[Transdiagnostic study of impulsivity dimensions. Comparative analysis of impulsivity profiles in adult Attention Deficit Hyperactivity Disorder and Borderline Personality Disorder]

INTRODUCTION

High levels of impulsivity represent a core feature of various psychiatric conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), Impulse Control and Conduct Disorders, Bulimia Nervosa, Substance Use Disorders, and other maladaptive behaviors, like non-suicidal self-harm and suicidal behavior. The overall aim of our research is to carry out a trans-diagnostic study of impulsivity as a common behavioral risk factor, taking into consideration the different dimensions of impulsivity (motor, attentional, non-planning). The project investigates inhibitory neurocognitive deficits, electrophysiological correlates, childhood adversities and genetic vulnerability factors in the background of impulsivity.

METHODS

In this report, we describe the results of our pilot study which aims to compare impulsivity profiles, personality traits, and levels of aggression in patients with adult ADHD (aADHD) and BPD primary diagnoses, and healthy control subjects, based on self report questionnaires (Barratt Impulivity Scale, Cloninger Temperament and Character Inventory). We have also carried out analyses on the role of childhood adverse events in the background of impulsivity. Because of the predominance of female participants in the BPD group, we restrict our analyses to only female subjects (N=111 out of 152 patients overall).

RESULTS

Comparing the three groups significant differences were observed in each impulsivity domain: higher levels of attentional and motor impulsivity were present in aADHD, while non-planning impulsivity was more characteristic to BPD (p<0.001). Using the Cloninger Temperament and Character Inventory aADHD patients reached significant higher levels on six subscales (novelty seeking, harm avoidance, reward dependency, perseverance, selfdirection, cooperation) than BPD patients (p<001). Childhood emotional neglect results in higher levels of impulsivity in adulthood (R=0.54, p<0.001) regardless of diagnosis.

CONCLUSION

Impulsivity, as a diagnostic criterion of different psychiatric disorders is a heterogenous construct. Different characteristics of impulsivity are pronounced with respect to the condition it is part of. Studying impulsivity can improve our understanding of the etiology of different psychiatric conditions, which can result in more specific and effective therapeutic interventions.

Measuring Users' Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study

Background

Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice.

Objective

The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST).

Methods

Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework.

Results

A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution.

Conclusions

Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact.

Probabilistic sequence learning in mild cognitive impairment

Mild Cognitive Impairment (MCI) causes slight but noticeable disruption in cognitive systems, primarily executive and memory functions. However, it is not clear if the development of sequence learning is affected by an impaired cognitive system and, if so, how. The goal of our study was to investigate the development of probabilistic sequence learning, from the initial acquisition to consolidation, in MCI and healthy elderly control groups. We used the Alternating Serial Reaction Time task (ASRT) to measure probabilistic sequence learning. Individuals with MCI showed weaker learning performance than the healthy elderly group. However, using the reaction times only from the second half of each learning block—after the reactivation phase—we found intact learning in MCI. Based on the assumption that the first part of each learning block is related to reactivation/recall processes, we suggest that these processes are affected in MCI. The 24-h offline period showed no effect on sequence-specific learning in either group but did on general skill learning: the healthy elderly group showed offline improvement in general reaction times while individuals with MCI did not. Our findings deepen our understanding regarding the underlying mechanisms and time course of sequence acquisition and consolidation.

Basic HGF-like peptides inhibit generation of liver metastases in murine and human tumor models

PURPOSE

We have postulated that the peptide domain(s) of the heparin-binding cytokine(s) might have biological activity, which theoretically could be exploited for modulation of the biological behavior of cancer cells.

MATERIALS AND METHODS

We used HGF as a model heparin-binding cytokine and synthesized two HGF beta-chain domains, HHRGK (HGP1) and RYRNKH (HGP2), as well as four variants. As target cells, we used three cancer cell lines (HT25 human colonic, HT168-M1/9 human melanoma and 3LL-HH murine lung carcinoma) all characterized by strong liver metastatic potentials. The effects of peptides on cell proliferation, tumor growth and liver metastasis were evaluated.

RESULTS

All the basic penta- or hexapeptides exhibited similar antiproliferative effects in vitro in a dose range of 100-1000 ng/ml. Meanwhile, none of the HGP peptides exhibited significant antitumoral effects on the primary spleen tumors in the form of systemic treatment. However, systemic treatment with HGP1, but not with HGP2, applied at the early phase of the dissemination process, showed an inhibitory effect on liver metastatization of all the tumor lines studied. Furthermore, one out of the four hexapeptides, BP4 (KRKRKR), had similar activity.

CONCLUSION

Recent data on the antiangiogenic effects of these basic peptides partially explain the in vivo antimetastatic activity. We suggest the small basic penta-hexapeptides as a new class of biological response modifiers which can modulate the metastatic process.

Experimental and clinicopathologic studies on the function of the HGF receptor in human colon cancer metastasis

The organ-specific metastasis characterizes several human cancers, including colon carcinoma, a disease that frequently involves metastases in the liver. The data on the molecular mechanisms of liver metastasis would therefore be highly useful for prognostic purposes. Although the upregulation/amplification of the hepatocyte growth factor (HGF) receptor, c-met, has been frequently observed in colon cancer metastasis, the actual functional significance of the feature in the liver metastatization is not yet known. We have used three human colon carcinoma cell lines (HT29, HT25 and WiDr), characterized by different liver metastatic potentials in SCID mice, to analyze the expression of c-met and the biological effects of HGF. We found that HGF induces scattering in in vitro liver-metastatic cell lines (HT25 and WiDr) only at doses which are non-mitogenic (1-20 ng/ml). Analysis of the c-met expression revealed that the metastatic cell lines express authentic c-met gene and protein material, unlike the non-metastatic HT29 cell line, which expresses only the c-terminal cytoplasmic domain of the c-met beta-chain. Interestingly, c-met was found to be localized in the substrate-attached peripheral membrane and partially colocalized with phosphotyrosine-proteins in the metastatic cells only when kept on fibronectin. On the other hand, we have analyzed 86 primary human colon cancers in Dukes' B (invasive but non-metastatic) and C (invasive and lymph node metastatic) stages. Western blotting of the proteins isolated from the tumor tissues and immunohistochemical control study on the paraffin samples of a third of these cases (25/86) all indicated a significant upregulation of the c-met protein in the Dukes' C tumor glands compared to the Dukes' B stages (P < 0.001 and P < 0.05, respectively). Since the two stages differ in the involvement of the regional lymph nodes but not in the invasion depth, the clinicopathological data and our experimental findings further support the notion that the c-met expression in human colon cancer can be considered as a marker of the metastatic potential due to its involvement in the generation of the motility signal.

Expression of CD44v3 splice variant is associated with the visceral metastatic phenotype of human melanoma

We analyzed the immunohistochemical expression of the metastasis-associated protein, CD44v3, in 46 primary human malignant melanomas (MMs). This is the first time that the v3 splice variant of CD44 was found to be expressed in human melanomas (15 of 46), ranging from 3% to 35% of the cell population in the positive tumors. The expression of CD44v3 was observed in tumors thicker than 1.0 mm, and one-third of these tumors proved to be positive irrespective of the thickness. Patients were followed for a minimum of 61 months. The onset of lymph node or organ metastases occurred not later than 58 months and 60 months, respectively. Of the 15 CD44v3 positive tumors, 14 were observed in the organ metastatic tumor group, comprising the majority of those cases (14 of 21), and this association proved to be statistically significant compared with the non-metastatic (P<0.05) and lymph-node metastatic cases (P<0.01). CD44v3 expression in melanoma was also confirmed at the protein and messenger (mRNA) level in several human melanoma cell lines using flow cytometry and reverse transcriptase polymerase chain reaction analysis. In parallel to CD44v3, MMP-2 expression (determined using immunohistochemistry) was significantly elevated (P<0.05) but only in the organ metastatic group of MM. The 5-year survival of patients having thicker tumors than 1.0 mm (where v3 expression occurred) who had CD44v3+ tumors was significantly lower than those of the negative ones (35.7% versus 68.2%, respectively; P=0.025). Finally, we observed that the CD44v3-expressing tumors were characterized by significantly higher MMP-2 expression than the CD44v3-negative tumors (P<0.001), indicating a possible correlation between CD44v3- and MMP-2-positive phenotype and the organ metastatic potential of MM.

Effect of HGF-like basic hexapeptides on angiogenesis

The interaction of glycosaminoglycans (GAG) with peptides relies on noncovalent binding to basic amino acid sequences, for which a minimal requirement is a pentapeptide region in the protein and the sulfated and carboxyl region in the GAG. Since such sequences are present in the heparin-binding angiogenic cytokines, including hepatocyte growth factor (HGF), we have postulated that such small peptides may have biological activity. Two basic peptide regions of the beta chain of HGF (RYRNKH512-516, HHRGK645-649) exhibited significant antiangiogenic activity in vivo in the chorioallantoic membrane assay and showed some antiproliferative activity in vitro on normal human brain microvessel endothelial-but not on anchorage-independent endothelial-cells (Kaposi sarcoma). Basic HIV-TAT peptides and scrambled hexapeptides did not show similar activity, except for KRKRKR, indicating sequence specificity of the phenomena. An HGF-derived basic peptide, HHRGK, modulated tumor-induced angiogenesis in vivo by interfering with the morphogenic, but not with the proliferative, phase of the process. These observations suggest small basic peptides as a new class of angiogenesis modulators.

Angiogenesis-dependent diseases and angiogenesis therapy

The discovery of the molecular mechanisms of physiological vasculogenesis and pathological angiogenesis helped to recognize two classes of diseases: one where the therapeutic angiogenesis can repair the tissue damages (arteriosclerosis, myocardial infarction, limb ischemia) and the other one where inhibition of pathological angiogenesis can cure the disease or delay its progression (retinopathies, benign and malignant angiogenic tumors, progression of malignant tumors). Although there are an exponentially growing number of new synthetic molecules characterized mainly by antiangiogenic properties, the discovery of a large battery of natural pro- and anti-angiogenic factors suggests that this may provide a more physiological approach to treat both class of angiogenesis-dependent diseases in the near future.

[Regulation of the cell cycle]

The basic steps of the eukaryotic cell cycle process have been known for almost half a century. The development of the molecular biological methods allowed the identification of the cell cycle regulatory genes and their products. The cycline-dependent kinases as catalytic subunits of the multiprotein nuclear enzyme complexes, regulate the cell cycle machinery in a direct way in complex with the cyclins which appear periodically and the negatively modulating cyclin inhibitors. To assure strategy of the cell for global survival during the DNA injury, the Ataxia Teleangiectasia Mutator gene function has a supervisory role in the coordination and parallel activation of the checkpoint control, p53 tumor suppressor gene, GADD45 protein and of the DNA repair, thus prevents the activation of the cell death program. The outlined regulator system gives an opportunity to explain some of the phenomena related to tumor biology and pharmacology.

[Sesamoid osteoopathy of the foot]

Taking parts of sesamoids in several arthroosteopathies of 160 males and 156 females in the retrospective study were investigated. On the comparative dorsi-plantar, oblique, inversion and eversion pedal plain films could demonstrate bony hypotrophy and hypertrophy of sesamoids in 124 (39.55%) of 316 subjects. Until the dorsi-plantar radiographs were obtained with 15 degrees cephalic tube angulation, then the oblique, inversion and eversion ones were unangled. Radiographically the sesamoid osteopathies were divided into mild (grade 1, 36 of 124 cases), moderate (grade 2, 44 of 124 cases) and severe (grade 3, 44 of 124 cases) forms. The affictions involved the constant sesamoid bones of forefeet (1st and 5th metatarsophalangeal joints) exclusively. Sesamoid osteopathy was clinically specified by the serious locomotive pain of ball of the feet as well unfavourable chances against conservative treatment.

Elevated nascent DNA content of peripheral blood mononuclear cell compartment in lymphoma patients

The kinetics of DNA synthesis and the DNA pattern of isolated peripheral blood mononuclear cells from control subjects and lymphoma patients prior to drug treatment were studied as a possible tool in the early diagnosis of lymphoma. Thymidine and [H3]-dTTP incorporation represented the measure of replicative DNA synthesis in permeable murine thymocytes and HT-168 human melanoma cells as described earlier. The kinetic parameters of nucleotide incorporation were compared with the ploidity parameters of the Feulgen-stained smears examined by the DNASK TV-cytophotometric system. For better evaluation and visualization of the S-phase population, the method of silver impregnation of the Nucleolar-Organizer-Region in combination with the Feulgen technique was used. Significant differences were observed among the five determined parameters of healthy and lymphoma patients. Our results allow to explain some of the facts related to T-cell function deficiency in lymphoma.

Pemberton's pericapsular osteotomy for the treatment of acetabular dysplasia

We present the results of 80 Pemberton procedures carried out between 1977 and 1990. The patient age at the time of operation ranged between 2 and 12 years, and follow-up was between 1 and 15 years. Before Pemberton's operation, conservative treatment, closed and open reduction, and derotation femoral osteotomy were used. Pemberton's operation was combined with intertrochanteric femoral osteotomy in 30 cases. The mean values of the acetabular and center edge angle of Wiberg showed postoperative improvement of 19 and 17 degrees, respectively; whereas at follow-up, improvement was 20 and 23 degrees, respectively. Radiologically, 79% of the cases met Severin's classification grade I-II criteria. Clinically, 81% were classified as excellent and good. The results were closely correlated with ischemic necrosis due to preoperative treatment. Only patients belonging to groups II-IV of Kalamchi and MacEwen, plus one patient operated on at relatively old age (12 years), were found radiologically to be in Severin's groups III and IV. The results among patients operated on before age 7 were more favorable than those of patients operated on at an older age.

Preliminary results of early open reduction by an anterior approach for congenital dislocation of the hip

We report the results of 113 early open reductions of congenitally dislocated hips using a technique we have developed. Surgery is followed by functional postoperative treatment with a Pavlik harness or abduction splint. The age of the patients and the follow-up period ranged from 6 to 24 months and 2 to 12 years, respectively. Radiologic results corresponded to Severin grades I and II in 98%. Severe ischemic necrosis was not observed. Secondary surgery (femoral derotation osteotomy and/or Pemberton's operation) was performed in 21% of the cases. Reduction at a young age resulted in fewer secondary procedures. Good results were attributed to postoperative treatment: Abandoning rigid fixation prevented soft tissue stretching, which may endanger blood supply to the joint. This treatment ensures concentric reduction and allows early and spontaneous joint mobilization in a functional position. These factors stimulate further joint development.

[Autonomic neuropathy in chronic liver diseases]

Autonomic neuropathy has been evaluated by various cardiovascular bedside tests in 172 patients with chronic alcoholism (36 alcoholics without liver disease, 50 patients with fatty liver and 86 with cirrhosis), in 21 patients with HBsAg-positive chronic liver disease, in 14 patients with primary biliary cirrhosis, in 14 patients with cirrhosis of other origin and in 86 healthy controls. Parasympathetic integrity was evaluated by beat-to-beat variation during deep breathing, Valsalva manoeuvre and standing up, sympathetic function by blood pressure response to standing and to sustained handgrip test. Autonomic reflex damage was found in all groups examined. Patients with alcoholic cirrhosis exhibited the most severe alterations. Our results suggest, that chronic hepatopathy itself presents a pathogenetic factor of autonomic neuropathy. Autonomic failure has to be considered as a possible cause of symptoms in liver diseases with all its prognostic consequences.

The effect of early anterior approach open reduction with functional postoperative treatment on the early development of the acetabulum in CDH

Between 1980 and 1983, 30 anterior approach open reductions were performed on congenitally dislocated hips of 29 patients after unsuccessful conservative treatment; patients were between 6 and 18 months old. After the removal of the obstruction from the acetabulum, the reduction was performed with preservation of the limbus. Some part of the capsule was removed to constrict and tighten it and to prevent redislocation. This capsuloplasty demonstrates the success of a Pavlik harness and abduction splint postoperatively, without plaster fixation. The accelerated development of the acetabulum could be observed on radiograph by this functional treatment, compared to the control group treated with the usual hip spica postoperatively. The development of the acetabulum on the operated side almost equals the sound side within a year. If the operation was performed earlier, joint development would be quicker.