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Abdallah CG, Roache JD, Gueorguieva R, Averill LA, Young-McCaughan S, Shiroma PR, Purohit P, Brundige A, Murff W, Ahn KH, Sherif MA, Baltutis EJ, Ranganathan M, D’Souza D, Martini B, Southwick SM, Petrakis IL, Burson RR, Guthmiller KB, López-Roca AL, Lautenschlager KA, McCallin JP, Hoch MB, Timchenko A, Souza SE, Bryant CE, Mintz J, Litz BT, Williamson DE, Keane TM, Peterson AL, Krystal JH. Dose-related effects of ketamine for antidepressant-resistant symptoms of posttraumatic stress disorder in veterans and active duty military: a double-blind, randomized, placebo-controlled multi-center clinical trial. Neuropsychopharmacology 2022; 47:1574-1581. [PMID: 35046508 PMCID: PMC8767037 DOI: 10.1038/s41386-022-01266-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 01/27/2023]
Abstract
This study tested the efficacy of repeated intravenous ketamine doses to reduce symptoms of posttraumatic stress disorder (PTSD). Veterans and service members with PTSD (n = 158) who failed previous antidepressant treatment were randomized to 8 infusions administered twice weekly of intravenous placebo (n = 54), low dose (0.2 mg/kg; n = 53) or standard dose (0.5 mg/kg; n = 51) ketamine. Participants were assessed at baseline, during treatment, and for 4 weeks after their last infusion. Primary analyses used mixed effects models. The primary outcome measure was the self-report PTSD Checklist for DSM-5 (PCL-5), and secondary outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Montgomery Åsberg Depression Rating Scale (MADRS). There were no significant group-by-time interactions for PTSD symptoms measured by the PCL-5 or CAPS-5. The standard ketamine dose ameliorated depression measured by the MADRS significantly more than placebo. Ketamine produced dose-related dissociative and psychotomimetic effects, which returned to baseline within 2 h and were less pronounced with repeated administration. There was no evidence of differential treatment discontinuation by ketamine dose, consistent with good tolerability. This clinical trial failed to find a significant dose-related effect of ketamine on PTSD symptoms. Secondary analyses suggested that the standard dose exerted rapid antidepressant effects. Further studies are needed to determine the role of ketamine in PTSD treatment. ClinicalTrials.gov identifier: NCT02655692.
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Affiliation(s)
- Chadi G. Abdallah
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,grid.413890.70000 0004 0420 5521Michael E. DeBakey VA Medical Center, Houston, TX USA ,grid.39382.330000 0001 2160 926XMenninger Department of Psychiatry, Baylor College of Medicine, Houston, TX USA ,grid.39382.330000 0001 2160 926XCore for Advanced Magnetic Resonance Imaging (CAMRI), Baylor College of Medicine, Houston, TX USA
| | - John D. Roache
- grid.267309.90000 0001 0629 5880Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX USA ,grid.280682.60000 0004 0420 5695Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX USA
| | - Ralitza Gueorguieva
- grid.47100.320000000419368710Department of Biostatistics, School of Public Health, Yale University School of Medicine, New Haven, CT USA
| | - Lynnette A. Averill
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,grid.413890.70000 0004 0420 5521Michael E. DeBakey VA Medical Center, Houston, TX USA ,grid.39382.330000 0001 2160 926XMenninger Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - Stacey Young-McCaughan
- grid.267309.90000 0001 0629 5880Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX USA ,grid.280682.60000 0004 0420 5695Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX USA
| | - Paulo R. Shiroma
- grid.491585.4Minneapolis VA Medical Center and the Department of Psychiatry University of Minnesota, Minneapolis, MN USA
| | - Prerana Purohit
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Antoinette Brundige
- grid.267309.90000 0001 0629 5880Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX USA ,grid.280682.60000 0004 0420 5695Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX USA
| | - William Murff
- grid.267309.90000 0001 0629 5880Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Kyung-Heup Ahn
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Mohamed A. Sherif
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA ,grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, and Carney Institute, Brown University; and Lifespan Physician Group, Providence, RI USA
| | - Eric J. Baltutis
- grid.491585.4Minneapolis VA Medical Center and the Department of Psychiatry University of Minnesota, Minneapolis, MN USA
| | - Mohini Ranganathan
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Deepak D’Souza
- grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Brenda Martini
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Steven M. Southwick
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Ismene L. Petrakis
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Rebecca R. Burson
- grid.416653.30000 0004 0450 5663Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Kevin B. Guthmiller
- grid.416653.30000 0004 0450 5663Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA ,grid.42505.360000 0001 2156 6853Keck School of Medicine at the University of Southern California, Los Angeles, CA USA
| | - Argelio L. López-Roca
- grid.416653.30000 0004 0450 5663Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Karl A. Lautenschlager
- grid.416653.30000 0004 0450 5663Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - John P. McCallin
- grid.416653.30000 0004 0450 5663Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Matthew B. Hoch
- grid.416653.30000 0004 0450 5663Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Alexandar Timchenko
- grid.416653.30000 0004 0450 5663Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Sergio E. Souza
- grid.416653.30000 0004 0450 5663Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Charles E. Bryant
- grid.416653.30000 0004 0450 5663Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio – Fort Sam Houston, Houston, TX USA
| | - Jim Mintz
- grid.267309.90000 0001 0629 5880Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX USA ,grid.280682.60000 0004 0420 5695Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX USA
| | - Brett T. Litz
- grid.410370.10000 0004 4657 1992Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA
| | - Douglas E. Williamson
- grid.412100.60000 0001 0667 3730Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, NC USA ,grid.512153.1Durham VA Health Care System, Durham, NC USA
| | - Terence M. Keane
- grid.189504.10000 0004 1936 7558Department of Psychiatry, Boston University School of Medicine, Boston, MA USA ,grid.410370.10000 0004 4657 1992National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA USA
| | - Alan L. Peterson
- grid.267309.90000 0001 0629 5880Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX USA ,grid.280682.60000 0004 0420 5695Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX USA ,grid.215352.20000000121845633Department of Psychology, University of Texas at San Antonio, San Antonio, TX USA
| | - John H. Krystal
- grid.418356.d0000 0004 0478 7015National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT USA ,grid.47100.320000000419368710Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Abdallah CG, Roache JD, Gueorguieva R, Averill LA, Young-McCaughan S, Shiroma PR, Purohit P, Brundige A, Murff W, Ahn KH, Sherif MA, Baltutis EJ, Ranganathan M, D'Souza D, Martini B, Southwick SM, Petrakis IL, Burson RR, Guthmiller KB, López-Roca AL, Lautenschlager KA, McCallin JP, Hoch MB, Timchenko A, Souza SE, Bryant CE, Mintz J, Litz BT, Williamson DE, Keane TM, Peterson AL, Krystal JH. Correction to: Dose-related effects of ketamine for antidepressant-resistant symptoms of posttraumatic stress disorder in veterans and active duty military: a double-blind, randomized, placebo-controlled multi-center clinical trial. Neuropsychopharmacology 2022; 47:1583-1584. [PMID: 35545665 PMCID: PMC9205895 DOI: 10.1038/s41386-022-01339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chadi G Abdallah
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA. .,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. .,Michael E. DeBakey VA Medical Center, Houston, TX, USA. .,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA. .,Core for Advanced Magnetic Resonance Imaging (CAMRI), Baylor College of Medicine, Houston, TX, USA.
| | - John D Roache
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Ralitza Gueorguieva
- Department of Biostatistics, School of Public Health, Yale University School of Medicine, New Haven, CT, USA
| | - Lynnette A Averill
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Paulo R Shiroma
- Minneapolis VA Medical Center and the Department of Psychiatry University of Minnesota, Minneapolis, MN, USA
| | - Prerana Purohit
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Antoinette Brundige
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - William Murff
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kyung-Heup Ahn
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Mohamed A Sherif
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Psychiatry and Human Behavior, and Carney Institute, Brown University; and Lifespan Physician Group, Providence, RI, USA
| | - Eric J Baltutis
- Minneapolis VA Medical Center and the Department of Psychiatry University of Minnesota, Minneapolis, MN, USA
| | - Mohini Ranganathan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Deepak D'Souza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brenda Martini
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Southwick
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Ismene L Petrakis
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rebecca R Burson
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Kevin B Guthmiller
- Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA.,Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Argelio L López-Roca
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Karl A Lautenschlager
- Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - John P McCallin
- Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Matthew B Hoch
- Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Alexandar Timchenko
- Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Sergio E Souza
- Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Charles E Bryant
- Department of Rehabilitation, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, Houston, TX, USA
| | - Jim Mintz
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Douglas E Williamson
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, NC, USA.,Durham VA Health Care System, Durham, NC, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.,National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Alan L Peterson
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - John H Krystal
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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3
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Beretta S, Versace A, Martini B, Viganò M, Diamanti S, Pini C, Paternò G, Carone D, Mariani J, Monza L, Riva M, Padovano G, Rossi E, Citerio G, Castoldi G, Padelli F, Giachetti I, Aquino D, Giussani C, Sganzerla EP, Ferrarese C. Head down tilt 15° in experimental intracerebral hemorrhage: a randomized noninferiority safety trial. Eur J Neurol 2020; 28:525-531. [PMID: 32986293 DOI: 10.1111/ene.14560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Head down tilt 15° (HDT15°), applied before recanalization, increases collateral flow and improves outcome in experimental ischemic stroke. For its simplicity and low cost, HDT15° holds considerable potential to be developed as an emergency treatment of acute stroke in the prehospital setting, where hemorrhagic stroke is the major mimic of ischemic stroke. In this study, we assessed safety of HDT15° in the acute phase of experimental intracerebral hemorrhage. METHODS Intracerebral hemorrhage was produced by stereotaxic injection of collagenase in Wistar rats. A randomized noninferiority trial design was used to assign rats to HDT15° or flat position (n = 64). HDT15° was applied for 1 h during the time window of hematoma expansion. The primary outcome was hematoma volume at 24 h. Secondary outcomes were mass effect, mortality, and functional deficit in the main study and acute changes of intracranial pressure, hematoma growth, and cardiorespiratory parameters in separate sets of randomized animals (n = 32). RESULTS HDT15° achieved the specified criteria of noninferiority for hematoma volume at 24 h. Mass effect, mortality, and functional deficit at 24 h showed no difference in the two groups. HDT15° induced a mild increase in intracranial pressure with respect to the pretreatment values (+2.91 ± 1.76 mmHg). HDT15° had a neutral effect on MRI-based analysis of hematoma growth and cardiorespiratory parameters. CONCLUSIONS Application of HDT15° in the hyperacute phase of experimental intracerebral hemorrhage does not worsen early outcome. Further research is needed to implement HDT15° as an emergency collateral therapeutic for acute stroke.
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Affiliation(s)
- S Beretta
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Neuroscience, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - A Versace
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - B Martini
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - M Viganò
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - S Diamanti
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - C Pini
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - G Paternò
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - D Carone
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - J Mariani
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - L Monza
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - M Riva
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - G Padovano
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - E Rossi
- Center of Biostatistics, Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - G Citerio
- Department of Intensive Care, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - G Castoldi
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - F Padelli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - I Giachetti
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - D Aquino
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - C Giussani
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Neuroscience, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - E P Sganzerla
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Neuroscience, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - C Ferrarese
- Laboratory of Experimental Stroke Research, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Neuroscience, ASST Monza, San Gerardo Hospital, Monza, Italy
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4
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Abdallah CG, Roache JD, Averill LA, Young-McCaughan S, Martini B, Gueorguieva R, Amoroso T, Southwick SM, Guthmiller K, López-Roca AL, Lautenschlager K, Mintz J, Litz BT, Williamson DE, Keane TM, Peterson AL, Krystal JH. Repeated ketamine infusions for antidepressant-resistant PTSD: Methods of a multicenter, randomized, placebo-controlled clinical trial. Contemp Clin Trials 2019; 81:11-18. [PMID: 30999057 DOI: 10.1016/j.cct.2019.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/04/2019] [Accepted: 04/13/2019] [Indexed: 10/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating disorder with limited medication treatment options. Recent reports have described the dearth of research on new drug development as a crisis in the pharmacotherapy of PTSD. There are only two PTSD medications approved by the U.S. Food and Drug Administration, and both are serotonergic antidepressants. Therefore, there is a tremendous need to identify more effective and more rapidly acting pharmacotherapies for PTSD that work through novel neural mechanisms. Pilot evidence and case reports provided preliminary evidence supporting the safety and utility of investigating the therapeutic effects of ketamine in PTSD. However, the efficacy of this drug for PTSD has not yet been tested in active duty military or veteran populations. Here, we report the design and methods of a study funded under the Consortium to Alleviate PTSD. The study is a multisite, placebo-controlled, double-blind, randomized clinical trial to examine the dose-related efficacy of ketamine, as compared to placebo, in producing a rapid and sustained reduction in PTSD symptomatology in veterans and active duty military populations with antidepressant-resistant PTSD. Approximately 198 eligible participants who meet criteria for PTSD will be randomized to the study drug (i.e., ketamine 0.5 mg/kg, ketamine 0.2 mg/kg, or placebo). The study drug will be administered intravenously twice per week for 4 weeks, followed by a 4-week follow-up period. This ongoing study is the only trial of therapeutic effects of ketamine for PTSD and the first placebo-controlled trial to determine the dose-related effects of repeated ketamine on PTSD.
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Affiliation(s)
- Chadi G Abdallah
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Lynnette A Averill
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Brenda Martini
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Ralitza Gueorguieva
- Department of Biostatistics, School of Public Health, Yale University School of Medicine, New Haven, CT, USA.
| | - Timothy Amoroso
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Steven M Southwick
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Kevin Guthmiller
- Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA.
| | - Argelio L López-Roca
- Department of Behavioral Health, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA.
| | - Karl Lautenschlager
- Department of Pain Management, Brooke Army Medical Center, Joint Base San Antonio - Fort Sam Houston, TX, USA.
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Brett T Litz
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Douglas E Williamson
- Duke University School of Medicine, Durham, NC, USA; Durham Veterans Affairs Medical Center, Durham, NC, USA.
| | - Terence M Keane
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA.
| | - John H Krystal
- National Center for PTSD, Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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5
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Akiki TJ, Averill CL, Wrocklage KM, Scott JC, Averill LA, Schweinsburg B, Alexander-Bloch A, Martini B, Southwick SM, Krystal JH, Abdallah CG. Topology of brain functional connectivity networks in posttraumatic stress disorder. Data Brief 2018; 20:1658-1675. [PMID: 30364328 PMCID: PMC6195053 DOI: 10.1016/j.dib.2018.08.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022] Open
Abstract
Here we present functional neuroimaging-based network data (focused on the default mode network) collected from a cohort of US Veterans with history of combat exposure, combined with clinical assessments for PTSD and other psychiatric comorbidities. The data has been processed and analyzed using several network construction methods (signed, thresholded, normalized to phase-randomized and rewired surrogates, functional and multimodal parcellation). An interpretation and discussion of the data can be found in the main NeuroImage article by Akiki et al. [51].
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Affiliation(s)
- Teddy J Akiki
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher L Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Kristen M Wrocklage
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Gaylord Specialty Healthcare, Department of Psychology, Wallingford, CT, United States
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Lynnette A Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brian Schweinsburg
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Aaron Alexander-Bloch
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brenda Martini
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Steven M Southwick
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - John H Krystal
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chadi G Abdallah
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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6
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Akiki TJ, Averill CL, Wrocklage KM, Scott JC, Averill LA, Schweinsburg B, Alexander-Bloch A, Martini B, Southwick SM, Krystal JH, Abdallah CG. Default mode network abnormalities in posttraumatic stress disorder: A novel network-restricted topology approach. Neuroimage 2018; 176:489-498. [PMID: 29730491 DOI: 10.1016/j.neuroimage.2018.05.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/15/2018] [Accepted: 05/01/2018] [Indexed: 01/23/2023] Open
Abstract
Disruption in the default mode network (DMN) has been implicated in numerous neuropsychiatric disorders, including posttraumatic stress disorder (PTSD). However, studies have largely been limited to seed-based methods and involved inconsistent definitions of the DMN. Recent advances in neuroimaging and graph theory now permit the systematic exploration of intrinsic brain networks. In this study, we used resting-state functional magnetic resonance imaging (fMRI), diffusion MRI, and graph theoretical analyses to systematically examine the DMN connectivity and its relationship with PTSD symptom severity in a cohort of 65 combat-exposed US Veterans. We employed metrics that index overall connectivity strength, network integration (global efficiency), and network segregation (clustering coefficient). Then, we conducted a modularity and network-based statistical analysis to identify DMN regions of particular importance in PTSD. Finally, structural connectivity analyses were used to probe whether white matter abnormalities are associated with the identified functional DMN changes. We found decreased DMN functional connectivity strength to be associated with increased PTSD symptom severity. Further topological characterization suggests decreased functional integration and increased segregation in subjects with severe PTSD. Modularity analyses suggest a spared connectivity in the posterior DMN community (posterior cingulate, precuneus, angular gyrus) despite overall DMN weakened connections with increasing PTSD severity. Edge-wise network-based statistical analyses revealed a prefrontal dysconnectivity. Analysis of the diffusion networks revealed no alterations in overall strength or prefrontal structural connectivity. DMN abnormalities in patients with severe PTSD symptoms are characterized by decreased overall interconnections. On a finer scale, we found a pattern of prefrontal dysconnectivity, but increased cohesiveness in the posterior DMN community and relative sparing of connectivity in this region. The DMN measures established in this study may serve as a biomarker of disease severity and could have potential utility in developing circuit-based therapeutics.
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Affiliation(s)
- Teddy J Akiki
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher L Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Kristen M Wrocklage
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Gaylord Specialty Healthcare, Department of Psychology, Wallingford, CT, USA
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Lynnette A Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Schweinsburg
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Brenda Martini
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Southwick
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - John H Krystal
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Chadi G Abdallah
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
Macrophage infiltration is frequent in the early stages of various proliferative eye disorders, including subretinal neovascularization. In this study, we set out to establish the origin of macrophages found in an animal model of laser-induced subretinal neovascularization. One primate received several intravenous injections of a colloidal carbon suspension. We then applied standard argon laser lesions to the retina of both eyes, which were enucleated eight days later and sectioned serially for histological examination. A quantitative estimate of carbon-laden and non-laden leukocytes was made based on morphological criteria. Mononuclear leukocytes accumulated in the laser lesions and the percentage of carbon-laden mononuclear leukocytes in relation to the total leukocyte number was higher in the extravascular area of the laser sites than in the systemic circulation. These findings indicate that the majority of mononuclear leukocytes that accumulate at the sites of laser lesions are derived from the systemic circulation.
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Affiliation(s)
- B Martini
- Department of Ophthalmology, Karolinska Hospital and Institute, Stockholm, Sweden
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Akiki TJ, Averill CL, Wrocklage KM, Schweinsburg B, Scott JC, Martini B, Averill LA, Southwick SM, Krystal JH, Abdallah CG. The Association of PTSD Symptom Severity with Localized Hippocampus and Amygdala Abnormalities. ACTA ACUST UNITED AC 2017; 1. [PMID: 28825050 PMCID: PMC5562232 DOI: 10.1177/2470547017724069] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background The hippocampus and amygdala have been repeatedly implicated in the
psychopathology of posttraumatic stress disorder (PTSD). While numerous
structural neuroimaging studies examined these two structures in PTSD, these
analyses have largely been limited to volumetric measures. Recent advances
in vertex-based neuroimaging methods have made it possible to identify
specific locations of subtle morphometric changes within a structure of
interest. Methods In this cross-sectional study, we used high-resolution magnetic resonance
imaging to examine the relationship between PTSD symptomatology, as measured
using the Clinician Administered PTSD Scale for the DSM-IV, and structural
shape of the hippocampus and amygdala using vertex-wise shape analyses in a
group of combat-exposed U.S. Veterans (N = 69). Results Following correction for multiple comparisons and controlling for age and
cranial volume, we found that participants with more severe PTSD symptoms
showed an indentation in the anterior half of the right hippocampus and an
indentation in the dorsal region of the right amygdala (corresponding to the
centromedial amygdala). Post hoc analysis using stepwise regression suggest
that among PTSD symptom clusters, arousal symptoms explain most of the
variance in the hippocampal abnormality, whereas reexperiencing symptoms
explain most of the variance in the amygdala abnormality. Conclusion The results provide evidence of localized abnormalities in the anterior
hippocampus and centromedial amygdala in combat-exposed U.S. Veterans
suffering from PTSD symptoms. This novel finding provides a more
fine-grained analysis of structural abnormalities in PTSD and may be
informative for understanding the neurobiology of the disorder.
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Affiliation(s)
- Teddy J Akiki
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher L Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Kristen M Wrocklage
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.,Gaylord Specialty Healthcare, Department of Psychology, Wallingford, Connecticut
| | - Brian Schweinsburg
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Brenda Martini
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Lynnette A Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Steven M Southwick
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - John H Krystal
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Chadi G Abdallah
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, Connecticut.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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9
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Wrocklage KM, Averill LA, Cobb Scott J, Averill CL, Schweinsburg B, Trejo M, Roy A, Weisser V, Kelly C, Martini B, Harpaz-Rotem I, Southwick SM, Krystal JH, Abdallah CG. Cortical thickness reduction in combat exposed U.S. veterans with and without PTSD. Eur Neuropsychopharmacol 2017; 27:515-525. [PMID: 28279623 PMCID: PMC5429865 DOI: 10.1016/j.euroneuro.2017.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/20/2017] [Accepted: 02/21/2017] [Indexed: 12/26/2022]
Abstract
We investigated the extent of cortical thinning in U.S. Veterans exposed to combat who varied in the severity of their posttraumatic stress disorder (PTSD) symptoms. In addition, we explored the neural correlates of PTSD symptom dimensions and the interactive effects of combat exposure and PTSD upon cortical thickness. Sixty-nine combat exposed Veterans completed high-resolution magnetic resonance imaging (MRI) scans to estimate cortical thickness. The Clinician Administered PTSD Scale (CAPS) and Combat Exposure Scale (CES) assessments were completed to measure current PTSD and historical combat severity, respectively. PTSD symptom dimensions (numbing, avoidance, reexperiencing, anxious arousal, and dysphoric arousal) were studied. Vertex-wise whole cerebrum analyses were conducted. We found widespread negative correlations between CAPS severity and cortical thickness, particularly within the prefrontal cortex. This prefrontal correlation remained significant after controlling for depression severity, medication status, and other potential confounds. PTSD dimensions, except anxious arousal, negatively correlated with cortical thickness in various unique brain regions. CES negatively correlated with cortical thickness in the left lateral prefrontal, regardless of PTSD diagnosis. A significant interaction between CES and PTSD diagnosis was found, such that CES negatively correlated with cortical thickness in the non-PTSD, but not in the PTSD, participants. The results underscore the severity of cortical thinning in U.S. Veterans suffering from high level of PTSD symptoms, as well as in Veterans with no PTSD diagnosis but severe combat exposure. The latter finding raises considerable concerns about a concealed injury potentially related to combat exposure in the post-9/11 era.
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Affiliation(s)
- Kristen M Wrocklage
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Lynnette A Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - J Cobb Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Christopher L Averill
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brian Schweinsburg
- Department of Psychiatry, University of Connecticut Medical Center, Farmington, CT, United States
| | - Marcia Trejo
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Alicia Roy
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Valerie Weisser
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Kelly
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Brenda Martini
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Ilan Harpaz-Rotem
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Steven M Southwick
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - John H Krystal
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Chadi G Abdallah
- National Center for PTSD - Clinical Neurosciences Division, US Department of Veterans Affairs, West Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
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10
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Wisco BE, Marx BP, May CL, Martini B, Krystal JH, Southwick SM, Pietrzak RH. Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study. Depress Anxiety 2017; 34:340-347. [PMID: 28370818 DOI: 10.1002/da.22614] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/31/2017] [Accepted: 02/17/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Combat exposure is associated with increased risk of mental disorders and suicidality. Moral injury, or persistent effects of perpetrating or witnessing acts that violate one's moral code, may contribute to mental health problems following military service. The pervasiveness of potentially morally injurious events (PMIEs) among U.S. combat veterans, and what factors are associated with PMIEs in this population remains unknown. METHODS Data were analyzed from the National Health and Resilience in Veterans Study (NHRVS), a contemporary and nationally representative survey of a population-based sample of U.S. veterans, including 564 combat veterans, collected September-October 2013. Types of PMIEs (transgressions by self, transgressions by others, and betrayal) were assessed using the Moral Injury Events Scale. Psychiatric and functional outcomes were assessed using established measures. RESULTS A total of 10.8% of combat veterans acknowledged transgressions by self, 25.5% endorsed transgressions by others, and 25.5% endorsed betrayal. PMIEs were moderately positively associated with combat severity (β = .23, P < .001) and negatively associated with white race, college education, and higher income (βs = .11-.16, Ps < .05). Transgressions by self were associated with current mental disorders (OR = 1.65, P < .001) and suicidal ideation (OR = 1.67, P < .001); betrayal was associated with postdeployment suicide attempts (OR = 1.99, P < .05), even after conservative adjustment for covariates, including combat severity. CONCLUSIONS A significant minority of U.S combat veterans report PMIEs related to their military service. PMIEs are associated with risk for mental disorders and suicidality, even after adjustment for sociodemographic variables, trauma and combat exposure histories, and past psychiatric disorders.
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Affiliation(s)
- Blair E Wisco
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC
| | - Brian P Marx
- U.S. Department of Veterans Affairs National Center for PTSD, VA Boston Healthcare System, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Casey L May
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC
| | - Brenda Martini
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - John H Krystal
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - Steven M Southwick
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for PTSD, VA Connecticut Healthcare System, CT, USA
- Department of Psychiatry, Yale University School of Medicine, West Haven, CT, USA
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11
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Abdallah CG, Wrocklage KM, Averill CL, Akiki T, Schweinsburg B, Roy A, Martini B, Southwick SM, Krystal JH, Scott JC. Anterior hippocampal dysconnectivity in posttraumatic stress disorder: a dimensional and multimodal approach. Transl Psychiatry 2017; 7:e1045. [PMID: 28244983 PMCID: PMC5545643 DOI: 10.1038/tp.2017.12] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/30/2016] [Indexed: 02/07/2023] Open
Abstract
The anterior hippocampus (aHPC) has a central role in the regulation of anxiety-related behavior, stress response, emotional memory and fear. However, little is known about the presence and extent of aHPC abnormalities in posttraumatic stress disorder (PTSD). In this study, we used a multimodal approach, along with graph-based measures of global brain connectivity (GBC) termed functional GBC with global signal regression (f-GBCr) and diffusion GBC (d-GBC), in combat-exposed US Veterans with and without PTSD. Seed-based aHPC anatomical connectivity analyses were also performed. A whole-brain voxel-wise data-driven investigation revealed a significant association between elevated PTSD symptoms and reduced medial temporal f-GBCr, particularly in the aHPC. Similarly, aHPC d-GBC negatively correlated with PTSD severity. Both functional and anatomical aHPC dysconnectivity measures remained significant after controlling for hippocampal volume, age, gender, intelligence, education, combat severity, depression, anxiety, medication status, traumatic brain injury and alcohol/substance comorbidities. Depression-like PTSD dimensions were associated with reduced connectivity in the ventromedial and dorsolateral prefrontal cortex. In contrast, hyperarousal symptoms were positively correlated with ventromedial and dorsolateral prefrontal connectivity. We believe the findings provide first evidence of functional and anatomical dysconnectivity in the aHPC of veterans with high PTSD symptomatology. The data support the putative utility of aHPC connectivity as a measure of overall PTSD severity. Moreover, prefrontal global connectivity may be of clinical value as a brain biomarker to potentially distinguish between PTSD subgroups.
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Affiliation(s)
- C G Abdallah
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs or Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151E West Haven, CT 06516, USA. E-mail:
| | - K M Wrocklage
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - C L Averill
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - T Akiki
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - B Schweinsburg
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - A Roy
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - B Martini
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - S M Southwick
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J H Krystal
- Clinical Neurosciences Division, VA National Center for PTSD, US Department of Veterans Affairs, West Haven, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - J C Scott
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,VISN4 Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA, USA
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12
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Campo G, Papale A, Baldasseroni A, Di Leone G, Magna B, Martini B, Mattioli S. The surveillance of occupational diseases in Italy: the MALPROF system. Occup Med (Lond) 2015; 65:632-7. [DOI: 10.1093/occmed/kqv167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Casiglia E, Tikhonoff V, Boschetti G, Bascelli A, Saugo M, Guglielmi G, Caffi S, Rigoni G, Giordano N, Grasselli C, Martini B, Mazza A, Lazzari FD, Palatini P. The C825T GNB3 polymorphism, independent of blood pressure, predicts cerebrovascular risk at a population level. Am J Hypertens 2012; 25:451-7. [PMID: 22258330 DOI: 10.1038/ajh.2011.257] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The role of C825T polymorphism of the candidate GNB3 gene in predicting cerebrovascular outcome has been poorly explored in longitudinal setting at a population level. METHODS In an epidemiological setting, 1,678 men and women from general population were genotyped for C825T polymorphism of GNB3 gene and follow-up for 10 years to detect nonfatal and fatal cerebrovascular events (CE). Established cerebrovascular risk factors were used to adjust the multivariate Cox analysis for confounders. RESULTS Seventy-three nonfatal and 30 fatal CE were recorded. Incidence of CE was higher in TT than in C-carriers (fatal: 2.6 vs. 1.7%, P < 0.03; nonfatal: 7.8 vs. 3.9%, P < 0.03; fatal recurrences: 1.6 vs. 0.6%, P < 0.03). In Cox analysis, the TT genotype predicted nonfatal (hazard ratio 1.99, 95% confidence interval 1.05-3.79, P = 0.03), fatal (2.91, 1.05-8.12, P = 0.04), and fatal recurrent CE (6.82, 1.50-31.1, P = 0.02) also after adjustment for age, gender, systolic and diastolic blood pressure, body adiposity, atherogenetic blood lipids, serum uric acid, diabetes, calories, caffeine and ethanol intake, and coronary events at baseline. Further adjustment for historical CE made the association between TT genotype and incident fatal CE nonsignificant (hazard ratio 2.72, 95% confidence interval 0.96-7.22, P = 0.06). CONCLUSIONS The TT genotype of GNB3 gene predicts incident CE independent of blood pressure and other established risk factors at a population level. Further studies are needed to clarify the nature and pathways of this association.
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14
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Casiglia E, Tikhonoff V, Caffi S, Bascelli A, Guglielmi F, Mazza A, Martini B, Saugo M, D'Este D, Masiero S, Guidotti F, Boschetti G, Schiavon L, Spinella P, de Kreutzenberg SV, De Lazzari F, Pessina AC. Glycaemic fall after a glucose load. A population-based study. Nutr Metab Cardiovasc Dis 2010; 20:727-733. [PMID: 19822409 DOI: 10.1016/j.numecd.2009.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/24/2009] [Accepted: 06/30/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS A blood glucose (BG) fall after an oral glucose load has never been described previously at a population level. This study was aimed at looking for a plasma glucose trend after an oral glucose load for possible blood glucose fall if any, and for its impact on coronary mortality at a population level. METHODS AND RESULTS In subjects from an unselected general population, BG and insulin were detected before and 1 and 2h after a 75-g oral glucose load for insulin sensitivity and β-cell function determination. Blood pressure, blood examinations and left ventricular mass were measured, and mortality was monitored for 18.8±7.7 years. According to discriminant analysis, the population was stratified into cluster 0 (1-h BG < fasting BG; n=497) and cluster 1 (1-h BG ≥ fasting BG; n=1733). To avoid any interference of age and sex, statistical analysis was limited to two age-gender-matched cohorts of 490 subjects from each cluster (n=940). Subjects in cluster 0 showed significantly higher insulin sensitivity and β-cell function, lower visceral adiposity and lower blood pressure values. Adjusted coronary mortality was 8 times lower in cluster 0 than 1 (p<0.001). The relative risk of belonging to cluster 1 was 5.40 (95% CI 2.22-13.1). CONCLUSION It seems that two clusters exist in the general population with respect to their response to an oral glucose load, independent of age and gender. Subjects who respond with a BG decrease could represent a privileged sub-population, where insulin sensitivity and β-cell function are better, some risk factors are less prevalent, and coronary mortality is lower.
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Affiliation(s)
- E Casiglia
- Department of Clinical and Experimental Medicine, Chair of Internal Medicine, University of Padova, Padova, Italy.
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Martini B. The ajmaline challenge and a strange ECG. Europace 2009; 11:1406; author reply 1406-7. [DOI: 10.1093/europace/eup224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Cynomolgus monkeys were injected intravitreally with a colloidal suspension of carbon microparticles (size 20-70 nm) under aseptic surgical conditions. An intravitreal cellular proliferation occurred, inducing retinal detachment and neovascularization that started from the optic nerve head, ciliary body and ora serrata. Transmission electron microscopy revealed the features of the intravitreal cellular response to be inflammatory cells, mononuclear phagocytes (the predominant cell type), and fibroblasts. Newly-formed collagen fibrils (banding 70 nm) were found in the vitreous. The newly-formed vasculature generally showed continuous endothelial lining, but some intravitreal cellular proliferation is primarily a macrophagic response. We suggest that mononuclear phagocytes play a major role by triggering the collagen formation and neovascularization in the vitreous.
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Baldelli M, Pradelli J, Zucchi P, Martini B, Orsi F, Fabbo A. Occupational therapy and dementia: The experience of an Alzheimer special care unit. Arch Gerontol Geriatr 2007; 44 Suppl 1:49-54. [DOI: 10.1016/j.archger.2007.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Casali C, Valente EM, Bertini E, Montagna G, Criscuolo C, De Michele G, Villanova M, Damiano M, Pierallini A, Brancati F, Scarano V, Tessa A, Cricchi F, Grieco GS, Muglia M, Carella M, Martini B, Rossi A, Amabile GA, Nappi G, Filla A, Dallapiccola B, Santorelli FM. Clinical and genetic studies in hereditary spastic paraplegia with thin corpus callosum. Neurology 2004; 62:262-8. [PMID: 14745065 DOI: 10.1212/wnl.62.2.262] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A complicated form of recessive hereditary spastic paraplegias (HSPs) with thin corpus callosum (TCC) was first described in Japan, and most of the Japanese families showed linkage to chromosome 15q13-15. A recessive HSP locus (SPG11) has also been mapped to chromosome 15q13-15 in Italian and North American families with and without TCC, and it overlaps the region identified in the Japanese families. OBJECTIVE To study clinically and genetically 12 Italian families with HSP and TCC. METHODS The authors investigated 18 affected and 30 healthy individuals from 12 unrelated Italian families with recessive HSP-TCC. Clinical, neurophysiologic, and neuroradiologic studies were undertaken. All patients were negative for SPG7 mutations. Genetic linkage analyses were carried out with polymorphic DNA markers on 15q13-15. RESULTS Five families were consistent with linkage, thus defining a 19.8-cM region between markers D15S1007 and D15S978, encompassing the SPG11 interval. In one consanguineous family, linkage could be firmly excluded, confirming genetic heterogeneity. Two families appeared not linked to the region, but this could not be firmly proved because of the small family size. The remaining four families were uninformative for linkage purposes. CONCLUSION HSP-TCC is common in Italy. The phenotype is fairly homogeneous and is associated with impaired cognition. There are at least two loci for HSP-TCC, one of which is on chromosome 15q13-15.
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Affiliation(s)
- C Casali
- Department of Neurology and ORL, La Sapienza University, Rome, Italy.
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19
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Nava A, Cannas S, Martini B. More evidence-based data are required for a consensus on the aetiology of the so-called Brugada Syndrome. Eur Heart J 2003; 24:2072; author reply 2072-3. [PMID: 14613748 DOI: 10.1016/j.ehj.2003.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Cupini LM, Massa R, Floris R, Manenti G, Martini B, Tessa A, Nappi G, Bernardi G, Santorelli FM. Migraine-like disorder segregating with mtDNA 14484 Leber hereditary optic neuropathy mutation. Neurology 2003; 60:717-9. [PMID: 12601121 DOI: 10.1212/01.wnl.0000048662.77572.fb] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The authors report neurologic features in a large family harboring the mitochondrial DNA (mtDNA) mutation T14484C associated with Leber hereditary optic neuropathy (LHON). In the maternal line the mtDNA mutation was associated with optic neuropathy or migraine with aura or without aura and transient neurologic/visual disturbances. The segregation of familiar cases of migraine and LHON mutation broadens the clinical phenotype associated with a primary LHON mutation.
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Affiliation(s)
- L M Cupini
- Clinica Neurologica, Ospedale S. Eugenio, Università di Roma Tor Vergata, Rome, Italy.
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Siciliano G, Tessa A, Petrini S, Mancuso M, Bruno C, Grieco GS, Malandrini A, DeFlorio L, Martini B, Federico A, Nappi G, Santorelli FM, Murri L. Autosomal dominant external ophthalmoplegia and bipolar affective disorder associated with a mutation in the ANT1 gene. Neuromuscul Disord 2003; 13:162-5. [PMID: 12565915 DOI: 10.1016/s0960-8966(02)00221-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The authors report on a family with dominantly inherited progressive external ophthalmoplegia and a diagnostic and statistical manual (fourth revised edition) diagnosis of bipolar psychiatric disorder in several members. Skeletal muscle biopsy from the proposita showed decreased cytochrome c oxidase staining, several ragged-red fibers, and multiple mtDNA deletions. The authors identified a missense mutation (leucine 98-->proline) in the adenine nucleotide translocator 1 gene. The presence of bipolar affective disorder expands the phenotype of adenine nucleotide translocator 1 allelic variants.
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Affiliation(s)
- G Siciliano
- Neurological Institute, University of Pisa, Pisa, Italy
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22
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Martini B, Grieco GS, Fortini D, Costa A, Nappi G, Santorelli FM. Heterogeneity in migraine: many genes for many phenotypes? Funct Neurol 2002; 16:63-7. [PMID: 11996532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- B Martini
- IRCCS C. Mondino Institute of Neurology, Laboratory of Molecular Neurobiology, Mondino--Tor Vergata--S. Lucia Center of Experimental Neurobiology, Rome, Italy
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Naccarella F, Naccarelli G, Fattori R, Nava A, Martini B, Corrado D, Masotti A, Gatti M. Arrhythmogenic right ventricular dysplasia: cardiomyopathy current opinions on diagnostic and therapeutic aspects. Curr Opin Cardiol 2001; 16:8-16. [PMID: 11124713 DOI: 10.1097/00001573-200101000-00002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Right Ventricular Dysplasia constitutes a genetic cardiomyopathy characterized by fibrous-adipose substitution of the right and rarely of the left ventricular myocardium. This disorder is associated with ventricular arrhythmias ranging from frequent ventricular ectopic beats, nonsustained and sustained ventricular tachycardia of left bundle branch morphology and sudden death. Therefore, the syndrome has been labelled Arrhythmogenic RVD Cardiomyopathy. Diagnostic criteria, preliminary genetic data, and clinical manifestations are summarized and critical addressed, using data from the literature and from our own experience. The most important aspects of the ECG in this syndrome are reviewed and stressed with particular attention to initial versus advanced clinical subsets. The typical anatomical abnormalities and biopsy or pathology material are presented.
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Affiliation(s)
- F Naccarella
- Cardiology Azienda USL Città di Bologna, Italy; Penn State University, Cardiology Hershey PA, USA
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Tessa A, Manca ML, Mancuso M, Renna MR, Murri L, Martini B, Santorelli FM, Siciliano G. Abnormal H-Tfam in a patient harboring a single mtDNA deletion. Funct Neurol 2000; 15:211-4. [PMID: 11213524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We report on a patient suffering from a progressive mitochondrial disorder characterized by ocular myopathy, exercise intolerance, and muscle wasting. Morphological examination of muscle biopsy showed increased variability in fiber size and scattered ragged-red fibers. Analysis of muscle mitochondrial DNA by Southern blot and PCR revealed a heteroplasmic single deletion of 4100 base pairs, located between nucleotide positions 8300 and 12,400. Western blot analysis showed high levels of the human mitochondrial transcription factor A (Tfam). Interestingly, we also detected an additional Tfam product, of approximately 22 kDa. This is the first case in which a qualitatively abnormal Tfam has been found to be associated with a mitochondrial disorder in humans.
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Affiliation(s)
- A Tessa
- Department of Neurosciences, Institute of Neurology, University of Pisa
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Tarantini G, Menti L, Angelini A, Martini B, Thiene G, Daliento L. Life-threatening ventricular arrhythmias associated with giant cell myocarditis (possibly sarcoidosis). Am J Cardiol 2000; 85:1280-2. [PMID: 10802022 DOI: 10.1016/s0002-9149(00)00749-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- G Tarantini
- Department of Cardiology, University of Padua, Italy
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Picherit C, Coxam V, Oudadesse H, Martini B, Gaumet N, Davicco MJ, Lebecque P, Miller S, Irrigaray JL, Barlet JP. Dihydrotestosterone prevents glucocorticoid-negative effects on fetal rat metatarsal bone in vitro. Biol Neonate 2000; 77:181-90. [PMID: 10729722 DOI: 10.1159/000014214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effects of dihydrotestosterone (DHT) on glucocorticoid-pretreated fetal rat long bone were studied in an in vitro culture system. First, dose-response curves of corticosterone, hydrocortisone, and dexamethasone were studied at several concentrations. Then, hydrocortisone (H) at 10(-5) M was selected for the second part of the study, as it slackened rudiment mineralization (104 +/- 16% of the initial dark zone vs. 141 +/- 9% in control bones), as well as its lengthening (140 +/- 4% of the harvesting day length vs. 160 +/- 1% in control bones), by both inhibition of cell proliferation and stimulation of resorption. On the contrary, in H-pretreated metatarsal bones, DHT (10(-7) M) partly limited slackening of mineralization (124 +/- 5%) and lengthening (153 +/- 2%). Moreover, a control-like cell proliferation was re-established and resorption holes were filled in. Thus, in this study, DHT partly limited hydrocortisone-induced impairment of fetal rat metatarsal bone development.
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Affiliation(s)
- C Picherit
- INRA Clermont/Theix, Saint-Genès-Champanelle, France
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Abstract
The aim of our study was to analyze how the clinical history and the main clinical characteristics of patients suffering from loss of consciousness may influence the results of the upright tilt test. A series of 745 patients (333 males, 412 females; mean age 44 +/- 18 years) with recurrent episodes of syncope or presyncope underwent complete clinical and noninvasive laboratory examination, including vagal maneuvers and upright tilt test (60 degrees for 45 min). Cardiological and neurological findings were normal in every case. Upright tilt test was positive in 462 patients (62%). Patients with presyncope showed a lower positivity compared to patients with syncope (70.2% vs 42.9%, P < 0.001). Younger patients (< 25 years) displayed highest upright tilt test positivity (68.5%), while familial occurrence of syncope or presyncope, results of vagal maneuvers, and different gender did not correlate with the results of the test. The time interval between the last syncopal episode and the day of upright tilt test negatively influenced the proportion of positive tests (> 30 days = 45.1% vs < 30 days = 77.2%; P < 0.001). Patients with more than three syncopal episodes in the 2 months preceding the test showed a higher upright tilt test positivity (83.9% vs 64.5%, P < 0.001). In conclusion, upright tilt test seems to be more sensitive in young patients with syncopal episodes during symptomatic periods. These findings suggest both an individual and temporal variability in autonomic nervous system activity, the implication of which are relevant to the indications for testing as well as the analysis of results.
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Affiliation(s)
- A F Folino
- Department of Cardiology, University of Padua, Italy
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Corrado D, Nava A, Buja G, Martini B, Fasoli G, Oselladore L, Turrini P, Thiene G. Familial cardiomyopathy underlies syndrome of right bundle branch block, ST segment elevation and sudden death. J Am Coll Cardiol 1996; 27:443-8. [PMID: 8557918 DOI: 10.1016/0735-1097(95)00485-8] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We sought to assess whether structural heart disease underlies the syndrome of right bundle branch block, persistent ST segment elevation and sudden death. BACKGROUND Ventricular fibrillation and sudden death may occur in patients with a distinctive electrocardiographic (ECG) pattern of right bundle branch block and persistent ST segment elevation in the right precordial leads. METHODS Sixteen members of a family affected by this syndrome underwent noninvasive cardiac evaluation, including electrocardiography, Holter ambulatory ECG monitoring, stress testing, echocardiography and signal-averaged electrocardiography; two patients had electrophysiologic and angiographic study. Endomyocardial biopsy was performed in one living patient, and postmortem examination, including study of the specialized conduction system, was performed in one victim of sudden death. RESULTS Five years before a fatal cardiac arrest, the proband had been resuscitated from sudden cardiac arrest due to recorded ventricular fibrillation. Serial ECGs showed a prolonged PR interval, right bundle branch block, left-axis deviation and persistent ST segment elevation in the right precordial leads, in the absence of clinical heart disease. Postmortem investigation disclosed right ventricular dilation and myocardial atrophy with adipose replacement of the right ventricular free wall as well as sclerotic interruption of the right bundle branch. A variable degree of right bundle branch block and upsloping right precordial ST segment was observed in seven family members; four of the seven had structural right ventricular abnormalities on echocardiography and late potentials on signal-averaged electrocardiography. A sib of the proband also had a prolonged HV interval, inducible ventricular tachycardia and fibrofatty replacement on endomyocardial biopsy. CONCLUSIONS An autosomal dominant familial cardiomyopathy, mainly involving the right ventricle and the conduction system, accounted for the ECG changes and the electrical instability of the syndrome.
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Affiliation(s)
- D Corrado
- Department of Pathology, University of Padua Medical School, Italy
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31
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Martini B, Basso C, Thiene G. Sudden death in mitral valve prolapse with Holter monitoring-documented ventricular fibrillation: evidence of coexisting arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 1995; 49:274-8. [PMID: 7649675 DOI: 10.1016/0167-5273(95)02294-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report the case of a 42-year-old female, affected by mitral valve prolapse and ventricular arrhythmias, who died suddenly from ventricular fibrillation recorded during Holter monitoring. The lethal arrhythmia initiated with late diastolic couplets followed by a ventricular tachycardia that eventually degenerated into ventricular fibrillation. The patient had experienced four orthostatic and stress-related syncopal episodes, associated with nausea and diaphoresis, and a positive tilt test. Holter monitoring documented ventricular arrhythmias, consisting of both isolated monomorphic and sporadic repetitive beats. Her standard ECG and exercise test were normal, but signal-averaged study findings were significantly positive. QT prolongation in the absence of arrhythmias was observed during the Valsalva manoeuvre and isoproterenol infusion. 2D echo showed a remarkable mitral valve prolapse without regurgitation and localized structural abnormalities of the right ventricle. Postmortem study confirmed mitral valve prolapse, and also disclosed pulmonary infundibulum dilatation, massive adipose infiltration of the right ventricular free wall, patchy fibrosis and scattered myocardial inflammatory infiltrates in the left ventricle; these features are all consistent with arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- B Martini
- Division of Cardiology, Civil Hospital, Thiene, Italy
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Bassan L, Martini B, Dalle Molle G, Rossi L. [Ventricular tachycardia secondary to myocardial contusion in an athlete: a clinical case report]. G Ital Cardiol 1995; 25:203-6. [PMID: 7642025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 22-year-old athlete complained of palpitations shortly after a chest trauma during a basket competition. His electrocardiogram showed a ventricular tachycardia of 250 beats per minute, reverted to sinus rhythm with a chest thump. Standard electrocardiogram was normal. The following days he had an enzymatic pattern consistent with acute myocardial infarction, and the echocardiogram evidentiated an apical hypokinesia with a mural thrombosis. The patient recovered completely; and 15 days after the acute event, a coronary arteriography and ventriculography did not revealed any abnormality.
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Affiliation(s)
- L Bassan
- Divisione di Cardiologia, Ospedale Civile di Thiene, VI
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Folino AF, Buja GF, Martini B, Miorelli M, Nava A. Prolonged cardiac arrest and complete AV block during upright tilt test in young patients with syncope of unknown origin--prognostic and therapeutic implications. Eur Heart J 1992; 13:1416-21. [PMID: 1396818 DOI: 10.1093/oxfordjournals.eurheartj.a060076] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study was to define the history and prognosis of 12 patients (8 males, 4 females) with syncope of unknown origin (5 to 15 episodes), who developed prolonged asystole or complete AV block during the upright tilt test (UTT). The mean age (+/- SD) of the patients was 29 +/- 7.4 years, and all had normal neurological and cardiological findings on evaluation. These patients were selected from a larger group of 92 cases with positive UTT out of a total of 136 subjects who were referred for recurrence of syncope. Neither clinical nor autonomic nervous system evaluation distinguished these 12 patients from those with positive UTT. Following UTT, therapy was initiated and consisted of transdermal scopolamine in four, disopyramide in two, and beta-blockers in four patients. During follow-up (mean, 17 +/- 5.4 months), four patients had recurrences but none experienced episodes of life-threatening syncope. These patients do not show an enhanced risk of sudden death, and drug therapy seems to improve their clinical course. Only long-term follow-up would correctly identify a subgroup at higher risk.
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Affiliation(s)
- A F Folino
- Department of Cardiology, University of Padova, Italy
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Rosen MI, Bridge TP, O'Malley SS, Pearsall HR, Martini B, O'Connor PG, Brett-Smith H, Thomas HM, van Dyck CH, Woods SW, Kosten TR. Peptide T Treatment of Cognitive Impairment in HIV-Positive Intravenous Drug Users. Am J Addict 1992. [DOI: 10.1111/j.1521-0391.1992.tb00359.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nava A, Thiene G, Canciani B, Martini B, Daliento L, Buja G, Fasoli G. Clinical profile of concealed form of arrhythmogenic right ventricular cardiomyopathy presenting with apparently idiopathic ventricular arrhythmias. Int J Cardiol 1992; 35:195-206; discussion 207-9. [PMID: 1572740 DOI: 10.1016/0167-5273(92)90177-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 24 subjects presenting with apparently idiopathic ventricular arrhythmias, a final diagnosis of arrhythmogenic right ventricular cardiomyopathy was formulated following global evaluation of the clinical, cross-sectional echocardiography and angiographic findings, and the observation of myocardial atrophy with fibrous-fatty substitution in right ventricular endomyocardial biopsy. All patients had good effort tolerance, and a normal cardiac silhouette. Ventricular arrhythmias with a left bundle branch block pattern were present in 23 cases (sustained ventricular tachycardia, nonsustained ventricular tachycardia, ventricular couplets, and ventricular premature complexes); 1 patient experienced an episode of ventricular fibrillation. A nearly constant electrocardiographic feature was T wave negativity in the right precordial leads. Cross-sectional echocardiography and hemodynamic studies showed that right ventricular impairment consisted only of localized structural and dynamic abnormalities; in a few cases the left ventricle was segmentally involved. Familial occurrence was present in 29% of the cases. No case of sudden death was observed during follow-up. These findings confirm that the concealed form of arrhythmogenic right ventricular cardiomyopathy is a cause of so-called "idiopathic" ventricular arrhythmias in subjects with apparently "normal hearts". Echocardiographic and angiographic investigations may lead to the correct diagnosis.
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Affiliation(s)
- A Nava
- Department of Cardiology, University of Padua Medical School, Italy
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Canciani B, Nava A, Toso V, Martini B, Thiene G. A casual spontaneous mutation as possible cause of the familial form of arrhythmogenic right ventricular cardiomyopathy (arrhythmogenic right ventricular dysplasia). Clin Cardiol 1992; 15:217-9. [PMID: 1551270 DOI: 10.1002/clc.4960150314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
In a family affected by arrhythmogenic right ventricular cardiomyopathy (ARVC) the familial occurrence was investigated. All 14 members of two generations were investigated carefully, and only 2 (father and one son) members were affected. Both subjects had a massive form of the disease with relevant ventricular arrhythmias. Apart from the limitations of having investigated few subjects, this behavior suggests a genetic mutation appearing in the father and transmitted via an autosomal dominant trait.
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Affiliation(s)
- B Canciani
- Department of Cardiology, Medical School, Padua University, Italy
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Martini B, Pandey R, Ogden TE, Ryan SJ. Cultures of human retinal pigment epithelium. Modulation of extracellular matrix. Invest Ophthalmol Vis Sci 1992; 33:516-21. [PMID: 1544780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The extracellular matrix of retinal pigment epithelial (RPE) cells is an important component of the fibroelastic membranes formed in proliferative vitreoretinopathy (PVR). These membranes consist of cells intermingled with fibrillar proteins, such as elastin and collagen. Because RPE cells may be exposed to vitreous and serum-derived factors in conditions that lead to PVR, the effects of vitreous and serum on the deposition of fibrillar proteins by RPE cells were studied using radioactive labeling and indirect immunofluorescence techniques. The RPE cells, modulated by combined vitreous and serum into a fibrocytic-like appearance, deposited less fibroelastic proteins per cell. However, as a result of simultaneous cell proliferation, the total deposition of fibroelastic proteins per culture was increased. Indirect immunofluorescence studies suggest that it is type I collagen that is altered in the matrix of these modulated cell cultures. This information is important in pathologic conditions characterized by intraocular cell proliferation and fibroelastic membrane formation; these phenomena are seen in many vitreoproliferative disorders.
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Affiliation(s)
- B Martini
- Department of Ophthalmology (Doheny Eye Institute), University of Southern California School of Medicine, Los Angeles 90033
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Rosen MI, Bridge TP, O'Malley SS, Pearsall HR, Martini B, O'Connor PG, Brett-Smith H, Thomas HM, van Dyck CH, Woods SW, Kosten TR. Peptide T Treatment of Cognitive Impairment in HIV-Positive Intravenous Drug Users. Am J Addict 1992. [DOI: 10.3109/10550499208993153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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40
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Canciani B, Nava A, Martini B, Buja G. Arrhythmia development in a young subject with right ventricular cardiomyopathy (right ventricular dysplasia). Jpn Heart J 1991; 32:403-8. [PMID: 1920827 DOI: 10.1536/ihj.32.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In right ventricular cardiomyopathy the relationship between the progression of structural abnormalities and arrhythmia development is not yet well known. This report describes a case in which severe ventricular arrhythmias appeared 3 years after the demonstration of right ventricular (RV) structural and dynamic abnormalities. In this interval of time structural changes were not detectable with the commonly used diagnostic methods, but endocavitary RV late fractionated QRS potentials appeared suggesting the development of an arrhythmic component of the disease.
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Affiliation(s)
- B Canciani
- Department of Cardiology, University of Padua, Medical School, Italy
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41
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Martini B, Wang HM, Lee MB, Ogden TE, Ryan SJ, Sorgente N. Synthesis of extracellular matrix by macrophage-modulated retinal pigment epithelium. Arch Ophthalmol 1991; 109:576-80. [PMID: 2012562 DOI: 10.1001/archopht.1991.01080040144046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In proliferative vitreoretinopathy, macrophages and retinal pigment epithelial cells are associated with microfibrillar matrix proteins in the vitreous cavity, but the contribution of this extracellular matrix to the pathophysiology is not known. We used radiolabeling techniques on cultured human retinal pigment epithelial cells to correlate the secretion of extracellular matrix proteins with macrophage-induced modulation of cell proliferation and morphologic features. Retinal pigment epithelial cells incubated in a macrophage-conditioned medium assumed fibrocytelike morphologic characteristics, grew faster, and exhibited a decreased cellular release of fibrillar and nonfibrillar matrix components. However, due to a simultaneous greater increase in cell numbers in these modulated cultures, the total production of fibrillar and nonfibrillar matrix components by the culture population was increased.
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Affiliation(s)
- B Martini
- Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles 90033
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42
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Martini B, Nava A. Electrophysiological features and the clinical follow-up of patients affected by ventricular tachycardias. Pacing Clin Electrophysiol 1991; 14:245. [PMID: 1706511 DOI: 10.1111/j.1540-8159.1991.tb05097.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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43
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Buja G, Canciani B, Martini B, Scognamiglio R, Corrado D, Nava A. Coexistence of kent accessory pathway, enhanced AV node conduction, and various conduction disturbances in a young athlete with tricuspid valve dysplasia. J Electrocardiol 1991; 24:71-6. [PMID: 2056270 DOI: 10.1016/0022-0736(91)90083-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An asymptomatic 19-year-old top-level athlete had electrocardiographic evidence of intermittent cardiac preexcitation and intermittent left bundle branch block. The electrophysiologic study demonstrated the presence of a direct accessory pathway and enhanced atrioventricular node conduction that resulted in infrahisian and intraventricular conduction disturbances. The echocardiogram disclosed tricuspid valve dysplasia.
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Affiliation(s)
- G Buja
- Department of Cardiology, University of Padua, Medical School, Italy
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44
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Martini B, Bassan L, Della Valentina P, Valente M, Buja GF. [Unusual manifestations of Ebstein's disease in a 53 year old adult. Ebstein's disease in an adult]. Minerva Cardioangiol 1990; 38:345-7. [PMID: 2080025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
B.P., asymptomatic until her fifties, was admitted to hospital because of precordial pain. Her ECG and chest X rays were normal. When 52 she was again admitted, because of congestive heart failure. ECG showed repolarization abnormalities and chest X rays showed marked cardiomegaly. 2d echocardiogram was consistent with right atrial dilatation, dislodged posterior leaflet of the tricuspid valve and marked tricuspid regurgitation; these features were consistent with Ebstein anomaly. The patient was successfully treated by digitalis and diuretics. This case shows that in very rare cases this congenital heart disease can produce its clinical manifestations only late in lifetime.
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Affiliation(s)
- B Martini
- Cattedra di Cardiologia, Università di Padova
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45
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Canciani B, Buja G, Betto A, Schiavinato ML, Martini B, Miorelli M, Nava A. [Electro-vectorcardiographic study of ventricular extrasystole in arrhythmogenic dysplasia of the right ventricle]. Ann Cardiol Angeiol (Paris) 1990; 39:265-8. [PMID: 1695076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The morphology of ventricular extrasystole (VES) in 46 cases of arrhythmogenic dysplasia of the right ventricle (ADRV) was correlated with the point of origin located by intracavitary mapping. The cases concerned 41 of left bundle-branch block (LBB) with various axes on the frontal plane (FP), 4 of right bundle-branch block (RBB), and 5 of atypical morphology (frontal plane shifted inferiorly and increased R from V1 to V6; on the horizontal plane, clockwise rotation of the loop oriented anteriorly and leftward). There is a good correlation with the site of origin: VESs which were LBB in appearance originated in the right ventricle (apex, septum, infundibulum); VESs which were RBB in appearance originated in the apex of the left ventricle, while the atypical VESs started in the upper posterior septum. A study of morphology may therefore also give an indication of the location of the disease.
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Affiliation(s)
- B Canciani
- Cattedra di Cardiologia, Università di Padova, Italy
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46
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Martini B, Nava A, Thiene G, Buja G, Canciani B, Miraglia G, Scognamiglio R, Daliento L, Dalla Volta S. Monomorphic repetitive rhythms originating from the outflow tract in patients with minor forms of right ventricular cardiomyopathy. Int J Cardiol 1990; 27:211-21. [PMID: 2365509 DOI: 10.1016/0167-5273(90)90162-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We studied in detail 17 patients presenting with monomorphic repetitive ventricular rhythms having left bundle branch block morphology and right axis deviation. All had an apparently normal heart at physical examination. At chest radiography, three patients had mild cardiomegaly, and at electrocardiography, five patients had inverted T waves beyond V2. Five patients had syncope or near syncope. In seven patients the tachycardia occurred on effort. One patient died suddenly. The patients were extensively investigated, using cross-sectional echocardiography, complete haemodynamic and angiographic studies, electrophysiology and histology, to search for any structural basis of the arrhythmias. Tachycardia was sustained in 8 patients, nonsustained in 3, and consistent with accelerated idioventricular rhythm and repetitive paroxysmal ventricular tachycardia in 5 and 1 patients, respectively. Despite the differences in clinical and arrhythmologic features, similar abnormalities of right ventricular structure and/or wall motion were detected in all patients, consistent with localized forms of right ventricular cardiomyopathy. Different antiarrhythmic drugs were successfully used in twelve patients (the four patients with accelerated idioventricular rhythm were not treated). The patient who died suddenly had previously had a sustained ventricular tachycardia and was being treated by beta-blockade. Postmortem study revealed massive fibro-adipose substitution of the right ventricular free wall and pulmonary infundibulum.
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Affiliation(s)
- B Martini
- Department of Cardiology, University of Padua, Italy
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Martini B, Villanova C, Zanetti G, Bellotto F, Maddalena F. [Association of multiple risk factors for atherosclerosis, in absence of vascular lesions. Description of a case]. G Clin Med 1990; 71:221-2. [PMID: 2365170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- B Martini
- Cattedra di Cardiologis, Università di Padova
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Abstract
A P wave of 7.5 mm in lead I and 12.5 in V1 was detected in a 28-year-old man, with a progressive cardiomegaly since the age of 14 years. At last admission he had minor symptoms, and a systolic murmur consistent with tricuspid regurgitation. The electrocardiogram showed an extremely tall P wave and a QRS of a very low amplitude; T waves were inverted on the precordial leads. These ECG features, and subsequent investigations, were consistent with right ventricular cardiomyopathy with massive tricuspid regurgitation, and right atrial abnormality.
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Affiliation(s)
- B Martini
- Department of Cardiology, University of Padua, Italy
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49
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Rizzardo P, Nava A, Martini B, Buja G, Canciani B. [Arrhythmogenic myocardiopathy of the left ventricle: dynamic ECG. Morphologic data and age of the patient in the prediction of the onset of arrhythmic events]. Minerva Cardioangiol 1990; 38:3-9. [PMID: 2342645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 57 patients with arrhythmogenic right ventricular cardiomyopathy, 34 males 23 females, aged 5 to 60 average 27.93 years, arrhythmias recorded during the whole clinical history have been compared with the 24 hours ECG ambulatory monitoring data, age and anatomic extension of the disease. In 77.77% of patients with history of sustained ventricular tachycardia Holter monitoring showed Lown class less than or equal to 3 arrhythmias, in 75% of patients with ventricular fibrillation Holter monitoring showed no arrhythmias. 55.88% of patients whose Holter monitoring documented Lown class less than or equal to 3 arrhythmias had more severe arrhythmias in their history. There is not a close relation between Holter data and arrhythmias that occurred during the whole history; however, Holter monitoring is a useful tool in evaluating risk when it shows complex arrhythmias.
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Affiliation(s)
- P Rizzardo
- Cattedra di Cardiologia, Università degli Studi di Padova
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Martini B, Nava A, Thiene G, Buja GF, Canciani B, Scognamiglio R, Daliento L, Dalla Volta S. Ventricular fibrillation without apparent heart disease: description of six cases. Am Heart J 1989; 118:1203-9. [PMID: 2589161 DOI: 10.1016/0002-8703(89)90011-2] [Citation(s) in RCA: 216] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Since 1977, six patients (five males and one female), aged 14 to 35 years, resuscitated from ventricular fibrillation, were referred to our department for detailed evaluation, after exclusion of major cardiac pathologic conditions. Four patients had a family history of heart disease. Basic ECGs showed sinus rhythm in all of them. PR interval was prolonged in one. Two patients had complete and one had incomplete right bundle branch block. One patient had inverted t waves in V1-3 and late potentials. Three had an upsloping ST-T segment elevation in V1-2. The cardiothoracic index was less than 0.5 in five and 0.50 in one. In one of the five patients studied, the clinical episode of ventricular fibrillation was reproduced by stimulation of the right ventricular outflow tract during electrophysiologic study. Results of cross-sectional echocardiography and angiography showed predominantly structural and wall motion abnormalities of the right ventricle in five patients and slight wall motion abnormalities of the left ventricle in two. Two patients also had mitral and tricuspid valve prolapse. Coronary arteries were normal in all five patients examined. Results of endomyocardial biopsy showed no abnormalities in one patient, fibrosis in two, and fibrolipomatosis in one. Two patients died during follow-up: autopsy was performed in one and results showed right ventricular cardiomyopathy. Thus in five of these selected patients with apparent idiopathic ventricular fibrillation, some abnormalities, predominantly of the right ventricle, were documented only after detailed investigation; however, clinical history and some nonspecific ECG abnormalities were factors in the diagnostic procedure.
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Affiliation(s)
- B Martini
- Department of Cardiology, University of Padua, Italy
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