The results are of relevance to understand neutron emission associated to beam penetration in a solid target, with applications to diagnostic systems for the SPIDER and MITICA Neutral Beam Injection prototypes.

3D numerical simulations of negative hydrogen ion extraction using realistic plasma parameters, geometry of the extraction aperture and full 3D magnetic field map

Decreasing the co-extracted electron current while simultaneously keeping negative ion (NI) current sufficiently high is a crucial issue on the development plasma source system for ITER Neutral Beam Injector. To support finding the best extraction conditions the 3D Particle-in-Cell Monte Carlo Collision electrostatic code ONIX (Orsay Negative Ion eXtraction) has been developed. Close collaboration with experiments and other numerical models allows performing realistic simulations with relevant input parameters: plasma properties, geometry of the extraction aperture, full 3D magnetic field map, etc. For the first time ONIX has been benchmarked with commercial positive ions tracing code KOBRA3D. A very good agreement in terms of the meniscus position and depth has been found. Simulation of NI extraction with different e/NI ratio in bulk plasma shows high relevance of the direct negative ion extraction from the surface produced NI in order to obtain extracted NI current as in the experimental results from BATMAN testbed.

First negative ion beam measurement by the Short-Time Retractable Instrumented Kalorimeter Experiment (STRIKE)

The Source for Production of Ion of Deuterium Extracted from Rf plasma (SPIDER) test facility is under construction in Padova to optimise the operation of the beam source of ITER neutral beam injectors. The SPIDER beam will be characterised by the instrumented calorimeter STRIKE, whose main components are one-directional carbon-fibre-carbon-composite tiles. A small-scale version of the entire system has been employed in the BAvarian Test MAchine for Negative ions (BATMAN) testbed by arranging two prototype tiles in the vertical direction. The paper presents a description of the mini-STRIKE system and of the data analysis procedures, as well as some results concerning the BATMAN beam under varying operating conditions.

First results of the ITER-relevant negative ion beam test facility ELISE (invited)

An important step in the European R&D roadmap towards the neutral beam heating systems of ITER is the new test facility ELISE (Extraction from a Large Ion Source Experiment) for large-scale extraction from a half-size ITER RF source. The test facility was constructed in the last years at Max-Planck-Institut für Plasmaphysik Garching and is now operational. ELISE is gaining early experience of the performance and operation of large RF-driven negative hydrogen ion sources with plasma illumination of a source area of 1 × 0.9 m(2) and an extraction area of 0.1 m(2) using 640 apertures. First results in volume operation, i.e., without caesium seeding, are presented.

The post illumination pupil response is reduced in seasonal affective disorder

Individuals with seasonal affective disorder (SAD) may have a decreased retinal sensitivity in the non-image forming light-input pathway. We examined the post illumination pupil response (PIPR) among individuals with SAD and healthy controls to identify possible differences in the melanopsin signaling pathway. We also investigated whether melanopsin gene (OPN4) variations would predict variability in the PIPR. Fifteen SAD and 15 control participants (80% women, mean age 36.7 years, S.D.=14.5) were assessed in the fall/winter. Participants were diagnosed based on DSM-IV-TR criteria. Infrared pupillometry was used to measure pupil diameter prior to, during, and after red and blue stimuli. In response to blue light, the SAD group had a reduced PIPR and a lower PIPR percent change relative to controls. The PIPR after the blue stimulus also varied on the basis of OPN4 I394T genotype, but not OPN4 P10L genotype. These findings may indicate that individuals with SAD have a less sensitive light input pathway as measured by the PIPR, leading to differences in neurobiological and behavioral responses such as alertness, circadian photoentrainment, and melatonin release. In addition, this sensitivity may vary based on sequence variations in OPN4, although a larger sample and replication is needed.

Optical emission spectroscopy at the large RF driven negative ion test facility ELISE: instrumental setup and first results

One of the main topics to be investigated at the recently launched large (A(source) = 1.0 × 0.9 m(2)) ITER relevant RF driven negative ion test facility ELISE (Extraction from a Large Ion Source Experiment) is the connection between the homogeneity of the plasma parameters close to the extraction system and the homogeneity of the extracted negative hydrogen ion beam. While several diagnostics techniques are available for measuring the beam homogeneity, the plasma parameters are determined by optical emission spectroscopy (OES) solely. First OES measurements close to the extraction system show that without magnetic filter field the vertical profile of the plasma emission is more or less symmetric, with maxima of the emission representing the projection of the plasma generation volumes, and a distinct minimum in between. The profile changes with the strength of the magnetic filter field but under all circumstances the plasma emission in ELISE is much more homogeneous compared to the smaller IPP prototype sources. Planned after this successful demonstration of the ELISE OES system is to combine OES with tomography in order to determine locally resolved values for the plasma parameters.

Anterior Frontal Cortex and the Effect of Proactive Interference in Paired Associate Learning: A DC Potential Study

This contribution focuses on neurophysiological correlates of the cerebral processes subserving the control of proactive interference. Event-related negative shifts of the scalp-recorded cortical steady potential (negative DC shifts) were measured in 17 right-handed normals during two tasks of paired associate learning. The control condition was a standard word pair learning task in which unrelated word pairs were presented. In the experimental condition, proactive interference was maximized by presenting very similar words and by requiring negative transfer, i.e., by having them reappear, but in different pairings. Proactive interference leads to increased anterior frontal negative DC shifts. Furthermore, centrotemporal negative DC shifts predicted subsequent cued recall performance. In spite of elaborative strategies, an effect of subsequent mnestic performance on the P300 was observed.

The development of the radio frequency driven negative ion source for neutral beam injectors (invited)

Large and powerful negative hydrogen ion sources are required for the neutral beam injection (NBI) systems of future fusion devices. Simplicity and maintenance-free operation favors RF sources, which are developed intensively at the Max-Planck-Institut für Plasmaphysik (IPP) since many years. The negative hydrogen ions are generated by caesium-enhanced surface conversion of atoms and positive ions on the plasma grid surface. With a small scale prototype the required high ion current density and the low fraction of co-extracted electrons at low pressure as well as stable pulses up to 1 h could be demonstrated. The modular design allows extension to large source dimensions. This has led to the decision to choose RF sources for the NBI of the international fusion reactor, ITER. As an intermediate step towards the full size ITER source at IPP, the development will be continued with a half-size source on the new ELISE testbed. This will enable to gain experience for the first time with negative hydrogen ion beams from RF sources of these dimensions.

Long pulse H- beam extraction with a rf driven ion source on a high power level

IPP Garching is investigating the applicability of rf driven negative ion sources for the neutral beam injection of International Thermonuclear Experimental Reactor. The setup of the tested source was improved to enable long pulses up to 100 kW rf power. The efficiency of negative ion production decreases at high power. The extracted H(-) currents as well as the symmetry of the plasma density close to the plasma grid and of the beam divergence depend on the magnetic filter field. The pulse duration is limited by the increase in coextracted electrons, which depends on the rf power and the caesium conditions on the plasma grid.

Long pulse large area beam extraction with a rf driven H(-)/D(-) source

IPP Garching is heavily involved in the development of the rf driven H(-)/D(-) ion source for the ITER NBI. After the successful demonstration of the required physical parameters, the experimental conditions have been extended to long pulses and large area beam extraction. This paper contains descriptions of the source and power supply modifications necessitated for long pulses as well as the latest results including the first 1 h pulse. Suppression of the coextracted electron current is a key issue. Experiments with potential control, different magnetic filter fields, and cesium handling to suppress the electrons and stabilize the currents are also reported.

Low pressure and high power rf sources for negative hydrogen ions for fusion applications (ITER neutral beam injection)

The international fusion experiment ITER requires for the plasma heating and current drive a neutral beam injection system based on negative hydrogen ion sources at 0.3 Pa. The ion source must deliver a current of 40 A D(-) for up to 1 h with an accelerated current density of 200 Am/(2) and a ratio of coextracted electrons to ions below 1. The extraction area is 0.2 m(2) from an aperture array with an envelope of 1.5 x 0.6 m(2). A high power rf-driven negative ion source has been successfully developed at the Max-Planck Institute for Plasma Physics (IPP) at three test facilities in parallel. Current densities of 330 and 230 Am/(2) have been achieved for hydrogen and deuterium, respectively, at a pressure of 0.3 Pa and an electron/ion ratio below 1 for a small extraction area (0.007 m(2)) and short pulses (<4 s). In the long pulse experiment, equipped with an extraction area of 0.02 m(2), the pulse length has been extended to 3600 s. A large rf source, with the width and half the height of the ITER source but without extraction system, is intended to demonstrate the size scaling and plasma homogeneity of rf ion sources. The source operates routinely now. First results on plasma homogeneity obtained from optical emission spectroscopy and Langmuir probes are very promising. Based on the success of the IPP development program, the high power rf-driven negative ion source has been chosen recently for the ITER beam systems in the ITER design review process.

Sensitivity of prefrontal cortex to changes in target probability: a functional MRI study

Electrophysiological studies suggest sensitivity of the prefrontal cortex to changes in the probability of an event. The purpose of this study was to determine if subregions of the prefrontal cortex respond differentially to changes in target probabilities using functional magnetic resonance imaging (fMRI). Ten right-handed adults were scanned using a gradient-echo, echo planar imaging sequence during performance of an oddball paradigm. Subjects were instructed to respond to any letter but "X". The frequency of targets (i.e., any letter but X) varied across trials. The results showed that dorsal prefrontal regions were active during infrequent events and ventral prefrontal regions were active during frequent events. Further, we observed an inverse relation between the dorsal and ventral prefrontal regions such that when activity in dorsal prefrontal regions increased, activity in ventral prefrontal regions decreased, and vice versa. This finding may index competing cognitive processes or capacity limitations. Most importantly, these findings taken as a whole suggest that any simple theory of prefrontal cortex function must take into account the sensitivity of this region to changes in target probability.

Brain potentials with old/new distinction of non-words and geometric figures

Event-related potentials (ERPs) were recorded in a continuous memory recognition task. Readable non-words and abstract geometric figures were presented in an alternating manner with an inter-stimulus interval of 2.1 s. Probability of item repetition was 0.25, a lag of one item lay between initial presentation and repetition. OLD/NEW distinction was indicated by the subject's motor response. Using linked-mastoid electrodes for reference, material-specific hemispheric asymmetries of ERPs started 150 ms after stimulus onset in temporo-lateral and parietal recordings with ERPs elicited by non-words being lateralized to the left and those by figures to the right. Clear OLD/NEW ERP effects were found with non-words: Starting about 200-250 ms after stimulus presentation, ERPs of formerly presented (OLD) items were more positive-going in recordings over the midline than ERPs of items that were new and to be repeated (NEW). In contrast, no local OLD/NEW ERP-difference was found with figures. In some brain regions, OLD/NEW ERP-differences were larger over the left hemisphere compared to the right. This finding, however, did not differ between non-words and figures.

Measuring extracellular matrix turnover in the serum of patients with idiopathic or ischemic dilated cardiomyopathy and impact on diagnosis and prognosis

Circulating levels of extracellular matrix components were measured by radioimmunoassays and tested if they were useful for clinical staging in chronic heart failure. In 41 patients with dilated cardiomyopathy (33 idiopathic and 8 ischemic cases), the serum concentrations of procollagen type III aminoterminal peptide (PIIINP), type I collagen telopeptide (ICTP), and basement membrane laminin were significantly higher than in 30 healthy controls regardless of the underlying etiology. Patients with serum values of PIIINP, ICTP, and laminin > 7 micrograms/L, 7.6 micrograms/L, and 2.3 U/ml, respectively, were at higher relative risk for advanced clinical stage, poor hemodynamic condition, hyponatremia, heart transplantation, and death during follow-up than patients with low levels, with the exception that serum laminin > 2.3 U/ml was not significantly associated with hyponatremia and heart transplantation. Despite their interdependence on liver function, circulating levels of PIIINP and ICTP were independent predictors of mortality. In 17 of the 41 patients with cardiomyopathy whose explanted hearts were available for histologic evaluation, serum PIIINP, ICTP, and laminin significantly correlated with the myocardial area fractions of their tissue analogues (PIIINP vs myocardial collagen type III, r = 0.784, p = 0.0013; serum ICTP vs myocardial collagen type I, r = 0.603, p = 0.0527; and serum laminin vs myocardial laminin, r = 0.605, p = 0.0411). In conclusion, the increase in extracellular matrix turnover, which may partially be derived from fibrosis in the myocardium, can be measured in the serum of patients with dilated cardiomyopathy, and has an impact on risk stratification and prognosis.

Endomyocardial HLA expression is increased to the same extent in idiopathic and secondary dilated cardiomyopathy

In a total of 22 failing hearts from human transplant recipients, the expression of major histocompatibility complex (MHC) molecules, the CD phenotype of infiltrating mononuclear cells, and the number of fibroblasts were analyzed by immunohistochemistry. Compared with 10 non-failing control hearts, significantly higher morphometric area fractions of HLA-ABC and HLA-DR with a concomitant increase of CD3-, CD4- and CD8-positive cells were found to be comparable in 12 patients with idiopathic dilated cardiomyopathy and in 10 patients with secondary heart failure. Furthermore, the similarity of T-cell activation in idiopathic and secondary variants of the disease were substantiated by the following observations: (1) the site-specific distribution of MHC molecules and mononuclear cells in the myocardium was comparable in idiopathic and secondary dilated cardiomyopathy; (2) 6 individuals with lymphocytic aggregates in their myocardium in association with the highest levels of HLA-ABC expression were equally distributed among idiopathic and secondary patient subsets; and (3) expression of HLA-ABC and HLA-DR correlated with that of an endothelial cell marker, von Willebrand factor, in failing myocardia of both study groups. In conclusion, no difference was found in increased MHC molecule expression in failing myocardium of idiopathic and secondary variants of dilated cardiomyopathy, and these entities were not differentially associated with infiltration by increased numbers of T lymphocytes. Hence, we postulate that these immunopathological features are consequences rather than causative factors of myocardial degeneration and dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased regional cerebral blood flow in inferior occipital cortex and cerebellum of early blind humans

Cerebral flow indices were measured in 7 early blind and 13 sighted persons twice, during a task of passive and of active touch. In the blind, inferior occipital and cerebellar indices were higher. But they were not significantly modified by the kind of tactile task.

On the functionality of the visually deprived occipital cortex in early blind persons

In early blind mammals, the deprived visual cortex undergoes anatomical and functional alterations. Its functional role was investigated in the early human blind by using patterns of cortical activation as measured by scalp-recorded event-related slow negative DC potential shifts. The blind showed higher occipital negativity than did sighted persons both during a tactile reading task and a non-reading tactile control task. Results point to a possible role for the blind's visual cortex in tactile processes.