A behavioral comparison of female adolescent inpatients with and without borderline personality disorder

Patients with borderline personality disorder (BPD) are thought to have problematic hospitalizations. This study seeks to examine this phenomenon in adolescence by documenting the specific problem behaviors exhibited by patients, and the staff interventions in response to these behaviors in patients with and without BPD. Data were collected from the charts of 81 hospitalized adolescent girls regarding restraints, seclusions, incidents of self-abuse and aggression, incidents of signing the intent-to-leave form, nonroutine drug and/or alcohol screens, and discharges against medical advice. The two groups were compared using the analysis of variance (ANOVA) statistic for continuous variables and the chi-square statistic for the categorical variable. A follow-up multivariate ANOVA (MANOVA) was performed using the length of stay as a covariate. The BPD group displayed significantly higher rates of certain behaviors per day, but not of others. The length of stay was significantly higher in the BPD group. Further analysis indicated that some of the behavioral differences between the two groups may be due to the effect of the difference in length of stay. The data also suggest that while most BPD patients behave similarly to other patients, there may be a subset of BPD patients who behave in an extreme manner while hospitalized. BPD patients may display more of certain problematic behaviors than non-BPD patients in the hospital. However, it is hypothesized that these differences in hospital behavior may be largely due to the different lengths of stay between the two groups or to an acting-out subgroup of BPD patients.

A computational and perceptual account of motion lines

To indicate motion in a static drawing, artists often include lines trailing a moving object. The use of these motion lines is notable because they do not seem to be related to anything in the optic array. The dynamic behavior of a neural-network model for contour detection is analyzed and it is shown that it generates trails of oriented responses behind moving stimuli. The properties of the oriented response trails are shown to correspond to motion lines. The model generates trails of different orientations depending on the speed and length of the movement, and thereby predicts different uses of two types of motion lines. The model further predicts that motion lines should bias real motion in some situations. An experiment relating motion lines to ambiguous motion percepts demonstrates that motion lines contribute to motion percepts.

Spatial frequency and visual persistence: cortical reset

Psychophysical studies show that the duration of visual persistence increases with spatial frequency of gratings. Previous theories ascribe this finding to differences between the spatial and temporal properties of sustained and transient pathways. This paper proposes an alternative account that explains persistence as a side-effect of excitatory feedback in neural circuits for contour extraction. Mechanisms to break excitatory feedback include inhibitory reset signals at stimulus offset. Simulations demonstrate how gratings with lower spatial frequency generate stronger inhibitory reset signals, thereby resulting in shorter persistence for lower spatial frequencies. Additional simulations account for interactions of spatial frequency with stimulus duration, effects of adaptation, and properties of residual traces, as opposed to visual persistence.

Myocardial oxygenation during high work states in hearts with postinfarction remodeling

BACKGROUND

Postinfarction left ventricular remodeling (LVR) is associated with reductions in myocardial high-energy phosphate (HEP) levels, which are more severe in animals that develop overt congestive heart failure (CHF). During high work states, further HEP loss occurs, which suggests demand-induced ischemia. This study tested the hypothesis that inadequate myocyte oxygen availability is the basis for these HEP abnormalities.

METHODS AND RESULTS

Myocardial infarction was produced by left circumflex coronary artery ligation in swine. Studies were performed in 20 normal animals, 14 animals with compensated LVR, and 9 animals with CHF. Phosphocreatine (PCr)/ATP was determined with 31P NMR and deoxymyoglobin (Mb-delta) with 1H NMR in myocardium remote from the infarct. Basal PCr/ATP tended to be decreased in postinfarct hearts, and this was significant in animals with CHF. Infusion of dobutamine (20 microg x kg-1 x min-1 IV) caused doubling of the rate-pressure product in both normal and LVR hearts and resulted in comparable significant decreases of PCr/ATP in both groups. This decrease in PCr/ATP was not associated with detectable Mb-delta. In CHF hearts, rate-pressure product increased only 40% in response to dobutamine; this attenuated response also was not associated with detectable Mb-delta.

CONCLUSIONS

Thus, the decrease of PCr/ATP during dobutamine infusion is not the result of insufficient myocardial oxygen availability. Furthermore, in CHF hearts, the low basal PCr/ATP and the attenuated response to dobutamine occurred in the absence of myocardial hypoxia, indicating that the HEP and contractile abnormalities were not the result of insufficient oxygen availability.

Java experiments for introductory cognitive psychology courses

Interactive on-line experiments provide a unique and useful method for communicating material to students that is otherwise cumbersome and often confusing. The Java programming language is particularly suited for Internet-based programming applications of this sort because it bypasses many technical issues, including resource availability, security, and cross-platform compatibility. In most cases, topics appropriate to this medium of presentation should (1) not be easily demonstrated by other means, (2) represent an important finding in the field, and (3) be robust with respect to variations in both participants and equipment. The present paper outlines the integration of interactive experiments into an introductory cognitive psychology classroom, describing several experiments currently available on the World-Wide Web (WWW). Evaluation of the technical aspects of the technology as well as expansion of the format to other courses is discussed.

Pregnancy outcomes among women with and without diabetic microvascular disease (White's classes B to FR) versus non-diabetic controls

The objective of this paper is to evaluate the impact of contemporary management on the maternal and neonatal outcomes of pregnancies complicated by diabetes in women with microvascular disease versus women without microvascular disease. The study population consisted of two hundred and eighty-eight (288) pregnant women with pregestational diabetes and one hundred and fifty (150) healthy pregnant controls. Diabetic women were grouped according to the presence (n = 103) or absence of diabetic microvascular disease (n = 185). Data were collected regarding diabetes management, level of glycemic control, and the development of antenatal complications. Maternal and neonatal outcomes were compared among the three groups. Women in the diabetes groups were stratified according to mean blood glucose levels and glycosylated hemoglobin during each trimester. There was no significant difference found between the two diabetes groups in terms of preterm labor, polyhydramnios, pyelonephritis, and growth restriction. The only maternal complications that occurred with increased incidence among women with microvascular disease were acute hypertensive complications (51.6 vs. 32.9%; p<0.05). However, when the diabetes groups were compared to healthy controls, a significant difference was seen in all maternal and neonatal complications. Preterm delivery, polyhydramnios, and large-for-gestational-age (LGA) infants were associated with poor third-trimester metabolic control as compared with others in satisfactory metabolic controls: 30.8 vs. 11.4% for preterm delivery; 17.3 vs. 5.1% for polyhydramnios; 51.9 vs. 33.9% for LGA; p<0.05. Congenital malformations were associated with poor first-trimester glucose control (5.8 vs. 1.3% anomalies in well-controlled women). Furthermore, major congenital malformations were also significantly increased in the offspring of women with diabetic microvascular disease 6.8%, as compared to 1.69% in diabetic women without microvascular disease; p<0.01. The incidence of hypertensive complications did not differ between the two diabetic groups. Pregestational diabetic women with and without microvascular disease can be counseled to anticipate comparably favorable pregnancy outcomes, although maternal and neonatal complications may exceed that experienced by pregnant women without diabetes mellitus.

The Mayo Clinic-Canadian Cooperative trial of sulfasalazine in active multiple sclerosis

OBJECTIVE

To determine whether sulfasalazine is better than placebo in slowing disability progression in MS.

METHODS

In this randomized, double-blind, placebo-controlled phase III trial, 199 patients with active relapsing-remitting (n = 151) or progressive (n = 48) MS were evaluated at 3-month intervals for a minimum of 3 years (94% completed 3 years of follow-up; mean follow-up, 3.7 years). MRI studies were performed at 6-month intervals on a subset of 89 patients.

RESULTS

Sulfasalazine failed to slow or prevent disability progression as measured by the primary outcome (confirmed worsening of the Expanded Disability Status Scale [EDSS] score by at least 1.0 point on two consecutive 3-month visits). Sulfasalazine influenced favorably a number of secondary outcomes during the first 18 months of the trial (e.g., annualized relapse rate, proportion of relapse-free patients; progressive subgroup only: rate of EDSS progression at 1 and 2 years, median time to EDSS progression) but these positive findings were not sustained into the second half of the trial.

CONCLUSIONS

Sulfasalazine does not prevent EDSS score progression in the subset of MS patients studied by this protocol. Treatments may improve relapse-related outcomes in MS, at least temporarily, without providing sustained slowing of EDSS progression. Phase III MS trials should be of sufficient length to determine a meaningful impact on disease course.

The short-term effects of digoxin in patients with right ventricular dysfunction from pulmonary hypertension

OBJECTIVE

Studies on the effects of digoxin in patients with right ventricular failure and normal left ventricular function have not been performed. We evaluated the short-term effects of digoxin administration in patients with primary pulmonary hypertension on hemodynamics, neurohormones, and baroreceptor responsiveness.

DESIGN

This was a prospective study with patients serving as their own controls.

SETTING

University Hospital Intensive Care Unit with central monitoring.

PATIENTS

Seventeen patients with primary pulmonary hypertension and symptomatic heart failure were enrolled.

INTERVENTIONS

Following baseline hemodynamics, neurohormonal samples were drawn and the heart rate response to change in blood pressure following a challenge of phenylephrine and nitroprusside were recorded. One mg of intravenous digoxin was given and the measurements repeated after 2 hours.

RESULTS

Following digoxin there was a significant increase in cardiac output (3.49+/-1.2 to 3.81+/-1.2 L/min., p=0.028), a significant fall in norepinephrine (680+/-89 to 580+/-85 pg/ml, p=.013), and a significant increase in atrial natriuretic peptide (311+/-44 to 421+/-9 pg/ml, p=0.01). All of the patients had changes in heart rate and blood pressure following phenylephrine and nitroprusside challenge, but there was no significant difference in the change in heart rate response to change in blood pressure when rechallenged after digoxin treatment.

CONCLUSION

Digoxin produces a modest increase in cardiac output in patients with pulmonary hypertension and right ventricular failure, as well as a significant reduction in circulating norepinephrine. No detectable effects of digoxin on baroreceptor responsiveness were apparent. The use of digoxin in pulmonary hypertension is warranted.

In vivo differentiation of astrocytic brain tumors and isolated demyelinating lesions of the type seen in multiple sclerosis using 1H magnetic resonance spectroscopic imaging

We used computer pattern recognition of proton magnetic resonance spectroscopic image data to differentiate between brain tumors and large, isolated, demyelinating lesions of the type seen in multiple sclerosis. Leave-one-out linear discriminant analyses correctly classified resonance profiles from five acute demyelinating lesions, 20 low-grade astrocytomas, 22 anoplastic astrocytomas, and 24 glioblastomas. Classification of nonacute lesions will require further development, as the metabolic profiles of demyelinating lesions evolve over time.

The impact of initial surgical management on outcome in young patients with differentiated thyroid cancer

BACKGROUND/PURPOSE

It is generally believed that differentiated thyroid cancer (DTC) in young patients has an excellent prognosis. This calls into question the need for more extensive surgical ablation of the thyroid gland with attendant risks of surgical complications. The purpose of this report was to investigate both the incidence of surgical morbidity and the impact of surgery on locoregional recurrence of disease.

METHODS

The authors reviewed the clinical course of patients under 22 years of age treated for DTC within Department of Defense hospitals since 1950. Data were available for determination of surgical morbidity in 126 and for outcome in 105.

RESULTS

The incidence of postoperative hypocalcemia was 17% and of recurrent laryngeal nerve injury 3%. Factors predictive of morbidity were (1) more extensive thyroid surgery (P = .023), and (2) the presence of gross tumor invasion (P = .022). The incidence of neck recurrence was analyzed among a cohort of 90 patients. A total of 19 (21%) patients had a local recurrence. The median time to recurrence was 24 months. The factor predictive of recurrence was the presence of gross invasion (P = .0001). A strong trend toward locoregional recurrence was found among patients with metastatic disease to more than five cervical nodes (P < .08). The primary operations on the thyroid and regional nodes were not significant predictors of neck recurrence. Among these 19 patients there have been no deaths, but 25% had persistent disease at a mean follow-up of 12.6 years.

CONCLUSIONS

The incidence of surgical morbidity does increase with more extensive surgery. Outcome is predicted primarily by the initial extent of disease.

Improved correlation between scores on the expanded disability status scale and cerebral lesion load in relapsing-remitting multiple sclerosis. Results of the application of new imaging methods

We hypothesized that a better correlation between MRI and clinical measures of neurological disability using the expanded disability status scale (EDSS) in multiple sclerosis could be obtained by assessing lesion load only in and around the corticospinal tracts, since the EDSS is weighted towards motor and ambulatory deficits. Multiple sclerosis lesions in cerebral MRIs from 39 patients with relapsing-remitting multiple sclerosis were manually painted using a three-dimensional computer display tool and mapped into a standardized three-dimensional coordinate space. Total lesion load was then measured. A mask to expose only the corticospinal tract was extracted from an MRI atlas and used to measure lesion load in the corticospinal tract. To account for the residual anatomical variability among the different MRI volumes after stereotaxic transformation, the corticospinal tract mask was dilated to various degrees and the lesion load remeasured. Spearman's rank correlation coefficient was used to calculate the correlation between the EDSS and total lesion load and corticospinal tract lesion load and between the EDSS subscores and total lesion load and corticospinal tract lesion load. Spearman's rank correlation coefficient between the EDSS and total lesion load was 0.6, probably reflecting the rather broad EDSS range represented in the study. The highest correlation of 0.67 was between the EDSS and corticospinal tract lesion load, dilated with a blurring kernel of 8-10 mm. The pyramidal subscore alone showed a weaker correlation with total lesion load, and with corticospinal tract lesion load, than did the overall EDSS, possibly reflecting the narrow range of disability in these subscores in patients with EDSS scores of 1-6.5. The imperfect correlation between the EDSS and corticospinal tract lesion load suggests that factors other than cerebral T2-weighted lesion volume are important determinants of disability.

Serotyping of HIV type 1 infections: definition, relationship to viral genetic subtypes, and assay evaluation. UNAIDS Network for HIV-1 Isolation and Characterization

V3 serotyping refers to a system based on binding of antibody in patient sera to V3-loop peptides derived from HIV-1 env genetic subtypes. The V3x serotype represents reactivity of serum from an HIV-1-infected patient (regardless of viral genetic subtype), which reacts preferentially to a V3 peptide derived from the X subtype sequence. We have classified HIV-1 serotypes, determined the relationship between the HIV-1 V3 serotypes and viral genetic subtypes in a large study (n = 125), and evaluated the performance of three different V3 peptide-binding assays. Seven HIV-1 V3 serotypes were identified: A, B, B-Br, B-Th, C, D, and E. Serotypes B-Br and B-Th represent sera that react specifically to peptides derived from Brazilian B (B-Br, GWGR) and Thai B (B-Th, GPGQ) strains. The HIV-1 V3 B, C, and E serotypes correlated closely with their viral env genetic subtypes; 19-26 of 32 B sera (59-79%), 3-4 of 4 C sera (75-100%), and 19-22 of 23 E sera (83-96%) were identified as serotypes B, C, and E, respectively. In contrast, two major V3 serotypes were classified in A sera: A (14-18 of 36 [40-50%]) and C (12-19 of 36 [33-54%]). Similarly, two major V3 serotypes were classified in D sera: B (6-10 of 20 [30-50%]) and D (9-12 of 20 [45-60%]). Serotyping of subtype E sera showed the best concordance with genetic subtypes by all assays. Overall, HIV-1 V3 serotyping produced consistent results among three laboratories. However, HIV-1 V3 serotypes do not distinguish all HIV-1 genetic subtypes. The relative biological significance of the V3 serotypes remains to be elucidated.

The effect of insulin-like growth factor-I (IGF-I) on protein turnover in the meat-type chicken (Gallus domesticus)

Insulin-like growth factor-I (IGF-I) effects on chicken growth and development are poorly understood. This study examined the effect of IGF-I on protein synthesis rates in various tissues in the male broiler chicken. At three weeks of age, osmotic minipumps were subcutaneously implanted in the scapular area. Chickens were infused with either chicken IGF-I (450 micrograms/kg BW/day) or saline. After treatment for 5 days, the chickens received a flooding dose of [3H]-phenylalanine, and were sacrificed 20 min later. Wing vein blood samples were taken at 0, 5, 10 and 20 min post-injection. The following tissues were removed and frozen for analysis: pectoralis muscle, gastrocnemius muscle, heart, liver, and small intestine. In vivo total protein synthesis measurements were made using the double-label technique. Contractile protein degradation was evaluated using intracellular free 3-methylhistidine concentrations in skeletal muscle. There were no significant differences in absolute or relative body growth rates over the treatment period. Skeletal muscle (pectoralis and gastrocnemius) weights were significantly decreased with IGF-I treatment, while heart weight was significantly increased. Plasma insulin levels were significantly lower in IGF-treated chickens compared to that in control birds. There was no effect of IGF-I on protein synthesis rates in any of the tissues examined. Intracellular free 3-methylhistidine concentrations were higher in both the gastrocnemius (17%) and pectoralis muscles (25%) of chickens treated with IGF-I. This data demonstrates that IGF-I may have an indirect effect to regulate muscle protein turnover rates.

The effect of delayed reperfusion following infarction in the rat on structural changes in viable myocardium

OBJECTIVE

Evidence indicates that patency of the infarct related artery following the completion of myocardial necrosis can attenuate ventricular remodeling. Data have also demonstrated that inhibition of infarct expansion contributes to the anti-remodeling effect of delayed reperfusion. However, the influence of a patent artery on components of the remodeling process in the viable myocardium is poorly understood.

METHODS

Myocyte morphometrics (isolated cell technique) and collagen content (hydroxyproline analysis) were assessed 28 days following experimental myocardial infarction from rats with permanently ligated left coronary vessels (NRP; n = 10) compared with rats who underwent reperfusion 150 minutes after ligation (RP; n = 11) and a sham-operated group (n = 10).

RESULTS

Analysis of infarct size (planimetry) in a separate group of rats demonstrated that reperfusion at this late time point did not reduce infarct size (NRP: 33 +/- 3 vs. RP: 35 +/- 5%). Myocyte length in RP rats was less than in NRP rats in viable, non-infarcted left ventricular tissue (155 +/- 3 vs. 167 +/- 4 microns, p = 0.02), in the right ventricle (154 +/- 4 vs. 167 +/- 3 microns, p = 0.02) and in the septum (158 +/- 4 vs. 169 +/- 4 microns, p = 0.05). Reperfusion also attenuated the expected increase in cell volume compared with NRP rats (left ventricle 39.4 +/- 1.7 x 10(3) vs. 44.1 +/- 1.6 x 10(3) micron 3, p = 0.06; right ventricle 36.7 +/- 1.6 x 10(3) vs. 42.7 +/- 2.0 x 10(3) micron 3, p = 0.02; septum 41.0 +/- 1.6 x 10(3) vs. 44.2 +/- 1.8 x 10(3) micron 3, p = 0.19). Hydroxyproline content increased in the viable left ventricular tissue in both the reperfused and non-reperfused groups.

CONCLUSION

Reperfusion without myocardial salvage attenuates the increase in myocyte length and volume that occurs in remodeling myocardium following infarction in the rat, with no effect on the increase in collagen content. These data indicate that patency of the infarct vessel, which is known to have an inhibitory effect on infarct expansion, also has an anti-remodeling effect remote from the area perfused by this artery.

Cortical dynamics of lateral inhibition: metacontrast masking

The dynamic properties of a neural network model of visual perception, called the boundary contour system, explain characteristics of metacontrast visual masking. Computer simulations of the model, with a single set of parameters, demonstrate that it accounts for 9 key properties of metacontrast masking: Metacontrast masking is strongest at positive stimulus onset asynchronies (SOAs); decreasing target luminance changes the shape of the masking curve; increasing target duration weakens masking; masking effects weaken with spatial separation; increasing mask duration leads to stronger masking at shorter SOAs; masking strength depends on the amount and distribution of contour in the mask; a second mask can disinhibit the masking of the target; such disinhibition depends on the SOA of the 2 masks; and such disinhibition depends on the spatial separation of the 2 masks. No other theory provides a unified explanation of these data sets. Additionally, the model suggests a new analysis of data related to the SOA law and makes several testable predictions.

Cortical dynamics of visual persistence and temporal integration

In a temporal integration experiment, subjects must integrate two visual stimuli, presented at separate times, to perform an identification task. Many researchers have assumed that the persistence of the leading stimulus determines the ability to integrate the leading and trailing stimuli. However, recent studies of temporal integration have challenged that hypothesis by demonstrating that several theories of persistence are incompatible with data on temporal integration. This paper shows that an account of visual persistence given by a neural network model of preattentive vision, called the boundary contour system, explains data on temporal integration. Computer simulations of the model explain why temporal integration becomes more difficult when the display elements are separated by longer interstimulus intervals or are of longer duration or of higher luminance, or are spatially closer together. The model suggests that different mechanisms underlie the inverse duration effects for leading and for trailing elements. The model further predicts interactions of spatial separation, duration, and luminance of the trailing display.

Borderline personality disorder in adolescents: affective and cognitive features

OBJECTIVE

To examine systematically the affective and cognitive features of borderline personality disorder (BPD) in adolescence, using standardized measures of these constructs and controlling for depression.

METHOD

Nineteen depressed female adolescents with BPD were compared with 21 non-BPD depressed inpatients on measures of affect and cognitive style.

RESULTS

Both BPD and non-BPD adolescents endorsed significantly elevated levels of self-reported depression, anger, anxiety, hopelessness, self-deprecatory attributional style, and external locus of control. Adolescents with BPD endorsed significantly poorer self-concept than their non-BPD peers; this difference was not an artifact of depressive severity.

CONCLUSIONS

The findings indicate that adolescents with BPD experience significant impairments in self-concept, suggestive of pervasive emptiness and identity disturbance associated with BPD.

Cortical dynamics of lateral inhibition: visual persistence and ISI

Psychophysical studies show that increasing the interstimulus interval (ISI) between two stimuli decreases persistence of the first stimulus. While some researchers account for these results with interactions of transient and sustained inhibition, this paper describes an alternative explanation. In a neural-network model of boundary detection called the boundary contour system, persistence is the result of feedback-generated reverberations. Mechanisms to control these reverberations include lateral inhibition, which computer simulations show allows persistence in the network to qualitatively match the psychophysical data. Additional simulations predict that increasing the duration of the second stimulus should cause persistence to increase with ISI. The model links psychophysical data on visual persistence with computational requirements of spatial vision and properties of cells in visual cortex.

Prognostic significance of plasma norepinephrine in patients with asymptomatic left ventricular dysfunction. SOLVD Investigators

BACKGROUND

Elevated plasma neurohormonal levels are associated with increased mortality rates in patients with symptomatic heart failure. A previous Studies of Left Ventricular Dysfunction (SOLVD) trial suggested that neurohumoral activation precedes the development of symptoms as demonstrated by increased neurohormonal levels in patients with asymptomatic left ventricular dysfunction. However, the significance of this early neurohumoral activation is unclear. The goals of this study were to determine the prognostic significance of the plasma concentrations of plasma norepinephrine (PNE) and atrial natriuretic peptide (ANP) and the renin activity (PRA) in patients with asymptomatic left ventricular dysfunction.

METHODS AND RESULTS

PNE and PRA were measured before randomization in 514 patients with left ventricular ejection fractions < or = 35% who did not require treatment for congestive heart failure and were enrolled in the SOLVD Prevention Trial. Plasma ANP levels were measured in a subset of 241 patients owing to study design. Using the Cox proportional hazards model that included left ventricular ejection fraction, New York Heart Association functional class, age, sex, treatment assignment to placebo or enalapril, and cause of heart failure, we examined whether these neurohormones predicted all-cause mortality, cardiovascular mortality, hospitalization for heart failure, development of heart failure, or development of ischemic events (myocardial infarction or unstable angina). PNE was the strongest predictor of clinical events in this patient population. PNE levels above the median of 393 pg/mL were associated with a relative risk of 2.59 (P = .002) for all-cause mortality, 2.55 (P = .003) for cardiovascular mortality, 2.55 (P = .005) for hospitalization for heart failure, 1.88 (P = .002) for development of heart failure, 1.92 (P = .001) for ischemic events, and 2.59 (P = .005) for myocardial infarction. PNE remained the most powerful predictor for all-cause mortality and ischemic events when the analysis included only the patients with histories of ischemic left ventricular dysfunction. The increases in other neurohormonal levels were not useful in predicting the subsequent development of clinical events.

CONCLUSIONS

Increased PNE levels in patients with asymptomatic left ventricular dysfunction appear to predict all-cause and cardiovascular mortalities and development of clinical events related to the onset of heart failure or acute ischemic syndromes. Thus, measurement of PNE may be a possible early marker for assessment of disease progression in patients with left ventricular dysfunction, and modulating the release or effect of PNE may lead to improved prognosis and/or a reduction in morbidity.