Cognitive correlates of mixed depression

Introduction

Mixed depressive states portend greater rates of impulsivity, attempted suicide, treatment resistance, and poorer outcome than non-mixed forms of depression. The neurocognitive bases of such affective states have not been defined yet.

Objectives

This work represents an attempt to clarify the neuropsychology underlying mixed depressive states.

Methods

Thirty subjects with affective disorders with mixed depression (MxD), 54 subjects with non-mixed depression (nonMxD), 73 euthymic subjects (Eu) and 93 healthy comparisons (HC) underwent a neurocognitive battery including the Trail-Making Test (TMT), the Controlled Word Fluency Test (WFT) and the Semantic Fluency Test (SFT), the Wisconsin Card Sorting Test (WCST, the Rey Auditory Verbal Learning Test RAVLT, the Rey-Osterrieth Complex Figure Test ROCFT, the Raven’s Progressive Matrices (RPM), and the Interference Component of the Stroop Test (ST). Between-group differences were performed through multiple one-way analyses of variance. Post-hoc analyses were performed using Tukey post-hoc tests.

Results

HC performed better than the three patient groups in all the aforementioned neurocognitive tests. Eu performed better in RPM, TMT, SFT than nonMxD, and better on ST WCST than both nonMxD and MxD. MxD showed better performances in RPM, TMT-A, WCST than nonMxD, and more errors and less reaction times in the ST than nonMxD.

Conclusions

Mixed depressive states are characterized by enhanced attentional resources and greater set shifting abilities than non-mixed depressive states. On the other hand, they have less cognitive control than non-mixed depression. Such findings might explain some typical features observed in subjects with mixed depression, such impulsivity, suicidality, emotional reactivity and behavioral dyscontrol.

Disclosure

No significant relationships.

OP0187 DETERMINING OPTIMAL COOLING AND ADMINISTRATION METHODS FOR CNTX-4975 INTRA-ARTICULAR INJECTION IN SUBJECTS WITH MODERATE TO SEVERE OSTEOARTHRITIS KNEE PAIN

Background:

CNTX-4975 is a highly purified, synthetic capsaicin being developed to provide long-term analgesia after a single intra-articular (IA) injection for patients with moderate to severe osteoarthritis (OA) knee pain. CNTX-4975 IA administration is associated with short-term post-procedural pain that can be attenuated with preemptive joint cooling.

Objectives:

To evaluate cooling and administration procedures for CNTX-4975 IA injection, with goals of balancing patient comfort and ease of use and assessing clinical response 8 weeks after injection.

Methods:

This phase 3, open-label, 8-week study (NCT03661996) enrolled subjects aged 40–95 y with Kellgren-Lawrence grade 1–4, BMI ≤45 kg/m2, and stable, moderate to severe OA knee pain and who failed ≥2 therapies. Subjects were assigned to unilateral/bilateral CNTX-4975 1 mg IA injections as determined by OA pain/joint replacement status, then randomized by study site to 1 of 5 treatment regimens (Figure). The primary outcome measure assessed Breg cooling control vs other cooling regimens on day 1 using a combined sum of 1) pain (0, none; 4, severe) 30 minutes after CNTX-4975 injection; 2) subject satisfaction (SS) with cooling/injection procedures; and 3) investigator satisfaction (IS) with procedures. SS and IS were measured on a 1–7 scale (1, completely dissatisfied; 7, completely satisfied); pain was reverse scored and normalized (1, severe; 7, none) for equal weighting. Geometric mean ratios (GMR) with 95% CIs were constructed for each regimen vs Breg control (ANCOVA); lower 95% CI >0.7 was considered clinically acceptable. Secondary endpoints included percentage of subjects by subject type meeting criteria for Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responders 8 weeks after injection. Safety assessments included TEAEs.

Results:

The intent-to-treat population included 848 subjects. The primary combined outcome showed that all cooling and administration regimens were clinically acceptable, with the evaluated cold gel wraps being at least as effective as the Breg circulating ice-water wrap (Table). For subjects with unilateral OA, OMERACT-OARSI response rates were 67% in those with no/mild nonindex knee pain and 81% in those with nonindex knee single joint replacement. For subjects with bilateral knee OA receiving bilateral injections, response rates for index and nonindex knees were 73% and 79%. TEAEs were reported in 22% of subjects; <1% were serious. TEAEs occurring in >2% of subjects were procedural pain (2.9%), arthralgia (2.2%), and nausea (2.1%), with no meaningful differences across groups.

Conclusion:

All cooling regimens for CNTX-4975 IA administration were clinically acceptable and well tolerated, offering feasible options for use in routine practice. Importantly, high levels of clinical response were observed 8 weeks after unilateral or bilateral knee injections for moderate to severe OA knee pain.

Primary Combined Endpoint Outcome in the Index Knee, Normalized Scale, by Cooling and Administration Procedure (ANCOVA Model)

Breg Cooling ControlN=162Gel Pack CoolingN=179Shortened Gel Pack CoolingN=175Single Needle Injection,Gel Pack Cooling,2% LidocaineN=160Single Needle Injection,Gel Pack Cooling,1% LidocaineN=172Mean (SD)17.23 (2.660)18.23 (2.023)16.81 (2.891)17.57 (3.049)16.43 (3.138)Geometric LS Mean (SE)17.18 (1.016)18.26 (1.015)16.48 (1.016)17.40 (1.016)16.00 (1.015)95% CI16.66, 17.7217.74, 18.8015.99, 16.9916.87, 17.9515.53, 16.49Comparison vs Breg CoolingGMR (SE)1.06 (1.022)0.96 (1.022)1.01 (1.022)0.93 (1.022)95% CI1.02, 1.110.92, 1.000.97, 1.060.89, 0.97Clinically Acceptable?YesYesYesYes

LS, least squares; SD, standard deviation; SE, standard error.

GMR lower 95% CI >0.7 considered clinically equivalent.

Disclosure of Interests:

Randall Stevens Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, Peter Hanson Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, Paul Tiseo Employee of: Centrexion Therapeutics Corp, Kimberly Guedes Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, James Campbell Shareholder of: Centrexion Therapeutics Corp, Employee of: Centrexion Therapeutics Corp, James Connolly Employee of: Centrexion Therapeutics Corp, Stephanie Ruggiero Employee of: Centrexion Therapeutics Corp, Meg Corliss Employee of: Centrexion Therapeutics Corp, Valerie Smith Consultant of: Centrexion Therapeutics Corp, Philip G Conaghan Consultant of: AbbVie, BMS, Eli Lilly, EMD Serono, Flexion Therapeutics, Galapagos, GSK, Novartis, Pfizer, Speakers bureau: AbbVie, Eli Lilly, Novartis, Pfizer

Task Force on Design and Analysis in Oral Health Research: Medication-Related Osteonecrosis of the Jaw

Knowledge Transfer Statement: This article discusses the proceedings of the conference organized by the Task Force on Design and Analysis in Oral Health Research on the understanding of the translational evidence on the etiology and pathogenesis of medication-related osteonecrosis of the jaw as well as the clinical protocols on patient management.

Comparison between tungsten and steel polypectomy snares: evaluation of depth of colonic thermal wall injury in a pig model

BACKGROUND AND STUDY AIMS

Thermal injury of the colonic wall during polypectomy may induce complications such as bleeding and perforation. To date, the role of the snare material in these injuries has not been examined. The aim of this study was to evaluate the depth of colonic post-polypectomy thermal wall injury induced by tungsten and steel endoscopic snares, in an effort to reduce electrosurgery-related complications.

MATERIALS AND METHODS

This was a single tertiary center experimental study in a porcine model. A total of 90 polypectomies where performed in three live pigs under general anesthesia, using both steel and tungsten snares by cut, coagulation, and blend current modes. The pigs were then euthanized and their colons examined histologically.

RESULTS

Steel snares induced significantly deeper tissue injury than tungsten snares in the pure cut mode (Pearson χ2 = 6.136, P = 0.013). The ordinal logistic regression analysis showed that the current mode and snare material were significantly associated with the ordinal score for the depth of injury. Thus, cut mode was positively associated with a lower score and coagulation mode with a higher score. In addition, tungsten was significantly associated with a lower depth of tissue injury.

CONCLUSIONS

Due to its inherent electrical properties, tungsten is very well suited for manufacture into electrosurgical endoscopic devices. Thus, tungsten snares may be advantageous for routine use in endoscopic polypectomy, although further studies are needed to confirm these promising findings in human patients.

Ceftriaxone-induced pancreatitis in a pediatric patient: case report

We describe the first case of probable ceftriaxone-induced pancreatitis in a 2-year-old child. The patient was admitted to Santobono-pausilipon Children's Hospital with fever, vomiting and diarrhea and was treated with ceftriaxone 700 mg/day by intramuscular route. After the second administration of ceftriaxone, laboratory data revealed an increase in amylase. The patient's abdomen was mildly distended and diffusely painful. Drug-induced pancreatitis was considered and ceftriaxone was immediately discontinued, but after 24 hours laboratory data showed a further increase in amylase and an increase in lipase. Three days after interruption of ceftriaxone, the child's symptoms had improved. based on a) biochemical, clinical and instrumental parameters, b) criteria of drug-induced pancreas disorders and c) the Naranjo adverse drug reaction probability scale, we made a diagnosis of probable ceftriaxone-induced pancreatitis. To our knowledge, this is the first case report of probable primary ceftriaxone-induced pancreatitis in children.

[The role of endoscopy in gastroenteropancreatic neuroendocrine tumors]

Versione italiana Riassunto: Il ruolo dell'endoscopia nei tumori neuroendocrini gastroenteropancreatici. L. Magno, L. Sivero, V. Napolitano, S. Ruggiero, G. Fontanarosa, S. Massa I tumori neuroendocrini (NET) gastro-entero-pancreatici (GEP) sono neoplasie rare che originano dalle cellule neuroendocrine del tubo digerente e del pancreas. L'endoscopia digestiva e l'ecoendoscopia rivestono un ruolo importante nella diagnosi, stadiazione e sorveglianza dei pazienti con NET. Inoltre, in casi selezionati, le tecniche endoscopiche operative consentono il trattamento di queste neoplasie in fase precoce. English version Summary: The role of endoscopy in gastroenteropancreatic neuroendocrine tumors. L. Magno, L. Sivero, V. Napolitano, S. Ruggiero, G. Fontanarosa, S. Massa Gastroenteropancreatic (GEP) neuroendocrine tumors (NET) are rare neoplasia arisen from neuroendocrine cells present in the gut mucosa and pancreas. Digestive endoscopy and endoscopic ultrasonography play a relevant role in NET diagnosis, stadiation and surveillance. Moreover, in selected patients, surgical endoscopy allows the tratment of these cancers at an early stage.

Bisphosphonate use and osteonecrosis of the jaw: Pharmacovigilance and reporting of this serious adverse event from the Research on Adverse Drug Events and Reports (RADAR) project

6519

Background: Two years after zoledronate, received FDA approval, four dental professionals treated 107 cases of osteonecrosis of the jaw (ONJ). We review the timeline and source for initial recognition of ONJ and the comprehensiveness of dissemination of information on this adverse drug event. Methods: Data sources included primary case series from dental professionals; published case reports, clinical trials, and cases reported to the manufacturers or the FDA. Exposure adjusted incidence rates estimates were derived from manufacturer sponsored and investigator initiated review of claims data from large cancer centers. Safety notifications were disseminated by the manufacturers, regulatory authorities, and academic investigators. Results: Between 2001 and 2003, 107 patients with ONJ received care from dental professionals. In late 2003, and 2004 peer-reviewed case series were published. By 2006, safety databases maintained by the FDA, the manufacturer, and the RADAR project included information on 2,270, 1,178, and 368 cases of ONJ, respectively. In 2004 and 2005, incidence estimates of 0.8 and 22 ONJ cases per 1,000 person-years of intravenous bisphosphonate therapy were reported by the manufacturer and academic investigators. From 2003 to 2006, safety information from manufacturers, national regulatory authorities, case series, and clinical guidelines were disseminated. Conclusions: Recognition and reporting of ONJ occurred two years after FDA approval of zoledronate, dissemination of safety information occurred in the third year, and publications were disseminated from year three to year five. The life-cycle for identification and information dissemination for this serious adverse drug reaction was short and comprehensive.

[Table: see text] [Table: see text]

Teleradiology applications with DICOM-e-mail

For the connection of several partners to a Dicom-e-mail based teleradiology network concepts were developed to allow the integration of different teleradiology applications. The organisational and technical needs for such an integration were analysed. More than 60 institutions including 23 hospitals in the Rhein-Neckar-Region, Germany were connected. The needed functionality was grouped in six teleradiology applications (emergency consultation, tele-guided examinations, expert consultations, cooperative work, scientific cooperations and homework with on call services) and their technical and organisational needs according to availability, speed of transfer, workflow definitions and data security needs was analysed. For the local integration of teleradiology services the setup and workflow is presented for a standalone teleradiology workstation and a server based teleradiology gateway. The line type needed for different groups of applications and users is defined. The security concept and fallback strategies are laid out, potential security problems and sources of errors are discussed. The specialties for the emergency teleradiology application are presented. The DICOM-e-mail protocol is a flexible and powerful protocol that can be used for a variety of teleradiology applications. It can meet the conditions for emergency applications but is limited if synchronous applications like teleconferences are needed.

Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society

Until recently there has been no standard for an interoperable and manufacturer-independent protocol for secure teleradiology connections. This was one of the main reasons for the limited use of teleradiology in Germany. Various teleradiology solutions have been developed in the past, but the vast majority have not been interoperable. Therefore an ad hoc teleradiology connection was impossible even between partners who were already equipped with teleradiology workstations. Based on the evaluation of vendor-independent protocols in recent years the IT Working Group (AGIT) of the German Radiology Society set up an initiative to standardize basic teleradiology. An e-mail based solution using the Dicom standard for e-mail attachments with additional encryption according to the OpenPGP standard was found to be the common denominator. This protocol is easy to implement and safe for personalized patient data and fulfills the legal requirements for teleradiology in Germany and other countries. The first version of the recommendation was presented at the 85th German Radiology Convention in 2004. Eight commercial and three open-source implementations of the protocol are currently available; the protocol is in daily use in over 50 hospitals and institutions.

[Teleradiology with DICOM e-mail: recommendations of @GIT]

E-mail is ideal for ad-hoc connections in teleradiology. The DICOM standard offers the possibility to append DICOM data types as a MIME attachment to any e-mail, thus ensuring the transmission of the original DICOM data. Nevertheless, there are additional requirements (e.g. protection of data privacy) which must be obeyed. Because of the lack of given standards which would grant interoperability as well as manufacturer independence, teleradiology has not been established in Germany until today. Therefore, the IT-Team (Arbeitsgemeinschaft fur Informationstechnologie, @GIT) of the Radiological Society of Germany (Deutsche Rontgengesellschaft, DRG) set up an initiative to standardise telemedicine by using e-mail. Its members agreed that an e-mail-based variant would be the most practicable way to a communication solution -- as easy to implement as to use. In their opinion, e-mail represents the smallest common denominator for a safe data interchange that would fulfill the legal advantages for telemedicine in Germany.

Sonic hedgehog gene-enhanced tissue engineering for bone regeneration

Improved methods of bone regeneration are needed in the craniofacial rehabilitation of patients with significant bone deficits secondary to tumor resection, congenital deformities, and prior to prosthetic dental reconstruction. In this study, a gene-enhanced tissue-engineering approach was used to assess bone regenerative capacity of Sonic hedgehog (Shh)-transduced gingival fibroblasts, mesenchymal stem cells, and fat-derived cells delivered to rabbit cranial bone defects in an alginate/collagen matrix. Human Shh cDNA isolated from fetal lung tissue was cloned into the replication-incompetent retroviral expression vector LNCX, in which the murine leukemia virus retroviral LTR drives expression of the neomycin-resistance gene. The rat beta-actin enhancer/promoter complex was engineered to drive expression of Shh. Reverse transcriptase-polymerase chain reaction analysis demonstrated that the transduced primary rabbit cell populations expressed Shh RNA. Shh protein secretion was confirmed by enzyme-linked immunosorbent assay (ELISA). Alginate/ type I collagen constructs containing 2 x 10(6) Shh-transduced cells were introduced into male New Zealand White rabbit calvarial defects (8 mm). A total of eight groups (N=6) were examined: unrestored empty defects, matrix alone, matrix plus the three cell populations transduced with both control and Shh expression vectors. The bone regenerative capacity of Shh gene enhanced cells was assessed grossly, radiographically and histologically at 6 and 12 weeks postimplantation. After 6 weeks, new full thickness bone was seen emanating directly from the alginate/collagen matrix in the Shh-transduced groups. Quantitative two-dimensional digital analysis of histological sections confirmed statistically significant (P<0.05) amounts of bone regeneration in all three Shh-enhanced groups compared to controls. Necropsy failed to demonstrate any evidence of treatment-related side effects. This is the first study to demonstrate that Shh delivery to bone defects, in this case through a novel gene-enhanced tissue-engineering approach, results in significant bone regeneration. This encourages further development of the Shh gene-enhanced tissue-engineering approach for bone regeneration.

Heterotopic oral gastrointestinal cyst: report of 2 cases and review of the literature

Oral heterotopic gastrointestinal cyst is a rare entity occurring in infants and children and showing a predilection for males. The cyst usually appears as an asymptomatic swelling in the floor of the mouth. Difficulty in feeding, swallowing, respiration, and speech have been reported in approximately 30% of those affected. The tongue-in particular, its anterior aspectis involved in up to 60% of reported cases. The clinical, radiographic, and histopathologic features of cases of heterotopic gastrointestinal cyst involving the anterior tongue in a 2-year-old girl and the anterior floor of the mouth in a 2-month-old boy are presented, and theories of pathogenesis are discussed.