Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality

Circadian rhythms of body temperature, plasma cortisol, norepinephrine (NE), thyroid stimulating hormone (TSH), and melatonin were compared in 16 endogenously depressed, 15 recovered (after 3 weeks of anti-depressant treatment), and 16 normal subjects. The depressed patients showed clear circadian rhythm abnormalities, consisting mainly in amplitude reduction. This amplitude reduction was significantly correlated with the patients' Hamilton depression scores. Normal circadian profiles were restored after recovery when amplitude, in particular, was increased. Features of the circadian rhythms observed in remission may be associated with antidepressant drug effects, whereas those observed in depression resemble the circadian rhythms observed in normal subjects living under conditions of temporal isolation and those of blind subjects. Our findings suggest that depression may be related both to a weakening of the coupling processes between internal pacemakers and to an abnormal sensitivity to environmental information.

Randomized trial of hypotensive epidural anesthesia in older adults

BACKGROUND

Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients.

METHODS

This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement.

RESULTS

The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates.

CONCLUSIONS

Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.

Twenty-four-hour profiles of body temperature and plasma TSH in bipolar patients during depression and during remission and in normal control subjects

The 24-hour patterns of body temperature and plasma thyrotropin (TSH) were measured in eight bipolar patients in both depressed and recovered (after 3 weeks of treatment) states and in eight normal control subjects. Clear circadian patterns were detected for both temperature and TSH. Nocturnal body temperature was increased and the nocturnal surge of TSH was blunted during depression; these abnormalities were corrected after recovery. The inverse relationship between changes in body temperature and TSH levels at night suggests that changes in thermoregulation may be responsible for the neuroendocrine disturbance and may play a role in the pathophysiology of depression.

Titanium wear debris in failed cemented total hip arthroplasty. An analysis of 71 cases

Seventy-one cemented total hip arthroplasties (THAs) were reviewed following removal of the all-titanium alloy femoral stem. Fifty-one hips were primary arthroplasties that failed due to aseptic loosening, 8 were previous revisions with aseptic loosening, and 12 were removed for infection. The average duration of service for the three groups was 4.5 years, 5.0 years, and 3.7 years, respectively. Femoral bone loss in aseptically loose, primary THA was graded as severe in 51%, moderate in 24%, and mild in 20%. Femoral endosteolysis was present in 94%, while acetabular osteolysis was seen in 6%. Histological evaluation of tissues from failed primary arthroplasties revealed polymethyl methacrylate debris in 75% of cases, polyethylene debris in 80%, metal debris in 75%, and chronic inflammatory cells in all cases. Metallic debris was not seen in the failed revision cases and in only 17% of the infected cases. Examination of retrieved femoral components revealed burnishing of the head in all cases, while 71% of stems with aseptic loosening were abraded from the cement. Metal levels from 12 cases averaged 2,111 mg/g of dry tissue (range, 60-11,823); synovial fluid levels from 8 other cases averaged 106 mg/l (range, 22-340). While it is not certain whether metallic particles are a primary cause of loosening or are generated secondarily, their presence seems to accelerate bone loss and loosening.

Sigmoidoscopic examinations with rigid and flexible fiberoptic sigmoidoscopes in the surgeon's office: a comparative prospective study of effectiveness in 1,012 cases

The results obtained from 1,012 examinations in an on-going, cooperative study indicate that the overall yield provided by use of the flexible fiberoptic sigmoidoscope is 3.2 times greater than that of examinations with the rigid sigmoidoscope. More than twice (2.4 times) the number of polyps and more than three times the number of cancers were detected with the flexible fiberoptic sigmoidoscope. Experienced endoscopists can perform an examination with the flexible fiberoptic sigmoidoscope expeditiously in the office with minimal patient preparation, a high level of patient and physician acceptance, and relative safety when the usual mandatory colonoscopic precautions and guidelines are obeyed. The extraordinary advantages demonstrated by this study warrant wide clinical application of the flexible fiberoptic sigmoidoscope. We strongly recommend provision be made for appropriate training of physicians in the use of the instrument.

Seasonality of suicides: environmental, sociological and biological covariations

The monthly rates of completed suicides in France from 1978 until 1982 were analyzed. The seasonal variations of environmental (daylight and sunlight durations, mean temperature, geomagnetism), sociological (unemployment, deaths of all causes, birth and conception rates), and biological (melatonin, cortisol and serotonin circannual rhythms) factors were compared to the seasonal patterns of suicides. A clear seasonal variation (with peaks in May and September) in suicidal behavior was detected. These patterns tended to differ as a function of age (bimodal in young, unimodal in old people). The component analysis clearly pointed out that seasonal patterns of suicides may be considered as the sum of two components, unimodal and bimodal. Almost similar covariations were found between the main seasonal (unimodal) component of suicides and environmental (daylight duration and mean monthly temperature) or sociological factors whereas the secondary component was more correlated to variations in environmental factors and, to some extent, to biological parameters.

Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens

We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operative mortality and the cause of death using different thromboprophylactic regimens as follows: 1) no routine chemothromboprophylaxis (NRC); 2) Potent anticoagulation (PA) (unfractionated or low-molecular-weight heparin, ximelagatran, fondaparinux or rivaroxaban); 3) Potent anticoagulation combined (PAC) with regional anaesthesia and/or pneumatic compression devices (PCDs); 4) Warfarin (W); 5) Warfarin combined (WAC) with regional anaesthesia and/or PCD; and 6) Multimodal (MM) prophylaxis, including regional anaesthesia, PCDs and aspirin in low-risk patients. Cause of death was classified as autopsy proven, clinically certain or unknown. Deaths were grouped into cardiopulmonary excluding pulmonary embolism (PE), PE, bleeding-related, gastrointestinal, central nervous system, and others (miscellaneous). Meta-analysis based on fixed effects or random effects models was used for pooling incidence data. In all, 70 studies were included (99 441 patients; 373 deaths). The mortality was lowest in the MM (0.2%) and WC (0.2%) groups. The most frequent cause of death was cardiopulmonary (47.9%), followed by PE (25.4%) and bleeding (8.9%). The proportion of deaths due to PE was not significantly affected by the thromboprophylaxis regimen (PA, 35.5%; PAC, 28%; MM, 23.2%; and NRC, 16.3%). Fatal bleeding was higher in groups relying on the use of anticoagulation (W, 33.8%; PA, 9.4%; PAC, 10.8%) but the differences were not statistically significant. Our study demonstrated that the routine use of PA does not reduce the overall mortality or the proportion of deaths due to PE.

Searches for Lepton flavor violation in the decays tau{+/-}-->e{+/-}gamma and tau{+/-}-->mu{+/-}gamma

Searches for lepton-flavor-violating decays of a tau lepton to a lighter mass lepton and a photon have been performed with the entire data set of (963+/-7)x10{6} tau decays collected by the BABAR detector near the Upsilon(4S), Upsilon(3S) and Upsilon(2S) resonances. The searches yield no evidence of signals and we set upper limits on the branching fractions of B(tau{+/-}-->e{+/-}gamma)<3.3x10{-8} and B(tau{+/-}-->mu{+/-}gamma)<4.4x10{-8} at 90% confidence level.

Precise determination of the mass of the Higgs boson and tests of compatibility of its couplings with the standard model predictions using proton collisions at 7 and 8[Formula: see text]

Properties of the Higgs boson with mass near 125[Formula: see text] are measured in proton-proton collisions with the CMS experiment at the LHC. Comprehensive sets of production and decay measurements are combined. The decay channels include [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text] pairs. The data samples were collected in 2011 and 2012 and correspond to integrated luminosities of up to 5.1[Formula: see text] at 7[Formula: see text] and up to 19.7[Formula: see text] at 8[Formula: see text]. From the high-resolution [Formula: see text] and [Formula: see text] channels, the mass of the Higgs boson is determined to be [Formula: see text]. For this mass value, the event yields obtained in the different analyses tagging specific decay channels and production mechanisms are consistent with those expected for the standard model Higgs boson. The combined best-fit signal relative to the standard model expectation is [Formula: see text] at the measured mass. The couplings of the Higgs boson are probed for deviations in magnitude from the standard model predictions in multiple ways, including searches for invisible and undetected decays. No significant deviations are found.

Antidepressant effects of the sleep/wake cycle phase advance. Preliminary report

Five patients with endogenous depression were asked to participate in a phase-advance procedure consisting in advancing by 5 h the time schedule of the major external synchronizers such as light/dark, sleep/wake, meal time and social activity cycles. Clinical and biological parameters were observed throughout this 2-week process which followed one night of partial sleep deprivation. All patients improved with partial sleep deprivation and four of the five showed continuing remission during the phase-advance process. The antidepressant effects of the phase-advance process are discussed in light of different chronobiological models for depression.

Slipped capital femoral epiphyses complicating renal osteodystrophy: a report of three cases

Three adolescents with bilateral slipped capital femoral epiphyses complicating renal disease are presented. In one case, the severity of the deformities necessitated total hip replacement. Pathological specimens were available for evaluation. In all 3 cases, epiphysiolysis was accompanied by severe subperiosteal reabsorption along the medial aspect of the femoral neck, widening of the cartilaginous growth plate, and coxa vara. The radiographic diagnosis of a minimally displaced femoral epiphysis may precede the clinical symptoms. Early recognition of this complication is important, since the treatment of choice is prophylactic surgical stabilization before disabling deformities occur.

Observation of the diphoton decay of the Higgs boson and measurement of its properties

Observation of the diphoton decay mode of the recently discovered Higgs boson and measurement of some of its properties are reported. The analysis uses the entire dataset collected by the CMS experiment in proton-proton collisions during the 2011 and 2012 LHC running periods. The data samples correspond to integrated luminosities of 5.1[Formula: see text]at [Formula: see text] and 19.7[Formula: see text]at 8[Formula: see text] . A clear signal is observed in the diphoton channel at a mass close to 125[Formula: see text] with a local significance of [Formula: see text], where a significance of [Formula: see text] is expected for the standard model Higgs boson. The mass is measured to be [Formula: see text] , and the best-fit signal strength relative to the standard model prediction is [Formula: see text][Formula: see text][Formula: see text]. Additional measurements include the signal strength modifiers associated with different production mechanisms, and hypothesis tests between spin-0 and spin-2 models.

Study of the mass and spin-parity of the Higgs boson candidate via its decays to Z boson pairs

A study is presented of the mass and spin-parity of the new boson recently observed at the LHC at a mass near 125 GeV. An integrated luminosity of 17.3 fb(-1), collected by the CMS experiment in proton-proton collisions at center-of-mass energies of 7 and 8 TeV, is used. The measured mass in the ZZ channel, where both Z bosons decay to e or μ pairs, is 126.2 ± 0.6(stat) ± 0.2(syst) GeV. The angular distributions of the lepton pairs in this channel are sensitive to the spin-parity of the boson. Under the assumption of spin 0, the present data are consistent with the pure scalar hypothesis, while disfavoring the pure pseudoscalar hypothesis.