The temporal stability of premorbid intelligence: A non-clinical 10-year follow-up study using the Irregular Word Reading Test (TeLPI)

INTRODUCTION

The Cognitive Reserve (CR) describes the brain's ability to actively cope with neurological damage, enabling the maintenance of premorbid cognitive functioning through compensatory processes. The most common way to estimate CR is through formal education, the intelligence quotient (IQ) and participation in cognitive stimulating activities. In the absence of IQ data, the Irregular Word Reading Test (TeLPI) allows you to estimate the premorbid intelligence.

OBJECTIVE

The comparison of the TeLPI results between two times of assessment (baseline and re-assessment) with an interval time (IT) of 9 years. To analyze of the stability of their results as a valid dimension for the CR estimation.

RESULTS

The TeLPI presented temporal stability of its results between the two evaluation times (IT = 9.07 ± 1.02). The sample, composed by 63 cognitively healthy participants, showed no differences for the estimated Full Scale IQ (t(62) = 0.49, p = .63), for the Estimated Verbal IQ (t(62) = 0.71, p = .48) and for the estimated Performance IQ (t(62) = 0.64, p = .52). Likewise, no differences were found in the number of TeLPI errors at the two assessment times (t(62) = -0.61, p = .54).

CONCLUSIONS

Considering that CR is characterized as being relatively stable, the TeLPI should be included in its assessment, as an indicator with proved stability over a long period of time, on the physiological aging spectrum.

Society of pediatric liver transplantation: Current registry status 2011-2018

BACKGROUND

SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies.

OBJECTIVE

To report the outcomes of the SPLIT registry from 2011 to 2018.

METHODS

This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period.

RESULTS

A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.

Oral feeding of Lactobacillus bulgaricus N45.10 inhibits the lung inflammation and airway remodeling in murine allergic asthma: Relevance to the Th1/Th2 cytokines and STAT6/T-bet

Asthma is a chronic disease with impacts on public health. It affects the airways causing pulmonary inflammation mediated by CD4 T cells type Th2, eosinophilia, mucus hypersecretion, and elevated IgE. The unbalance between cytokines and transcription factors is an important feature in asthma. Probiotics has gaining highlight as a therapy for chronic diseases. Thus, we investigate the Lactobacillus bulgaricus (Lb) effect in murine allergic asthma. BALB/c-mice were sensitized to ovalbumin (OA) on days 0 and 7 and were challenged from day 14-28 with OA. Mice received Lb seven days prior to sensitization and it was kept until day 28. The Lb attenuated the eosinophils infiltration, mucus and collagen secretion, IgE production, pro-inflammatory cytokines, TLR4 expression, GATA3, STAT6 and RORγt in lung. Otherwise, Lb increased the anti-inflammatory cytokines, the T-bet and foxp3. Finally, Lb attenuated the allergic asthma-induced inflammation and airway remodeling by interfering on Th1/Th2 cytokines and STAT6/T-bet transcription factors.

When seizures are non-epileptic

Introduction

Non-epileptic seizures (NES) are a diverse group of disorders, whose paroxysmal events can be mistaken for epilepsy, although they are caused by a mental or psychogenic process rather than a neurological cause.

Objectives/methods

We present a case of a 45-year-old female patient with history of generalized seizures prior to Meningioma resection in August 2015, referred to the Liaison Psychiatry outpatient follow up clinic at the Royal London Hospital after has gone several times to emergency department complaining about flush and hot sensation that proceeded to corners of mouth turning down, teeth chattering, shaking of left arm and torso at first and then legs. During the episodes, she was awake with no consciousness loss. Her mood was low, with clinical evidence of depression and she had very high levels of health anxiety.

Discussion

A diagnosis of non-epileptic attacks was made in the sequence of those episodes. A holistic and multidisciplinary approach was made, including pharmacotherapy, cognitive-behavioral therapy and domiciliary support. The clinical response was good regarding both mood, anxiety levels and NES.

Conclusions

Approximately 25% of patients who have a previous diagnosis of epilepsy and are not responding to drug therapy are found to be misdiagnosed and it is common that epileptic patients have both epileptic and non-epileptic seizures. Although distinguishing epileptic and non-epileptic seizures is not easy, there are some clinical clues that the physicians should look for, like age of onset, time of the day that episodes occur and presence or absence of postictal confusion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Fecundity and bipolar spectrum disorder

Introduction

Fertility and fecundity are usually considered signs of social and emotional well-being. Bipolar disorder (BD) is a prevalent psychiatric disease that influences the individual's life style and behaviours. Some studies have addressed the issue of fecundity among women with bipolar disorder but few have focused on determining the differences between disease subtypes, which is expected, taking into account the studied differences in demographic measures.

Objectives

To examine the fecundity of a population of women with bipolar disorder.

Aim

The aim of this study is to compare the fecundity among women diagnosed with subtypes I to IV of BD, according to Akiskal's bipolar spectrum disorder classification.

Methods

A total of 108 female outpatients were divided into four groups. We analyzed number of offspring and demographic features between patients with different subtypes of BD using multivariate analyses.

Results

Our results showed a significantly higher average number of children for BD IV patients when compared with BD I patients. Although not reaching statistical significance, BD I patients had less offspring than BD II and BD III patients. BD I patients had lower marriage rates compared to the other groups.

Conclusions

Our results suggest that the subtype of bipolar disorder influences fecundity and behaviours, as is expressed by the lower number of marriages seen in BD I patients. We found that fecundity is significantly impaired among BD I patients, which may imply that female with more severe disorders are less likely to become parents. Fecundity is higher among BD IV patients, which makes a way to speculate about the adaptive role of hyperthimic temperamental traits.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Agenesis of the Corpus Callosum in A Patient With Bipolar Disorder

Background

The corpus callosum (CC) is the largest white matter structure in the brain, which plays a crucial role in interhemispheric communication. Agenesis of the CC is a rare development anomaly, with unknown cause. It could be asymptomatic or associated with mental retardation and neurologic symptoms. Some case reports, post-mortem studies and image studies have linked thickness reduction and agenesis of CC with psychotic symptoms, mainly in schizophrenia patients. Lately, anatomical abnormalities in the CC have been reported in patients with Bipolar Disorder (BD).

Case report

A 52-year-old woman was brought to the emergency room by the authorities after being physically aggressive to her 13-year-old daughter and inappropriate behavior in public. At the emergency department her mood was elevated with emotional lability, dispersible attention, slight increase of motor activity, pressured and difficult to interrupt speech, grandious and self-referent delusional ideas.

Her past history revealed hippomaniac episodes characterized by periods of excessive shopping and hyperphagia. In 2008, she had a major depressive episode.

Head CT-SCAN revealed agenesia of CC. She received the diagnosis of Manic Episode with mixed features and was treated with valproic acid, flurazepam and olanzapine.

Conclusion

This case reinforces the fact that changes in CC, probably due to deficiency in myelination, could have a crucial importance in the pathophysiology of Bipolar Disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Pharmacological study of the one spike spherical neuron phenotype in Gymnotus omarorum

The intrinsic properties of spherical neurons play a fundamental role in the sensory processing of self-generated signals along a fast electrosensory pathway in electric fish. Previous results indicate that the spherical neuron's intrinsic properties depend mainly on the presence of two resonant currents that tend to clamp the voltage near the resting potential. Here we show that these are: a low-threshold potassium current blocked by 4-aminopyridine and a mixed cationic current blocked by cesium chloride. We also show that the low-threshold potassium current also causes the long refractory period, explaining the necessary properties that implement the dynamic filtering of the self-generated signals previously described. Comparative data from other fish and from the auditory system indicate that other single spiking onset neurons might differ in the channel repertoire observed in the spherical neurons of Gymnotus omarorum.

Postprandial metabolism of Pacific bluefin tuna (Thunnus orientalis)

Specific dynamic action (SDA) is defined as the energy expended during ingestion, digestion, absorption and assimilation of a meal. This study presents the first data on the SDA response of individual tunas of any species. Juvenile Pacific bluefin tunas (Thunnus orientalis; body mass 9.7–11.0 kg; N=7) were individually fed known quantities of food consisting primarily of squid and sardine (meal energy range 1680–8749 kJ, ~4–13% of tuna body mass). Oxygen consumption rates () were measured in a swim tunnel respirometer during the postprandial period at a swimming speed of 1 body length (BL) s−1 and a water temperature of 20°C. was markedly elevated above routine levels in all fish following meal consumption [routine metabolic rate (RMR)=174±9 mg kg−1 h−1]. The peak during the SDA process ranged from 250 to 440 mg kg−1 h−1 (1.5–2.3 times RMR) and was linearly related to meal energy content. The duration of the postprandial increment in ranged from 21 h to 33 h depending upon meal energy content. Consequently, the total energy used in SDA increased linearly with meal energy and ranged from 170 kJ to 688 kJ, such that the SDA process accounted for 9.2±0.7% of ingested energy across all experiments. These values suggest rapid and efficient food conversion in T. orientalis in comparison with most other fishes. Implanted archival temperature tags recorded the increment in visceral temperature (TV) in association with SDA. returned to routine levels at the end of the digestive period 2–3 h earlier than TV. The qualitative patterns in and TV during digestion were similar, strengthening the possibility that archival measurements of TV can provide new insight into the energetics and habitat utilization of free-swimming bluefin in the natural environment. Despite efficient food conversion, SDA is likely to represent a significant component of the daily energy budget of wild bluefin tunas due to a regular and high ingestion of forage.

[Influence of fat diet in glicidic metabolism in obese women with Pro12Pro genotype in PPARgamma2 gene]

INTRODUCTION

The peroxisome proliferator-activated receptor gamma 2 (PPARgamma2) is an adipogenic transcription factor that influences in insulin resistance (IR) in the presence of agonists such as polyunsaturated fatty acids (PUFA).

OBJECTIVE

Evaluate the influence of dietary fat in glicidic metabolism in morbidly obese women with Pro12Pro genotype in the gene PPARgamma2.

METHODS

Were selected 25 women with genotype Pro12Pro. The fat intake was estimated by food records, being used for the division of groups, GA (until 30% of the total energy expenditure (TEE)) and GB (greater than 30% of the TEE). Biochemical and anthropometric evaluations were conducted in fasting, following the test meal high in n-6 PUFA and postprandial biochemical evaluations. IR and insulin sensitivity (IS) were assessed by HOMA-IR (Homeostasis Model Assessment) and QUICKI (Quantitative Insulin Sensitivity Check Index), respectively.

RESULTS AND DISCUSSION

GA presented normal HOMAIR and QUICKI. GB presented higher body mass index (BMI), HOMA-IR, saturated fatty acids (SFA) and monounsaturated (MUFA) intake higher, compared with GA (p < 0.05). In GA, the MUFA intake was negatively correlated with HOMA-IR, fasting glucose and insulin, and positively with QUICKI. The fat and SFA intake contributed to the increase in body mass and IR. However, MUFA intake may have reduced the impact of high fat diet in glicidic metabolism. It is suggested that obese women with Pro12Pro genotype in the PPARgamma2 gene avoid high fat and SFA diets, prioritizing MUFA for controlling obesity and improving the IS.

Positive cross-match living donor kidney transplantation: longer-term outcomes

The long-term graft outcomes after positive cross-match (PXM) living donor kidney transplantation (LDKT) are unknown and the descriptive published data present short-medium term results. We conducted a retrospective cohort study of LDKT with PXM by flow cytometry performed at our center during February 1999 to October 2006, compared to a control group, matched 1:1 for age, sex, race, retransplantation and transplant year. The PXM group was treated with a course of plasmapheresis/low-dose intravenous immunoglobulin (IVIg) preoperatively, and OKT3 or thymoglobulin induction. Both groups (n = 41 each) were comparable except for duration of end-stage renal disease (ESRD), induction, HLA mismatch and panel-reactive antibody (PRA). During the period of up to 9 years, 14 PXM and 7 controls lost their grafts (p < 0.04). Graft survival rates at 1 and 5 years were 89.9% and 69.4% for PXM group and 97.6% and 80.6% for the controls, respectively. PXM was associated with higher risk of graft loss (HR 2.6, p = 0.04; 95%CI 1.03-6.4) (t(1/2)= 6.8 years), but not with patient survival (HR 1.96, p = 0.29; 95%CI 0.6-7.0) or 1-year serum creatinine (beta= 0.06, p = 0.59 for ln (SCr); 95% CI -0.16 to 0.28). These results suggest that despite the favorable short-term results of PXM LDKT after PP/IVIg conditioning, medium-long-term outcomes are notably worse than expected, perhaps comparable to non-ECD deceased donor kidney transplantation (KT).

Early withdrawal of calcineurin inhibitors and rescue immunosuppression with sirolimus-based therapy in renal transplant recipients with moderate to severe renal dysfunction

Mammalian Target-of-Rapamycin inhibitors (mTOR inhibitors) can be used to replace the calcineurin inhibitors (CNIs) to prevent progression in chronic kidney disease (CKD) following organ transplantation. Discontinuation of tacrolimus in 136 recipients of kidney transplants with progressive renal dysfunction significantly decreased the rate of loss of estimated glomerular filtration rate (eGFR, mL/min/1.73 m(2)) (pre-intervention vs. post-intervention slopes, -0.013 vs. -0.002, p < 0.0001). Discontinuation of tacrolimus was associated with a sustained and significant improvement in graft function (pre-eGFR vs. post-eGFR; 26.0 +/- 1.1 vs. 47.4 +/- 2.1, p < 0.0001) in 74% of patients. This intervention was ineffective if the mean and (median) values of creatinine (mg/dL) and eGFR were 3.8 +/- 0.2 (3.4) and 18.4 +/- 1.9 (22.4), respectively, at the time of conversion therapy. During the follow-up (range, 1.5-34.6, months), a total of 13 patients had their first acute rejection following the conversion therapy, an annual incidence of less than 10% and none of these episodes resulted in graft loss. The salutary effects of sirolimus therapy following discontinuation of tacrolimus in patients with moderate to severe graft dysfunction due to allograft nephropathy even in high-risk patients improves kidney function and prevents acute rejection.

Cost efficiency in the prospective diagnosis and follow-up of polyomavirus allograft nephropathy

Evaluation of urine cytology (UC) for decoy cells and quantitative determinations of viruria (urine viral load [UPCR])and viremia (viral load in blood [VLB]) have been proposed as surrogate markers of polyomavirus allograft nephropathy (PVAN). In this study, we present the experience with the concurrent evaluation of UC, UPCR, and VLB in 349 patients (940 sets of samples). Results were correlated with each other and with a previous, concurrent, or subsequent biopsy diagnosis of PVAN. Patients were followed up for a mean of 27 months posttransplantation. We conclude that both UC and UPCR are useful for screening of renal transplant recipients. Simultaneous performance of both UC and UPCR does not add useful clinical information. In patients with positive UC, performance of UPCR, however, can allow for the distinction between BK and JC polyoma viruses. Quantitative measurement of viremia is not indicated in patients lacking viruria because no patients with PVAN present with this combination of findings. In patients with viruria, a positive viremia strongly correlates with PVAN. Rationale selection of screening protocols based on the current knowledge of the infection and tailored to the available laboratory capabilities in each transplantation center can optimize the use of resources.

Improved outcome of polyoma virus allograft nephropathy with early biopsy

Polyoma virus allograft nephropathy often results in accelerated graft loss despite reduction of immunosuppression and/or treatment with antiviral agents. Irreversible renal fibrosis due to late diagnosis is likely to be one of the important causes of treatment failure. Early biopsy in 14 patients resulted in stable graft function after a mean follow-up of 22 months.

Myosin Va is locally synthesized following nerve injury

The presence of Myosin Va (an actin-based molecular motor) in the peripheral nervous system was examined and its subcellular distribution within the axons of the sciatic nerve was demonstrated via immunocytochemistry. Myosin Va (M-Va) in the nerve was detected by using SDS-PAGE and Western blot techniques with a polyclonal antibody specifically raised against the M-Va globular tail domain. In addition, purification of M-Va from the rat sciatic nerve prior to immunoblotting yielded a M-Va standard band. Likewise, optical immunocytochemical procedures revealed the presence of M-Va, particularly in the cortical axoplasmic territory, but also in the Schwann cell soma. The above experiments were carried out both on intact as well as on severed sciatic nerves with similar results. The proximal stumps of severed sciatic nerves (from 0 to 72 h after injury) were labelled in vivo with (35)S-methionine. SDS-PAGE autoradiography of the immunoabsorbed M-Va from the radiolabelled homogenized nerve tissue showed a significant increment of the radioactive intensity of M-Va heavy chain band through time. Moreover, a significant increment of transcripts coding for M-Va heavy chain was detected through time using RT-PCR after nerve injury and compared to intact nerves. This data suggest that M-Va is up-regulated in a time-dependent manner. The latter suggests a possible involvement of M-Va in nerve regeneration processes.

Chondromyxoid fibroma of the lumbar spine

A bulky tumor of the first lumbar vertebra is described. The case is the 21st to be reported. The tumor resembled an aneurysmal bone cyst radiologically. It was resected without incident. The previously reported cases are reviewed and the literature discussed.

Prognostic factors and outcome in craniofacial surgery for malignant cutaneous tumors involving the anterior skull base

BACKGROUND

We retrospectively reviewed the medical charts of 57 patients with advanced malignant cutaneous tumors involving the anterior skull base who underwent combined craniofacial resection in our department from January 1, 1981, to December 31, 1994.

METHODS

The data regarding histological results, demographic aspects, clinical presentation, previous treatment, extent of the disease, extent of surgical procedure, type of reconstruction, complications, and follow-up were analyzed using the chi 2 method. Survival analysis was performed using the Kaplan-Meier method.

RESULTS

We found prevalence of the male sex (60%) and white race (86%), with a mean age of 62 years. Thirty-five patients (61%) showed extensive lesions directly invading the anterior skull base (type II); 46 patients (81%) had been treated previously; 10 patients (18%) had dural invasion; 29 patients (51%) could not have the eyeball preserved; 32 patients (56%) underwent microsurgical reconstruction; and 45 patients (79%) underwent pericranial or galeal-pericranial flap reconstruction for the anterior skull base defect. Postoperative complications occurred in 29 patients (51%). The most common complication was postoperative infection (17 patients [59%]). Thirty-two patients (56%) were free of disease, and 4 (7%) were alive with disease at the time of our study.

CONCLUSIONS

The extent of facial disease (P = .005) and the type of facial reconstruction (P = .01) were the most important risk factors in the development of infectious complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (P = .003) and meningoencephalitis (P = .06). Invasion of the dura mater significantly affected survival (P = .005).

The jejunal secretory response to Escherichia coli heat-stable enterotoxin is prolonged in malnourished rats

Undernutrition in human infants is associated with more prolonged episodes of diarrheal disease. Therefore, we tested the hypothesis that malnutrition prolongs the duration of Escherichia coli heat-stable enterotoxin-induced rat jejunal secretion. At weaning, rats were separated into two groups: malnourished rats were fed 50% of the previous day's intake of the fully fed control group. After approximately 2 wk of pair feeding, when malnourished rats weighed less than or equal to 60% of the full fed control group, we measured the secretory response to heat-stable enterotoxin in ligated jejunal loops. Toxin-induced secretion was equal in both groups until 30 min incubation time, after which net secretion continued to increase in the malnourished group but decreased in the fully fed group. Jejunal brush border membranes prepared from malnourished and fully fed rats demonstrated similar heat-stable enterotoxin receptor density, avidity of binding and guanyl cyclase activation. In both groups, radiolabeled toxin injected into in situ jejunal loops was converted into an altered radioligand unable to bind to brush border membranes. However, in malnourished rats, there was both increased appearance of two additional radioligands that still retained their ability to bind to brush border membranes and persistence of biologically active unlabeled toxin as measured in the suckling mouse bioassay. Our studies demonstrate that reduced or delayed inactivation of heat-stable enterotoxin, with continued presence of active toxin species, may contribute to prolonged secretion in the jejunum of malnourished rats.

Sibling psychological status and style as related to the disease of their chronically ill brothers and sisters: implications for models of biopsychosocial interaction

This study explores the relationship between disease type and disease activity, and the psychological status of siblings of chronically ill children. Closest-age siblings of children with Crohn's disease (CD) (n = 41) and ulcerative colitis (UC) (n = 24) were assessed for psychological disorder and psychological style, using reliable and standardized measures. The disease activity of the patients was also evaluated. Assessment occurred during outpatient visits to a pediatric gastroenterology division. Results indicated that CD siblings had more psychological disorder than UC siblings. This was not due to greater acute disease activity in the CD patients. However, as a group, siblings of the sickest CD patients displayed more "internalizing" behaviors, whereas siblings of the healthiest CD patients displayed more "externalizing" behaviors. UC siblings, who were psychologically healthier, displayed "externalizing" behaviors regardless of the patient's disease activity. These results are in accord with our previous findings on family functioning, which, together, yield a heuristic model representing the different patterns of biopsychosocial interaction for CD in contrast to UC.

Escherichia coli heat-stable toxin: its effect on motility of the small intestine

Escherichia coli heat-stable enterotoxin is a low-molecular-weight substance that has been shown to induce the active secretion of fluid and electrolytes in the small intestine. In this study, we have characterized the effects of purified E. coli heat-stable toxin (ST, strain 18D, serotype 042:K86:H37) on the motility of rabbit small intestine by using myoelectric recording techniques. Substances, such as cholera toxin, that activate the adenylate cyclase-cAMP system induced predominantly migrating action-potential complex activity. E. coli ST, a toxin that activates the guanylate cyclase-cGMP system, was infused into isolated in vivo ileal loops of New Zealand White rabbits. Inactivated toxin was also studied by exposing the ST to 1 mM dithiothreitol for 90 min. Active E. coli ST induced only repetitive bursts of action potentials. When the toxin was inactivated with dithiothreitol, no alteration in myoelectric activity was observed. We speculate that repetitive bursts of action-potential activity may represent a virulent factor of the bacterium, altering motor activity to slow transit and allowing for bacterial proliferation and invasion.