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The stability of symptomatology and of eleven schizophrenic diagnostic systems was studied in patients initially in an acute phase (group 1) compared to patients in a residual phase (group 2). The patients were evaluated over a period of 1 year with a standardized checklist and PANSS in both groups. The number of patients included by the Carpenter, Calego, 1CD9, New-Haven, Schneider and Vienne systems decreased significantly between admission and discharge in group 1, whereas no variation was observed in group 1 between discharge and one year later, or in group 2 over a period of 1 year. The instability of schizophrenic diagnostic systems such as New-Haven, Schneider and Vienne could be due to the variation of positive or general symptomatology. The number of patients included by Feighner or Langfeldt did not vary significantly between admission and discbarge in group 1, in spite of a significant decrease in symptomatology, probably because certain criteria, such as duration of illness, hindered the systems from changing. The results showed the importance of specifying in every study on schizophrenia the time of inclusion (admission, discharge) or the phase of illness (acute or residual phase).
Des données nombreuses mais contradictoires existent à l’heure actuelle sur l’implication du récepteur 2A à la sérotonine (5-HT2AR), codé par le gène HTR2A, dans le trouble dépressif majeur unipolaire [1,3]. Dans notre étude, nous combinons des données cliniques et précliniques pour déterminer l’impact d’une diminution de la transmission sérotoninergique dépendante du 5-HT2AR sur le développement et les caractéristiques des épisodes dépressifs caractérisés. Deux polymorphismes du gène HTR2A (His452Tyr et 102C/T), dont certains allèles entraîneraient une baisse de l’activité fonctionnelle du 5-HT2AR , ont été étudiés sur une population de 485 patients caucasiens présentant un épisode dépressif majeur (EDM) dans le cadre d’un trouble dépressif majeur unipolaire. D’autre part, une étude préclinique comparant l’effet d’une administration chronique de corticostérone sur l’apparition d’un phénotype de type dépressif  chez des souris mutées pour le Htr2a (Htr2a-/-) et des souris sauvages a été réalisée. Chez les patients, le variant TT du polymorphisme His452Tyr, particulièrement peu fréquent, a été détecté chez deux patients souffrant d’un EDM de type mélancolique. D’autre part, l’allèle C du polymorphisme 102C/T est plus fréquemment retrouvé chez les patients déprimés (p = 0,019) que dans la population générale et les génotypes CC et CT sont associés à des EDM plus sévères à l’HAMD-17 (p = 0,008). D’autre part, les tests comportementaux effectués chez les souris Htr2a-/- montrent que ces dernières développent un phénotype de type dépressif plus marqué par rapport aux souris sauvages (p < 0,01) en réponse à l’administration chronique de corticostérone. Cette étude translationnelle suggère qu’une diminution de la transmission sérotoninergique au niveau du 5-HT2AR pourrait favoriser le développement d’un trouble dépressif majeur unipolaire et entraîner une sévérité plus importante des épisodes dépressifs caractérisés.
The aim of this study was to test whether a positive and a negative component could be found in broadly defined schizophrenic patients. Therefore, 70 patients either in an exacerbated or in a stabilized phase were selected according to the criteria of at least 1 of the 4 following diagnostic systems: DSM III-R, Schneider, Carpenter, Langfeldt; principal component analyses (PCA) were carried out with the 9 global ratings of the Scales for Assessment of Negative and Positive Symptoms (SANS and SAPS) and with the Positive and Negative Syndrome Scale (PANSS). The PCA of the SANS-SAPS global ratings yielded a 3-factor solution explaining 72.14% of the total variance, depicting a negative, a positive and a disorganization component. The PCA of the PANSS provided a 5-factor solution with a total explained variance of 55.98%. The first 3 factors were similar to those of the SANS-SAPS global rating analysis. The results showed that the positive and negative components described in a homogeneous schizophrenic population could be replicated in a larger and more heterogeneous group of schizophrenic patients. The question regarding the sufficiency of the positive-negative dichotomy was strengthened by the presence of a third disorganization component which explained as much of the variance as the positive component.
The concordance and degree of overlap between 13 diagnostic systems for schizophrenia, including the five European systems of Berner, Bleuler, Langfeldt, Pull and Schneider, were evaluated in a cross-sectional study (N = 51) taking the phase of illness (acute or residual) into account. The diagnostic assessments were processed by computer using a 183-item standardised checklist and a data-processing program in GW-Basic language. The inter-rater reliability, as assessed by Kappa coefficient, was good to excellent for each diagnostic system established by this method (K from 0.5 to 1). When comparing the concordance between pairs of 13 diagnostic systems for schizophrenia in acute and residual phase groups, results showed that only two significant relationships were not influenced by the phase of illness (Carpenter x RDC; Catego x Schneider), while 24 were. These included only two relationships in the acute group (Carpenter Catego; Carpenter Schneider) and 22 links between pairs of systems in the residual group. In the acute group, no diagnosis of schizophrenia, including duration criteria such as those of DSM III-R, Feighner, Langfeldt, Pull and RDC, was linked to other systems. In the residual group, the operational systems such as Catego, DSM III-R, Feighner, Newhaven, Pull and RDC had more than five relationships with the other systems whereas the non-operational systems of Bleuler, ICD9, Langfeldt and Schneider had less than four relationships with the others. Except Pull's criteria, the European diagnostic systems, in particular Berner's and Bleuler's, seemed to differ from the others because of the few relationships displayed. The results underline the importance of taking the phase of illness into account when comparing between studies utilizing different diagnostic systems for schizophrenia. They also show the relationships between European and international diagnostic systems, insufficiently established so far.
In order to test the hypothesis that an excess of summer births is a risk factor for deficit syndrome, the month of birth was studied in 53 deficit schizophrenic patients compared to 158 non-deficit patients. No significant difference in terms of month of birth or season of birth was observed between deficit and non-deficit patients, suggesting that summer births might not be a risk factor for deficit schizophrenia.
Because of the heterogeneity of schizophrenia, this study researched different cognitive patterns in distinct subtypes of schizophrenic patients.
Thirty-five Diagnostic and Statistical Manual IV (DSM IV) schizophrenic patients and 35 healthy controls were included. Patients were categorized into deficit, disorganized and positive subtypes with the schedule for the deficit syndrome (SDS) and the positive and negative syndrome scale (PANSS). Executive/attentional functions were assessed with the modified card sorting test (MCST), a test of verbal fluency, the trail making test (TMT) and the Stroop color-word test (Stroop test). Episodic memory was explored through the California verbal learning test (CVLT).
The positive subtype had some executive/attentional (fluency and Stroop tests) and mnesic performances in the normal range, suggesting the preservation of good cognitive skills. In contrast, the deficit and disorganized subtypes had major mnesic and executive/attentional dysfunctions compared to healthy subjects. The deficit subtype compared to the control group performed predominantly worse on the MCST and fluency, whereas the disorganized subtype had the lowest scores on the TMT and the Stroop test.
This study showed distinct cognitive patterns in deficit, disorganized and positive patients in comparison with the controls, suggesting a heterogeneous cognitive dysfunction in schizophrenia.
Acute lithium intoxication is potentially lethal. Compared to conventional lithium preparations, sustained-release lithium formulations present specific problems for medical practice in the case of overdose. We report a case of intoxication with 8000 mg of sustained-release lithium carbonate preparation (Teralithe 400 LP®). Twenty-five hours after the ingestion, the patient was still asymptomatic, despite a serum level in the toxic range. After comparison of this case with reports found in the Medline database, we consider the clinical management of such cases.
The aim of this study was to test that deficit (D) schizophrenic patients as defined by Carpenter et al had a higher prevalence of family history of schizophrenia but less obstetric complications than non-deficit (ND) patients. A lower rate of obstetric complications but an excess of schizophrenic and a higher rate of alcoholism family antecedents in 18 D patients compared to 23 ND patients were found. These results could suggest that there is a different weight of genetic and early environmental factors in D and ND patients.
Les approches centrées sur l’autorégulation ainsi que sur l’acceptation des émotions et des sensations désagréables inspirées des programme MBSR et MBCT, représentent une voie intéressante dans la prise en charge des troubles du comportement alimentaire dans lesquels le contrôle et l’évitement sont au premier plan. Ces programmes permettent de travailler les aspects obsessionnels (comme les ruminations) et compulsifs (sur l’alimentation, la réactivité avec perte de contrôle) associés à ces troubles alimentaires. La clinique des maladies mentales et de l’encéphale (CMME), hôpital Sainte-Anne a mis en place un protocole « MBCT Boulimie » en huit séances. Le programme MBCT a été modifié, notamment au niveau des outils cognitifs et de la durée des pratiques de méditation pour des patients présentant un TCA. La recherche s’est réalisée sur vingt-quatre sujets de l’hôpital de jour de la CMME et avait pour objet d’évaluer l’impact du programme MBCT dans une population de sujets souffrant de boulimie et de Binge Eating Disorder.
BMI, EDI-2, EAT, BDI-13, BITE, STAI Ya/Yb, le Ruminative Response Scale for Eating Disorder (RRSED), l’Acceptance and Action Questionnaire-II (AAQ-II), le Five Facets Mindfulness Questionnaire (FFMQ), le Mindfulness Attention Awareness Scale (MAAS), le Kentucky Inventory of Mindfulness Skills (KIMS), le Body Shape Questionnaire (BSQ), l’Impulsive Behavior Scale : Urgency, Premeditation, Perseverance, and Sensation Seeking (UPPS), le Cambridge Exeter Repetitive Thinking Scale (CERTS) et le Three Factor Eating Questionnaire (TFEQ). Nous présenterons les résultats préliminaires de cette recherche ainsi que le projet de suite de ce travail de recherche clinique.
Interest in tactical medicine, the provision of medical support to law enforcement and military special operations teams, continues to grow. The majority of tactical physicians are emergency physicians with additional training and experience in tactical operations. A 2005 survey found that 18% of responding Emergency Medicine (EM) residencies offered their resident physicians structured exposure to tactical medicine at that time.
This study sought to assess interval changes in tactical medicine exposure during EM residency and Emergency Medical Services (EMS) fellowship training. A secure online survey was distributed electronically to all 212 EM residency programs and 44 EMS fellowship programs in the United States.
Responses were received from 99 (46%) EM residency and 40 (91%) EMS fellowship programs. Results showed that 52 (53%) of the responding residencies offered physician trainees formal exposure to tactical medicine as part of their training (P < .0001 compared to 18% in 2005). In addition, 32 (72%) of the 40 responding EMS fellowships (newly established since the initial survey) offered this opportunity. Experiences ranged from observation to active participation during tactical training and call-outs. The EM residents and EMS fellows provide support to local, state, and federal law enforcement agencies. A small number of programs (six residencies and four fellowships) allowed a subset of qualified trainees to be armed during tactical operations.
Overall, training opportunities in tactical medicine have grown significantly over the last decade from 18% to 53% of responding EM residencies. In addition, 72% of responding EMS fellowships incorporate tactical medicine in their training program.
Petit NP, Stopyra JP, Padilla RA, Bozeman WP. Resident involvement in tactical medicine: 12 years later. Prehosp Disaster Med. 2019;34(2):217–219
Human mesenchymal stem cells were reseeded in decellularized human bone subject to a controlled mechanical loading to create a bone-on-chip that was cultured for over 26 months. The cell morphology and their secretome were characterized using immunohistochemistry and in situ immunofluorescence under confocal microscopy. The presence of stem cell derived osteocytes was confirmed at 547 days. Different cell populations were identified. Some cells were connected by long processes and formed a network. Comparison of the MSCs in vitro reorganization and calcium response to in situ mechanical stimulation were compared to MLOY4 cells reseeded on human bone. The bone-on-chip produced an ECM of which the strength was nearly a quarter of native bone after 109 days and that contained calcium minerals at 39 days and type I collagen at 256 days. The cytoplasmic calcium concentration variations seemed to adapt to the expected in vivo mechanical load at the successive stages of cell differentiation in agreement with studies using fluid shear flow stimulation. Some degree of bone-like formation over a long period of time with the formation of a newly formed matrix was observed.
Recent spectropolarimetric surveys of bright, hot stars have found that ~10% of OB-type stars contain strong (mostly dipolar) surface magnetic fields (~kG). The prominent paradigm describing the interaction between the stellar winds and the surface magnetic field is the magnetically confined wind shock (MCWS) model. In this model, the stellar wind plasma is forced to move along the closed field loops of the magnetic field, colliding at the magnetic equator, and creating a shock. As the shocked material cools radiatively it will emit X-rays. Therefore, X-ray spectroscopy is a key tool in detecting and characterizing the hot wind material confined by the magnetic fields of these stars. Some B-type stars are found to have very short rotational periods. The effects of the rapid rotation on the X-ray production within the magnetosphere have yet to be explored in detail. The added centrifugal force due to rapid rotation is predicted to cause faster wind outflows along the field lines, leading to higher shock temperatures and harder X-rays. However, this is not observed in all rapidly rotating magnetic B-type stars. In order to address this from a theoretical point of view, we use the X-ray Analytical Dynamical Magnetosphere (XADM) model, originally developed for slow rotators, with an implementation of new rapid rotational physics. Using X-ray spectroscopy from ESA’s XMM-Newton space telescope, we observed 5 rapidly rotating B-types stars to add to the previous list of observations. Comparing the observed X-ray luminosity and hardness ratio to that predicted by the XADM allows us to determine the role the added centrifugal force plays in the magnetospheric X-ray emission of these stars.
Large magnetometric surveys have contributed to the detection of an increasing number of magnetic massive stars, and to the recognition of a population of magnetic massive stellar objects with distinct properties. Among these, NGC 1624-2 possesses the largest magnetic field of any O-type star; such a field confines the stellar wind into a circumstellar magnetosphere, which can be probed using observations at different wavelength regimes. Recent optical and X-ray observations suggest that NGC 1624-2’s magnetosphere is much larger than that of any other magnetic O star. By modeling the variations of UV resonance lines, we can constrain its velocity structure. Furthermore, recent spectropolarimetric observations raise the possibility of a more complex field topology than previously expected. Putting all of these multi-wavelength constraints together will allow us to paint a consistent picture of NGC 1624-2 and its surprising behavior, giving us valuable insight into the very nature of massive star magnetospheres.
Magnetic massive stars comprise approximately 10% of the total OB star population. Modern spectropolarimetry shows these stars host strong, stable, large-scale, often nearly dipolar surface magnetic fields of 1 kG or more. These global magnetic fields trap and deflect outflowing stellar wind material, forming an anisotropic magnetosphere that can be probed with wind-sensitive UV resonance lines. Recent HST UV spectra of NGC 1624-2, the most magnetic O star observed to date, show atypically unsaturated P-Cygni profiles in the Civ resonant doublet, as well as a distinct variation with rotational phase. We examine the effect of non-radial, magnetically-channeled wind outflow on P-Cygni line formation, using a Sobolev Exact Integration (SEI) approach for direct comparison with HST UV spectra of NGC 1624-2. We demonstrate that the addition of a magnetic field desaturates the absorption trough of the P-Cygni profiles, but further efforts are needed to fully account for the observed line profile variation. Our study thus provides a first step toward a broader understanding of how strong magnetic fields affect mass loss diagnostics from UV lines.
The evolution of rotational velocity and magnetic activity with age follows approximately a t−1/2 relation, the famous Skumanich law. Using a large sample of about 80 solar twins with precise ages, we show departures from this law. We found a steep drop in rotational velocity and activity in the first 2-3 Gyr and afterwards there seems to be a shallow decrease. Our inferred rotational periods suggest that the Sun will continue to slow down, validating thus the use of gyrochronology beyond solar age. The Sun displays normal rotational velocity and activity when compared to solar twins of solar age. We also show that stars with exceedingly high stellar activity for their age are spectroscopic binaries that also exhibit enhanced rotational velocities and chemical signatures of mass transfer.
Evidence of surface magnetism is now observed on an increasing number of cool stars. The detailed manner by which dynamo-generated magnetic fields giving rise to starspots traverse the convection zone still remains unclear. Some insight into this flux emergence mechanism has been gained by assuming bundles of magnetic field can be represented by idealized thin flux tubes (TFTs). Weber & Browning (2016) have recently investigated how individual flux tubes might evolve in a 0.3M⊙ M dwarf by effectively embedding TFTs in time-dependent flows representative of a fully convective star. We expand upon this work by initiating flux tubes at various depths in the upper ~50-75% of the star in order to sample the differing convective flow pattern and differential rotation across this region. Specifically, we comment on the role of differential rotation and time-varying flows in both the suppression and promotion of the magnetic flux emergence process.
Recent observations of solar flares at high frequencies have provided evidence of a new spectral component with flux increasing with frequency in the THz range. Its origin remains unclear. Here, we present preliminary results of simulations of synchrotron emission due to secondary positrons and electrons produced in nuclear reactions during a solar flare. We use the general purpose Monte-Carlo code FLUKA to obtain distributions of secondary particles resulting from accelerated protons interacting in the solar atmosphere. We calculate the synchrotron radiation spectrum and compare our results to observations of the November 4th, 2003 burst event.
Synoptic maps of the vector magnetic field have routinely been made available from stellar observations and recently have started to be obtained for the solar photospheric field. Although solar magnetic maps show a multitude of details, stellar maps are limited to imaging large-scale fields only. In spite of their lower resolution, magnetic field imaging of solar-type stars allow us to put the Sun in a much more general context. However, direct comparison between stellar and solar magnetic maps are hampered by their dramatic differences in resolution. Here, I present the results of a method to filter out the small-scale component of vector fields, in such a way that comparison between solar and stellar (large-scale) magnetic field vector maps can be directly made. This approach extends the technique widely used to decompose the radial component of the solar magnetic field to the azimuthal and meridional components as well, and is entirely consistent with the description adopted in several stellar studies. This method can also be used to confront synoptic maps synthesised in numerical simulations of dynamo and magnetic flux transport studies to those derived from stellar observations.