Group-based trajectory modeling a good model to explore sub-groups of recovery during acute bipolar mood episodes

Group-based trajectory modeling (GBTM) is a statistical method created to explore the heterogeneity of clinical groups based on their longitudinal outcomes by identifying distinct trajectories of change. This model can be applied to assess heterogeneity in responses to treatment. This pilot study explored the relevance of the GBTM associated with the dimensional evaluation of mood (MATHYS) to define trajectory of recovery in acute bipolar mood episodes on a short period of time during a naturalistic study.

Method

The sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.

Results

This method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.

Conclusion

When considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.

The Analysis of Vapor-Deposited Pd Particles Supported on Thin Oxides

Problems of analyzing by TEM and TPD (Temperature Programmed Desorption) the structure and micromorphology of small Pd particles vapor deposited in UHV onto clean oxide supports are discussed. Particle changes induced during extended exposures to high intensity electron irradiation of a number of electron transparent support materials such as Al2O3, SiO2, TiO2, MgO, and mica are examined. Different damage mechanisms are evaluated and experimental means of reducing the damage are explored. The possibility of extracting particle morphology information from a detailed analysis of CO thermal desorption spectra is also investigated. Evidence suggests that it may be possible to obtain micromorphology information down to very small particle sizes from TPD measurements if the effects of intrinsic particle morphology can be separated from the influence of diffusion of support species.

Predictors of early arrival at the emergency department in acute ischaemic stroke

BACKGROUND

A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window.

AIMS

We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area.

METHODS

A retrospective review of all case notes for 1 year was performed.

RESULTS

Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model.

CONCLUSION

The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.

Vesicle permeabilization by purified soluble oligomers of prion protein: a comparative study of the interaction of oligomers and monomers with lipid membranes

The conversion of normal cellular prion protein (PrP) into its pathological isoform, scrapie PrP, may occur at the cell surface or, more probably, in late endosomes. The early events leading to the structural conversion of PrP appear to be related to the presence of more or less stable soluble oligomers, which might mediate neurotoxicity. In the current study, we investigate the interaction of alpha-rich PrP monomers and beta-rich size-exclusion-chromatography-purified PrP oligomers with lipid membranes. We compare their structural properties when associated with lipid bilayers and study their propensities to permeabilize the membrane at physiological pH. We also study the influence of the N-terminal flexible region (residues 24-103) by comparing full-length PrP(24-234) and N-terminally truncated PrP(104-234) oligomers. We showed that both 12-subunit oligomers cause an immediate and large increase in the permeability of the membrane, whereas equivalent amounts of monomeric forms cause no detectable leakage. Although the two monomeric PrP constructs undergo an alpha-to-beta conformational change when bound to the negatively charged membrane, only the full-length form of monomeric PrP has a weak fusogenic effect. Finally, the oligomers affect the integrity of the membrane differently from the monomers, independently of the presence of the N-terminal flexible domain. As for other forms of amyloidogenesis, a reasonable mechanism for the toxicity arising from PrP fibrillization must be associated with low-molecular-weight oligomeric intermediates, rather than with mature fibrils. Knowledge of the mechanism of action of these soluble oligomers would have a high impact on the development of novel therapeutic targets.

[Severe depression : specific features of bipolar disorder]

Bipolar depressions can present all the clinical aspects from a major depressive episode with a mild intensity to severe one. However, part of this severity comes from the bipolarity by itself. Bipolar disorders belong to the 10 most disabling conditions in the world. Moreover, the complexity of bipolar depressions comes also from the complexity to treat them. Antidepressants are difficult to use in bipolar subjects because the risk of switch, the possible induction of rapid cycles or of a chronic dysphoric state. Currently, guidelines are not very helpful for the choice of the treatment in case of an acute major depressive disorder. Indeed, the current guidelines give the choice between a mood stabilizer alone or associated with an antidepressant, either between an antipsychotic more or less associated with an antidepressant. A better understanding of the clinical heterogeneity of bipolar depression could help to solve a part of this complexity.

[Management of patients with hepatitis C by French psychologists and psychiatrists: a practical investigation]

INTRODUCTION

A first part of this survey showed that up to 19% of patients with hepatitis C virus did not receive optimal treatment because of a psychiatric problem (psychiatric disorders or addictive behaviours) and that less than 50% of the managing clinicians worked with a psychiatrist or a psychologist in these cases. The aim of the second part of the survey was to describe the current practices provided by the psychiatrists and the psychologists to HCV infected patients as well as the knowledge and expectations of professionals in this area.

PATIENTS AND METHODS

Forty-seven psychiatrists and 43 psychologists who were or were not working with French reference poles for hepatitis C virus responded to a questionnaire of their practices.

RESULTS

Analysis of the 90 questionnaires showed that psychiatric and/or psychological care was not systematic. Psychiatrists and psychologists should be given more information and specific training about this topic.

CONCLUSION

Psychiatric and psychological care of chronic hepatitis C virus infected patients should be improved. French reference poles should also become "references" for psychiatric care.

Non-invasive extendible endoprostheses for limb reconstruction in skeletally-mature patients

We describe the application of a non-invasive extendible endoprosthetic replacement in skeletally-mature patients undergoing revision for failed joint replacement with resultant limb-length inequality after malignant or non-malignant disease. This prosthesis was developed for tumour surgery in skeletally-immature patients but has now been adapted for use in revision procedures to reconstruct the joint or facilitate an arthrodesis, replace bony defects and allow limb length to be restored gradually in the post-operative period.

We record the short-term results in nine patients who have had this procedure after multiple previous reconstructive operations. In six, the initial reconstruction had been performed with either allograft or endoprosthetic replacement for neoplastic disease and in three for non-neoplastic disease. The essential components of the prosthesis are a magnetic disc, a gearbox and a drive screw which allows painless lengthening of the prosthesis using the principle of electromagnetic induction. The mean age of the patients was 37 years (18 to 68) with a mean follow-up of 34 months (12 to 62). They had previously undergone a mean of six (2 to 14) open procedures on the affected limb before revision with the non-invasive extendible endoprosthesis.

The mean length gained was 56 mm (19 to 107) requiring a mean of nine (3 to 20) lengthening episodes performed in the outpatient department. There was one case of recurrent infection after revision of a previously infected implant and one fracture of the prosthesis after a fall. No amputations were performed. Planned exchange of the prosthesis was required in three patients after attainment of the maximum lengthening capacity of the implant. There was no failure of the lengthening mechanism. The Mean Musculoskeletal Tumour Society rating score was 22 of 30 available points (18 to 28).

The use of a non-invasive extendible endoprosthesis in this manner provided patients with good functional results and restoration of leg-length equality, without the need for multiple open lengthening procedures.

The major protein fraction of mouse milk revisited using proven proteomic tools

The PRM/Alf inbred mice exhibit a huge intestinal lengthening. Since milk contains bioactive factors implied in numerous biological processes, one hypothesis is that PRM/Alf milk contains intestinotrophic factors contributing to this remarkable phenotype. A comparison between the milk from PRM/Alf and C57BL/6J (as a control) strains could be helpful in the identification of such factors, including proteins. However, a complete description of the mouse milk major protein fraction is still missing. Hence we adapted a reliable technique to separate and identify the major mouse milk proteins. This approach was achieved through the protein study of milk from C57BL/6J and PWK/Pas strains representative of two Mus musculus subspecies, M. m. domesticus and M. m. musculus respectively. C57BL/6J milk samples were first skimmed and fractionated by reverse phase-HPLC (RP-HPLC). The protein content of each chromatographic peak was analysed by SDS-PAGE and identified by mass spectrometry. This methodological approach allowed characterization of nine major mouse milk proteins: alpha(s1), beta, gamma, epsilon and kappa-caseins, Whey Acidic Protein, lactoferrin, Serum Albumin, Fatty Acid Binding Protein, as well as an alpha(s1)-casein isoform. Then, RP-HPLC patterns of C57BL/6J milk proteins were compared with those obtained starting from the milk of PWK/Pas females. This comparison revealed a protein polymorphism for the alpha(s1)-casein.

[Emotional reactivity in euthymic bipolar patients]

BACKGROUND

Euthymic states in bipolar disorders are usually considered to be lacking serious psychiatric disorders. Moreover, recent results prove the need to take an interest in a potential emotional dysregulation during these intercrisis periods. Therefore, it seems relevant not only to focus on the emotions tonality (sadness/euphoria) felt by patients, but also on the intensity of their emotional background. Several reasons argue for a disturbance of emotional reactivity in euthymic bipolar patients. First, most bipolar patients spontaneously claim they have a higher sensitivity than average, which may lead to extreme emotional reactions, even during intercrisis periods. Secondly, the emotional reactivity is a way to raise the question of the bipolar patients' vulnerability to stress in euthymic periods. Several studies have shown the impact of stressful life events on the rate of relapse into bipolar disorders. The aim of this study is to examine the emotional reactivity of euthymic bipolar patients in comparison with a control group, using a test of emotional induction. Our hypothesis is that euthymic bipolar patients have a higher emotional reactivity than controls.

METHOD

One hundred and forty-five subjects were recruited: 90 controls and 55 euthymic bipolar patients. The patients were interviewed by a trained psychologist using the French version of the DIGS providing DSM-IV diagnosis. The euthymic state was confirmed with both MADRS (score<12) and Bech's Manic Scale (score<4). The subjective emotional reactivity of the subjects was assessed using a method of emotional induction, based on viewing a set of 18 (positive, negative or neutral) pictures. The subjects have to appreciate the valence (pleasant, neutral or unpleasant thoughts) and assess the arousal (degree of emotion triggered by each picture).

RESULTS

On average, euthymic bipolar patients report the same valence and arousal to positive (F [1.143]=0.18, p=0.68) and negative (F [1.143]=0.52, p=0.47) pictures as control subjects. Neutral pictures, however, were considered more pleasant and moving by euthymic bipolar patients than by control subjects (F [1.143]=8.40, p=0.004).

CONCLUSION

Euthymic bipolar patients seem to present an emotional hyperactivity which occurs especially in neutral situations. These results partly corroborate outcomes of other authors, while providing a new methodology through the emotional induction test. The highlight of emotional hyperreactivity during intercrisis periods allows us to understand differently the topic of specific vulnerability to stress of bipolar patients. This hypersensitivity could lead to thymic decompensations and could be linked with an emotional dysregulation, potential endophenotype of the bipolar pathology. Beyond the interest in understanding the physiopathology of the bipolar disorder, it could be associated with several clinical applications as well as in the psychoeducational field and in the screening of the individual risk within the family of bipolar subjects.

Management of psychiatric disorders and addictive behaviors in patients with viral hepatitis C in France

INTRODUCTION

Guidelines concerning the management of psychiatric disorders and addictive behaviors in patients with chronic hepatitis C and the conditions of collaboration between hepatogastroenterologists, infectiologists, psychiatrists and psychologists have not been published. This has a negative influence on optimal therapeutic management of chronic hepatitis C virus (HCV) infection. The aim of this study was to describe the current clinical practices for ambulatory management of psychiatric disorders and addictions, and the influence of a possible psychiatric and/or psychological collaboration.

PATIENTS AND METHODS

A retrospective survey was conducted among 101 clinicians treating patients with chronic hepatitis C. Data were collected from personal interviews with the managing clinicians and from the files of patients with chronic hepatitis C patients who presented psychiatric disorders.

RESULTS

Analysis of the 101 interviews and 598 patient files showed that 19% of patients had not received an optimal treatment for their HCV infection because of a psychiatric problem, and that less than 50% of the managing clinicians were working in collaboration with a psychiatrist or a psychologist. In conclusion, lack of collaboration between hepatogastroenterologists and psychiatrists could be deleterious for the optimal treatment of HCV infected patients. Improvement is required.

2q23.1 microdeletion identified by array comparative genomic hybridisation: an emerging phenotype with Angelman-like features?

BACKGROUND

Genome-wide screening of patients with mental retardation using array comparative genomic hybridisation (CGH) has identified several novel imbalances. With this genotype-first approach, the 2q22.3q23.3 deletion was recently described as a novel microdeletion syndrome. The authors report two unrelated patients with a de novo interstitial deletion mapping in this genomic region and presenting similar "pseudo-Angelman" phenotypes, including severe psychomotor retardation, speech impairment, epilepsy, microcephaly, ataxia, and behavioural disabilities.

METHODS

The microdeletions were identified by array CGH using oligonucleotide and bacterial artificial chromosome (BAC) arrays, and further confirmed by fluorescence in situ hybridisation (FISH) and semi-quantitative polymerase chain reaction (PCR).

RESULTS

The boundaries and sizes of the deletions in the two patients were different but an overlapping region of about 250 kb was defined, which mapped to 2q23.1 and included two genes: MBD5 and EPC2. The SIP1 gene associated with the Mowat-Wilson syndrome was not included in the deleted genomic region.

DISCUSSION

Haploinsufficiency of one of the deleted genes (MBD5 or EPC2) could be responsible for the common clinical features observed in the 2q23.1 microdeletion syndrome, and this hypothesis needs further investigation.

Posterior reversible encephalopathy syndrome during sunitinib therapy

A case of posterior reversible encephalopathy syndrome (PRES) occurring in a women treated by sunitinib for an ovarian metastatis of a renal cell carcinoma is described. This is the third case described in the literature. The three cases are very similar except for the delay to onset of the PRES (one week to five months). Both antiangiogenic and prohypertensive effects of sunitinib are probably involved in the pathophysiology of PRES. Physicians should be aware of this potentially life-threatening side-effect of sunitinib easily controlled by withdrawing sunitinib and symptomatic treatment.

Molecular basis for group-specific activation of the virulence regulator PlcR by PapR heptapeptides

The transcriptional regulator PlcR and its cognate cell–cell signalling peptide PapR form a quorum-sensing system that controls the expression of extra-cellular virulence factors in various species of the Bacillus cereus group. PlcR and PapR alleles are clustered into four groups defining four pherotypes. However, the molecular basis for group specificity remains elusive, largely because the biologically relevant PapR form is not known. Here, we show that the in vivo active form of PapR is the C-terminal heptapeptide of the precursor, and not the pentapeptide, as previously suggested. Combining genetic complementation, anisotropy assays and structural analysis we provide a detailed functional and structural explanation for the group specificity of the PlcR–PapR quorum-sensing system. We further show that the C-terminal helix of the PlcR regulatory domain, specifically the 278 residue, in conjunction with the N-terminal residues of the PapR heptapeptide determines this system specificity. Variability in the specificity-encoding regions of plcR and papR genes suggests that selection and evolution of quorum-sensing systems play a major role in adaptation and ecology of Bacilli.

Do relatives of elderly patients block the discharge process?

There is a perception that relatives of older patients "block" their discharge from acute hospitals, thereby compounding the capacity crises of Ireland's A+E departments. This study prospectively analyses 1,240 consecutive referrals to the discharge co-ordinator of an acute general hospital over a two-year period. The number of bed-days consumed by all patients whose discharge was delayed was calculated, in addition to reasons for delay and whether or not patients' relatives were opposing discharge. There were 90 cases of delayed discharge resulting in 2,436 bed-days consumed over the study period. Reasons for delays principally centred on access to long-term care facilities and organisation of community supports. Patients' relatives opposed discharge in 9 of the 90 delayed cases. Concerns expressed by patients' relatives reflected the paucity of community supports available for older people and their carers. Older people's relatives are patient advocates and seek appropriate facilities for those whom they represent.

[Cerebral vasculitis with aneurysms caused by varicella-zoster virus infection during AIDS: a new clinicoangiographical syndrome]

We describe three cases of cerebral angiopathy with aneurysms caused by a meningeal varicella-zoster virus infection occurring during AIDS. The clinical picture was rather stereotyped: severe immunocompromission due to HIV infection, ongoing multifocal cerebrovascular disease with territorial infarcts, lymphocytic meningitis with normal glucose content (two cases) or hypoglycorrhachia (one case), multifocal cerebral vasculopathy with narrowings and aneurysms, healing with or without neurological sequelae after intravenous aciclovir treatment. The diagnosis of varicella-zoster virus-induced angiopathy was ascertained by the positive specific PCR in the CSF in the three cases and by the results of the cerebromeningeal biopsy in one case. Although, varicella-zoster virus is already known as a cause of cerebral angiopathy both in the immunocompetent and the immunocompromised, these three cases are the first ever described of a particular angiopathy with narrowings and ectasias complicating AIDS. The infectious treatable cause and the risk of aggravation without treatment require early active oriented investigations in case of a patient with cerebrovascular disease occurring during HIV infection, including a CSF study with varicella-zoster PCR, to allow specific antiviral treatment. In our three cases, aciclovir intravenous treatment (30mg/kg per day) enabled VZ virus clearing from the CSF and stopped the course of the vasculopathy.

Development and application of SINE multilocus and quantitative genetic markers to study oilseed rape (Brassica napus L.) crops

A genetic marker system based on the S1 Short Interspersed Elements (SINEs) in the important commercial crop, oilseed rape ( Brassica napus L.) has been developed. SINEs provided a successful multilocus, dominant marker system that was capable of clearly delineating winter- and spring-type crop varieties. Sixteen of 20 varieties tested showed unique profiles from the 17 polymorphic SINE markers generated. The 3' or 5' flank region of nine SINE markers were cloned, and DNA was sequenced. In addition, one putative pre-transposition SINE allele was cloned and sequenced. Two SINE flanking sequences were used to design real-time PCR assays. These quantitative SINE assays were applied to study the genetic structure of eight fields of oilseed rape crops. Studied fields were more genetically diverse than expected for the chosen loci (mean H T = 0.23). The spatial distribution of SINE marker frequencies was highly structured in some fields, suggesting locations of volunteer impurities within the crop. In one case, the assay identified a mislabeling of the crop variety. SINE markers were a useful tool for crop genetics, phylogenetics, variety identification, and purity analysis. The use and further application of quantitative, real-time PCR markers are discussed.