Antioxidant systems in polymorphonuclear leucocytes of Type 2 diabetes mellitus

AIMS

To examine the effect of Type 2 diabetes mellitus (DM) on enzymes of importance for oxygen-dependent killing of microorganisms by leucocytes.

METHODS

Twenty patients with Type 2 DM and 20 nondiabetic controls provided blood samples for analysis.

RESULTS

The superoxide dismutase (SOD) activity was lower by 41% in polymorphonuclear leucocytes (PMNL) from patients with Type 2 DM than in controls (3.42+/-0.32 U/mg of protein vs. 5.79+/-0.71 U/mg of protein, P<0.005). Glutathione peroxidase (GSHPx) and glutathione reductase (GR) activities of Type 2 DM patients were 73.04% and 81.12% of control values (0.84+/-0.07 nkat/mg of protein vs. 1.15+/-0.10 nkat/mg of protein, P<0.003, and 2.02+/-0.12 nkat/mg of protein vs. 2.49+/-0.16 nkat/mg of protein, P < 0.023, respectively). The catalase activity showed no significant difference. A significant increase (141.37% of control) in the concentration of thiobarbituric acid reactive products was observed (9.91+/-0.78 miromol/l vs. 7.01+/-0.47 micromol/l, P<0.003). A positive correlation between thiobarbituric acid reactive products and glucose, glycated haemoglobin and fructosamine in the serum of diabetic patients was observed.

CONCLUSION

These findings may explain some of the mechanisms underlying the increased susceptibility to certain infection in patients with Type 2 DM.

Transient hypocalcemia after thyroidectomy

The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. The PTH decreased earlier and total calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy (at 48, 72, and 96 hours). Ten patients had on 2 occasions serum calcium levels below or equal to 2 mmol/L and were defined as having severe hypocalcemia. Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.

Uremic 'toxins' and blood platelet carbohydrate metabolism

The effect of various small and middle molecular substances on blood platelet glycolysis was studied in vitro. Creatinine inhibited glucose utilization only at a concentration of 30 mg/dl; no effect of urea was found. o-Hydroxyphenolic acid and guanidinosuccinic acid, which were supposed to interfere with platelet function, inhibited glucose utilization at concentrations found in plasma of patients with chronic renal failure (CRF). Inhibitor of glucose utilization (IGU) peptide of middle molecular weight was found to inhibit glucose utilization without affecting glycogenolysis or lactate production. No additive or potentiating effects were found when interaction of different substances was tested. The only exception was a potentiation of IGU action on platelet glucose utilization by creatinine at a concentration of 15 mg/dl. Impaired glucose metabolism caused by 'uremic toxins' may contribute to the pathogenesis of bleeding in CRF by affecting platelet function.

Blood pressure, 5-OH indoleacetic acid, and vanilmandelic acid excretion and blood platelet aggregation in hypertensive patients treated with ketanserin

Ketanserin, a new selective 5-HT2-serotonergic antagonist, was used to: confirm its hypotensive efficacy in acute and long-term treatment, determine its influence on the influence on the metabolism of serotonin (5-HT) and catecholamines, and elucidate their mutual relationship. Ketanserin was given intravenously to 10 patients with hypertensive crisis or resistant hypertension and orally to 15 patients with mild to severe hypertension for 1 year. Blood pressure, heart rate, 24-h urinary excretion of vanilmandelic acid (VMA; the major endproduct of catecholamines) and of 5-hydroxyindoleacetic acid (HIAA; the endproduct of serotonin metabolism), and platelet aggregation were measured. In doses normalizing blood pressure and platelet aggregation, ketanserin administered to hypertensive patients either intravenously in acute treatment or orally in chronic treatment caused: (a) decreased HIAA excretion (more marked in chronic than in acute treatment) and (b) simultaneous decrease in VMA excretion. It is concluded that the decisive sites of ketanserin action are the 5-HT2 receptors of platelets. The compound reduces platelet aggregation and the release of 5-HT, its metabolism, and, hence, the excretion of HIAA. The action of ketanserin on 5-HT2 receptors of vascular smooth muscle participates in the hypotensive effect of the drug but does not explain the decreased excretion of HIAA and VMA.

Perseverative Thinking Questionnaire (PTQ): French Validation of a Transdiagnostic Measure of Repetitive Negative Thinking

Repetitive negative thinking (RNT) is a transdiagnostic process involved in the onset and maintenance of many psychological disorders. The Perseverative Thinking Questionnaire (Ehring et al., 2011) is a content-independent scale composed of 15 items that assesses RNT from a transdiagnostic perspective in both clinical and general populations. The aim of the current research was to translate and validate the French version of the PTQ through two studies (total N = 1016) following the steps for the trans-cultural validation of psychometric instruments (Hambleton et al., 2006). An exploratory factor analysis conducted on a first community sample revealed a latent structure composed of 10 items distributed on one common factor, labeled RNT, and three subfactors that evaluated the repetitive characteristic of RNT, the intrusiveness of RNT and the effect of RNT on mental resources. This factorial structure was confirmed in two confirmatory factor analyses in community and clinical samples. Scale score reliability indices were good and confirmed the validity of the instrument. The French version of the PTQ is a good content-independent instrument to assess RNT in general and clinical populations of French speakers.

Impaired Specificity of Future Thinking in Alcohol Use Disorders

BACKGROUND

While there has been a body of work that has investigated past thinking in individuals with alcohol use disorders (AUD), little is known about future thinking in these individuals.

METHODS

We invited participants with AUD and control participants to construct past and future events. We have also investigated the relationship between constructing past and future events and depression.

RESULTS

By analyzing the specificity (i.e., the ability in constructing specific events situated in time and space) of these events, results demonstrated lower specificity of past and future thinking in AUD participants compared to control participants. No significant differences were observed between the specificity of past and future thinking in AUD or in control participants. Further, significant negative correlations were observed between depression and past/future thinking in AUD participants but not in controls.

CONCLUSIONS

Difficulties in constructing specific future scenarios, as observed in AUD participants compared with controls, are presumably related to ruminative thinking and emotional avoidance aspects of depression, which should be investigated in future studies. More specifically, individuals with AUD may tend to construct general future scenarios to dwell on negative past events and/or to avoid coping with hopelessness and processing of upsetting or distressful future scenarios.

Effects of dihydropyridines and their combination with aspirin on blood pressure and circadian platelet activity in patients with essential hypertension

The objective of this double-blind study was: 1) to evaluate and compare the effects of treatment with two dihydropyridines--isradipine and nitrendipine--on basal and circadian blood pressure and on 24-h platelet activity; and 2) to investigate the influence of low-dose aspirin on the antihypertensive, antiplatelet (antiaggregatory) efficacy of dihydropyridines. After a 4-week placebo period, 39 patients with mild-to-moderate essential hypertension were treated for 8 weeks, according to a double-blind design, with either isradipine at 2.5 mg/day (n = 20) or nitrendipine at 10 mg/day (n = 19). After this treatment period, aspirin at 100 mg/day was added to both treatments for a further 8 weeks. At week 0 (after placebo), week 8 (after dihydropyridines), and week 16 (after dihydropyridines + aspirin), blood pressure, plasma levels of beta-thromboglobulin (beta-TG) and platelet aggregation induced by serotonin (5-HT) were measured six times a day (at 5:30 AM, 9:00 AM, noon, 3:30 PM, 7:00 PM, and 11:30 PM). Both isradipine and nitrendipine significantly lowered basal and circadian blood pressure with no differences in antihypertensive efficacy between them. Low doses of aspirin did not interfere with the antihypertensive efficacy of either agent. All patients exhibited increased platelet activity after the placebo period in the form of increased beta-TG levels with circadian changes. The steepest increase in beta-TG was observed during the morning hours until midday. Treatment with the dihydropyridines inhibited platelet aggregability, shifting the beta-TG curve toward lower values. Addition of aspirin to nitrendipine produced a significant decrease and flattening of the beta-TG curve, whereas the combination of aspirin and isradipine was accompanied by a partial increase in plasma beta-TG levels. In conclusion, treatment with dihydropyridines alone or in combination with low-dose aspirin can prevent circadian increases in platelet activity in patients with essential hypertension.

Influence of inhibitor of glucose utilization on the blood platelet function

The inhibition of glycolysis by an inhibitor of glucose utilization isolated from urine of the uremic subjects reflects in: (1) decreased platelet aggregation induced by adenosine diphosphate, adrenaline, or collagen, respectively; (2) decreased platelet factor 4 release induced by the same inductors; (3) decreased availability of platelet factor 3, and (4) inhibition of retraction of reptilase clot. It is concluded that the inhibition of glycolysis by 'inhibitor of glucose utilization' contributes to the functional changes of platelets and thus to the alteration of hemostasis in uremic patients.

Treatment of hypertension with calcium antagonists and aspirin. Effects on 24-h platelet activity

The effects of calcium antagonists on platelets, and the effects of aspirin on the antihypertensive efficacy of calcium antagonists and on the 24-h platelet-activity profile were investigated in a double-blind study. Patients with essential hypertension were treated for 8 weeks with either nitrendipine (10 mg once daily) or isradipine (2.5 mg once daily). Aspirin (100 mg once daily) was added to both treatments for a further 8 weeks. Measurements were taken after placebo, after 8 weeks of active treatment, and after 8 weeks of treatment plus aspirin. Plasma levels of beta-thromboglobulin (beta-TG) and platelet aggregation (PA) were measured six times over 24 h. Isradipine and nitrendipine significantly lowered systolic and diastolic blood pressure. The addition of aspirin had no effect on blood pressure. Platelet activity before treatment exhibited circadian variations with the lowest values of beta-TG and PA at 0530 h and the steepest increases between 0530 and 0900 h. Although both calcium antagonists decreased beta-TG levels (P < .05), the effect with isradipine was more pronounced than that with nitrendipine (P < .05). Aspirin added to nitrendipine produced a significant decrease in beta-TG levels whereas isradipine plus aspirin was accompanied by a partial increase in beta-TG. It is concluded that hypertensive patients exhibit circadian increases in platelet activity that can be prevented by either isradipine alone or by treatment with nitrendipine plus aspirin. Chronic aspirin intake at a daily dose of 100 mg does not affect calcium antagonist antihypertensive efficacy.

[Are we underestimating the nephrotoxicity of drugs?]

In the submitted review the authors discuss the nephrotoxicity of drugs which is a serious danger of pharmacotherapy. Clinically it may be manifested in different ways from acute deterioration of renal functions to the picture of chronic renal insufficiency. It is particularly important to know the nephrotoxic potential of different drug groups and to ensure a careful stratification of patients. The most frequent drug groups which lead to affection of the kidneys are radiocontrasting substances, aminoglycoside antibiotics, non-steroid analgesics-antiphlogistics and ACE inhibitors. With the increasing number of transplantations the problem of nephrotoxicity of immunosuppressives is becoming important. The authors analyze in each group risk factors, the pathogenesis, clinical picture and prognosis of damage. Special emphasis is laid on adherence to preventive measures and careful monitoring of the laboratory and clinical picture, in particular in risk groups of patients as treatment of already developed nephrotoxic sequelae of pharmacotherapy is frequently difficult.

[Changes in thrombocyte aggregation in patients with type I diabetes]

The authors present the results of evaluation of platelet aggregation by means of an automated system (on line detection of platelet aggregation curves) in 80 patients with diabetes mellitus type I. After global analysis no significant changes were found between controls, patients without diabetic nephropathy, and patients with incipient and clinically manifested nephropathy. However, as a result of our data, the area below the aggregatory curve is minimal in the group of patients with clinically manifested diabetic nephropathy. Additional changes of platelet aggregation were observed after dividing the followed set of patients dividing into homogenous subgroups according to their sex. The sensitivity of platelets after induction by ADP was found to be lower in male diabetics than in male controls. Likewise the area below the aggregatory curve and the transmittance of absolute maximum of platelet aggregation was lower in female diabetics than in female controls. In both cases diabetic nephropathy could have participated in platelet sensitivity changes. The authors' findings in the followed group of patients when compared with the described platelet hyperaggregability in diabetes approves the possibility of the platelet aggregatory polymorphism being present in these patients. With respect to these findings the examination of the platelet aggregation and its general parameters exactly justifies the usefulness of the antiaggregatory therapy. (Fig. 4, Ref. 15.)

[Structured interview guide for evaluating depression in elderly patients, adapted from DSM IV and the GDS, HDRS and MADRS scales]

Depression in the elderly looks like depression in adulthood, without mention of a strict clinical specificity. In fact, depression in the elderly presents a semiologic inflexion, and a symptomatology attenuation. Some signs could be considered by others to twists as belonging the normal aging, but are in reality clinical elements of depression symptomatology. These reasons, as well as the variability of evaluation methods used, make that this pathology remains often underdiagnosed. Nevertheless, epidemiological studies have pointed out that this trouble is relatively frequent. Depression in the elderly is important to be detected, in reason that it could be treated, allowing to prevent somatic complications, repetition of troubles, relapse, suicide solution, and dementia development. Most of authors considers that the most useful diagnostic tests are screening assessments. In the geriatric population, about 43 tools exists for the depression, but some of these are better than other. Three validated rating scales are specially interessant for the depression in the elderly: GDS of Yesavage (Geriatric Depression Scale), HDRS of Hamilton (Hamilton Depression Rating Scale) and MADRS of Montgomery and Asberg (Montgomery and Asberg Depression Rating Scale). The purpose of this work is to present a psychiatric interview guide, allowing to better specify depressive symptoms with old subjects, constructed and adapted from these 3 rating scales and the DSM IV criteria. In order that, we have first synthetized all of the items of the 3 scales. Then, by following diagnostic criteria of the DSM IV, we have constructed with uniform manner the interview guide. It has been built to evaluate general clinical aspects, but also to precise clinical points. The interviewer can ask question, take into account the clinical dimension, and appreciate the intensity of the trouble. The guide has been experimented and tested with older depressive subjects. After a necessary training phase to control the assessment system, the guide is usable during a clinical interview. It allows to collect, in a standardized manner, sufficiently data to establish the diagnosis and to quantify the intensity of the trouble. Conceived initially for a practical clinic use, this guide will have future use in research studies, in return for some ulterior validation works.

I Feel I Remember: The Phenomenology of Autobiographical Recall in Individuals with Alcohol Use Disorder

INTRODUCTION

Beyond the memory deficits classically observed in individuals with alcohol use disorder (IwAUD), research has recently focused on the study of autobiographical memory (AM) processes in IwAUD by analysing the content of AM narratives, and the implications for self-conception have been discussed. However, little is known about how IwAUD subjectively experience autobiographical recall.

METHODS

Thirty-seven IwAUD and 37 control participants were invited to perform an AM task that involved recalling memories for 4 life periods (2 important memories per period). Then, they assessed their subjective experience during AM recall using 6 phenomenological scales evaluating emotional valence, emotional intensity, sensory details, distancing, sharing, and vividness. Anxiety and depression symptoms, interoceptive sensibility, and difficulties in emotion regulation were also measured.

RESULTS

The IwAUD experienced greater distancing during AM recall, except during childhood AM recall, indicating that IwAUD are more prone to feeling that the person they are today is different from the person in their retrieved AMs. Very few intergroup differences were observed for AMs from childhood, adolescence-young adulthood, and adulthood, and a greater number of differences were observed for AMs from the last year: the IwAUD experienced AMs with a more negative valence, greater emotional intensity, fewer sensory details, greater distancing, and less sharing. A positive correlation was observed between distancing and interoceptive sensibility in the IwAUD group.

CONCLUSION

Although these results suggest good preservation of autonoetic consciousness in IwAUD, except for more recent AMs, it is insufficient for IwAUD to experience a sense of self-continuity. This difficulty in maintaining a continuous sense of self may constitute a risk for AUD relapse.

Autobiographical memories cued by self-statements in patients with alcohol use disorder: linking self-conceptions to past events

The study examined the personal sense of identity in alcohol use disorder (AUD) through the relation between autobiographical memories and individuals' self-conception. The AUD detoxified patients and control participants were asked to create a list of self-statements to which they associated for the three main autobiographical memories illustrating them. The group variable was not associated with the number of positive self-statements, but it was associated with the number of negative self-statements. Furthermore, for the autobiographical memories cued by a positive self-statement, the group was related to the number of positive memories and general memories, while no relation was observed for the memories cued by a negative self-statement. Our results also support that AUD patients' memories cued by self-statements are older and more alcohol-related. Hierarchical regression analyses in the AUD patients demonstrated that the use of adaptive emotional regulation strategies was the only significant predictor of the use of positive or negative self-statements.