Neuropsychiatric symptoms and imbalance of atrophy in behavioral variant frontotemporal dementia.

Behavioral variant frontotemporal dementia is characterized by heterogeneous frontal, insular, and anterior temporal atrophy patterns that vary along left-right and dorso-ventral axes. Little is known about how these structural imbalances impact clinical symptomatology. The goal of this study was to assess the frequency of frontotemporal asymmetry (right- or left-lateralization) and dorsality (ventral or dorsal predominance of atrophy) and to investigate their clinical correlates. Neuropsychiatric symptoms and structural images were analyzed for 250 patients with behavioral variant frontotemporal dementia. Frontotemporal atrophy was most often symmetric while left-lateralized (9%) and right-lateralized (17%) atrophy were present in a minority of patients. Atrophy was more often ventral (32%) than dorsal (3%) predominant. Patients with right-lateralized atrophy were characterized by higher severity of abnormal eating behavior and hallucinations compared to those with left-lateralized atrophy. Subsequent analyses clarified that eating behavior was associated with right atrophy to a greater extent than a lack of left atrophy, and hallucinations were driven mainly by right atrophy. Dorsality analyses showed that anxiety, euphoria, and disinhibition correlated with ventral-predominant atrophy. Agitation, irritability, and depression showed greater severity with a lack of regional atrophy, including in dorsal regions. Aberrant motor behavior and apathy were not explained by asymmetry or dorsality. This study provides additional insight into how anatomical heterogeneity influences the clinical presentation of patients with behavioral variant frontotemporal dementia. Behavioral symptoms can be associated not only with the presence or absence of focal atrophy, but also with right/left or dorsal/ventral imbalance of gray matter volume.

It is Not (Always) the Mismatch That Beats You-On the Relationship Between Interaction of Early and Recent Life Stress and Emotion Regulation, an fMRI Study.

Stress may impact the ability to effectively regulate emotions. To study the impact of stressful experiences in early and recent life on emotion regulation, we examined the relationship between early life stress, recent stress, and brain activation during cognitive reappraisal. We investigated two regulation goals: the decrease and increase of emotional response to both negative and positive stimuli. Furthermore, two models of stress consequences were examined: the cumulative and match/mismatch models. A total of 83 participants (Mage = 21.66) took part in the study. There was an interaction between cumulative stress and stimuli valence in the cuneus, superior lateral occipital cortex, superior parietal lobule, supramarginal gyrus extending to superior temporal gyrus, and precentral gyrus extending to supplementary motor area. Interaction between mismatched stress index and stimuli valence was found in the left hippocampus, left insula extending to the orbitofrontal cortex and amygdala, and in a cluster including the anterior cingulate cortex, superior frontal gyrus, and frontal pole. Furthermore, there were differences between the effects of cumulative and mismatched stress indices on brain activation during reappraisal of positive but not negative stimuli. Results indicate that cumulative stress and match/mismatch approaches are both useful for explaining brain activation during reappraisal. This finding is important for our understanding of the multifaceted impact of stress on emotion regulation.

The relationship between early and recent life stress and emotional expression processing: A functional connectivity study.

The aim of this study was to characterize neural activation during the processing of negative facial expressions in a non-clinical group of individuals characterized by two factors: the levels of stress experienced in early life and in adulthood. Two models of stress consequences were investigated: the match/mismatch and cumulative stress models. The match/mismatch model assumes that early adversities may promote optimal coping with similar events in the future through fostering the development of coping strategies. The cumulative stress model assumes that effects of stress are additive, regardless of the timing of the stressors. Previous studies suggested that stress can have both cumulative and match/mismatch effects on brain structure and functioning and, consequently, we hypothesized that effects on brain circuitry would be found for both models. We anticipated effects on the neural circuitry of structures engaged in face perception and emotional processing. Hence, the amygdala, fusiform face area, occipital face area, and posterior superior temporal sulcus were selected as seeds for seed-based functional connectivity analyses. The interaction between early and recent stress was related to alterations during the processing of emotional expressions mainly in to the cerebellum, middle temporal gyrus, and supramarginal gyrus. For cumulative stress levels, such alterations were observed in functional connectivity to the middle temporal gyrus, lateral occipital cortex, precuneus, precentral and postcentral gyri, anterior and posterior cingulate gyri, and Heschl's gyrus. This study adds to the growing body of literature suggesting that both the cumulative and the match/mismatch hypotheses are useful in explaining the effects of stress.

Analysis of risk factors for pulmonary complications in patients with limited-stage small cell lung cancer : A single-centre retrospective study.

INTRODUCTION: The most effective therapy in patients with limited-stage small cell lung cancer (LS SCLC) seems to be chemotherapy (using platinum-based regimens) and thoracic radiotherapy (TRT), which is followed by prophylactic cranial irradiation. MATERIALS AND METHODS: The analysed group comprised 217 patients who received combined treatment for LS SCLC, i.e. chemotherapy (according to cisplatin and etoposide schedule) and TRT (concurrent in 101 and sequential in 116 patients). The influence of chemoradiotherapy (ChT-RT) schedule on treatment results (frequency of complete response, survival rates, and incidence of treatment failure and complications) was evaluated, and the frequency and severity of pulmonary complications were analysed to identify risk factors. RESULTS: The 5­year survival rates in concurrent vs. sequential ChT-RT schedules were 27.3 vs. 11.7% (overall) and 28 vs. 14.3% (disease-free). The frequencies of adverse events in relation to concurrent vs. sequential therapy were 85.1 vs. 9.5% (haematological complications) and 58.4 vs. 38.8% (pulmonary fibrosis), respectively. It was found that concurrent ChT-RT (hazard ratio, HR 2.75), a total dose equal to or more than 54 Gy (HR 2.55), the presence of haematological complications (HR 1.89) and a lung volume receiving a dose equal to or greater than 20 Gy exceeding 31% (HR 1.06) were the risk factors for pulmonary complications. CONCLUSION: Pulmonary complications after ChT-RT developed in 82% of patients treated for LS SCLC. In comparison to the sequential approach, concurrent ChT-RT had a positive effect on treatment outcome. However, this is a factor that can impair treatment tolerance, which manifests in the appearance of side effects.

Executive Function Deficits in Patients after Cerebellar Neurosurgery.

The cerebellum has long been perceived as a structure responsible for the human motor function. According to the contemporary approach, however, it plays a significant role in complex behavior regulatory processes. The aim of this study was to describe executive functions in patients after cerebellar surgery. The study involved 30 patients with cerebellar pathology. The control group comprised 30 neurologically and mentally healthy individuals, matched for sex, age, and number of years of education. Executive functions were measured by the Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT), Trail Making Test (TMT), and working memory by the Digit Span. Compared to healthy controls, patients made more Errors and Perseverative errors in the WCST, gave more Perseverative responses, and had a lower Number of categories completed. The patients exhibited higher response times in all three parts of the SCWT and TMT A and B. No significant differences between the two groups were reported in their performance of the SCWT and TMT with regard to the measures of absolute or relative interference. The patients had lower score on the backward Digit Span. Patients with cerebellar pathology may exhibit some impairment within problem solving and working memory. Their worse performance on the SCWT and TMT could, in turn, stem from their poor motor-somatosensory control, and not necessarily executive deficits. Our results thus support the hypothesis of the cerebellum's mediating role in the regulation of the activity of the superordinate cognitive control network in the brain. (JINS, 2016, 22, 47-57).

Neuropsychological characteristics of verbal and non-verbal fluency in schizophrenia patients.

This review paper provides analyses confirming correlation between various brain regions activity, particularly its prefrontal portions, and schizophrenia patients' performance in verbal fluency tests. Various factors modifying patients' performance in the aforementioned tasks were singled out and discussed. Systematically we have reviewed the results of non-verbal fluency tests conducted in the schizophrenic patients. The authors also summarizes findings of earlier studies stressing the role of semantic fluency as a predictor of first-episode psychosis. Verbal and non-verbal fluency tests engage complex cognitive processes and executive functions in patients. As a result, the interpretation of their results is often complicated and requires special competences. The tests are popular neuropsychological tools used for assessment of verbal memory, executive functions, visual-spatial abilities and psychomotor speed in patients with mental and neurological disorders. The aim of this paper is to discuss diagnostic tools used for measuring both types of fluency (verbal and non-verbal), test interpretation methods, as well as their usefulness in clinical diagnostics and scientific research.

The Prevalence of Orthostatic Hypotension in Cancer Patients.

BACKGROUND: Orthostatic hypotension (OH) is associated with a higher risk of mortality in the general population; however, it has not been studied in the cancer population. This study aimed to assess the prevalence of OH in cancer patients compared to that in the noncancer population. METHODS: A total of 411 patients (mean age 63.5 ± 10.6 years) were recruited: patients with active cancer (n = 223) and patients hospitalised for other reasons, but without a cancer diagnosis (n = 188). Medical histories were collected and an orthostatic challenge test was performed. OH was defined as a blood pressure (BP) decrease upon standing of ≥20 mmHg for the systolic or ≥10 mmHg for the diastolic BP after 1 or 3 min; or a systolic BP decrease <90 mmHg. RESULTS: The prevalence of OH in the subjects with cancer was significantly higher than in the subjects without cancer (28.7% vs. 16.5%, respectively, p = 0.003). OH was the most common in the lung cancer patients (57.5%). In a single-variable analysis, the predictors of OH were cancer presence, age ≥ 65 years, and body mass index (BMI) ≥ 30 kg/m2. In the multivariable model, the strongest independent predictor of OH was cancer status, which doubled the risk of OH, and BMI ≥ 30 kg/m2 and diabetes. CONCLUSIONS: Cancer patients are characterised by a high prevalence of OH. In this population, the recommendation of routine orthostatic challenge tests should be considered.

Longitudinal brain structure changes in Parkinson's disease: A replication study.

CONTEXT: An existing major challenge in Parkinson's disease (PD) research is the identification of biomarkers of disease progression. While magnetic resonance imaging is a potential source of PD biomarkers, none of the magnetic resonance imaging measures of PD are robust enough to warrant their adoption in clinical research. This study is part of a project that aims to replicate 11 PD studies reviewed in a recent survey (JAMA neurology, 78(10) 2021) to investigate the robustness of PD neuroimaging findings to data and analytical variations. OBJECTIVE: This study attempts to replicate the results in Hanganu et al. (Brain, 137(4) 2014) using data from the Parkinson's Progression Markers Initiative (PPMI). METHODS: Using 25 PD subjects and 18 healthy controls, we analyzed the rate of change of cortical thickness and of the volume of subcortical structures, and we measured the relationship between structural changes and cognitive decline. We compared our findings to the results in the original study. RESULTS: (1) Similarly to the original study, PD patients with mild cognitive impairment (MCI) exhibited increased cortical thinning over time compared to patients without MCI in the right middle temporal gyrus, insula, and precuneus. (2) The rate of cortical thinning in the left inferior temporal and precentral gyri in PD patients correlated with the change in cognitive performance. (3) There were no group differences in the change of subcortical volumes. (4) We did not find a relationship between the change in subcortical volumes and the change in cognitive performance. CONCLUSION: Despite important differences in the dataset used in this replication study, and despite differences in sample size, we were able to partially replicate the original results. We produced a publicly available reproducible notebook allowing researchers to further investigate the reproducibility of the results in Hanganu et al. (2014) when more data is added to PPMI.

Neural functional connectivity during rumination in individuals with adverse childhood experiences.

Background: Childhood adversity has been associated with greater risk of developing psychopathology, altered processing of emotional stimuli, and changes in neural functioning. Although the neural correlates of rumination have been previously described, little is known about how adverse childhood experiences are related to brain functioning during rumination. Objective: This study explored differences in neural functional connectivity between participants with and without histories of childhood adversity, controlling for tendency to ruminate, during resting-state and induction of rumination. Method: A total of 86 adults (51 women) took part. Based on a diagnostic clinical interview, participants were divided into groups with and without adverse childhood experiences. All participants underwent resting-state imaging and a functional magnetic resonance imaging scan where they performed a rumination induction task. Results: Individuals with childhood adversities differed from those without adverse experiences in seed-based functional connectivity from right angular gyrus and left superior frontal gyrus during the rumination task. There were also group differences during resting-state in seed-based functional connectivity from the right angular gyrus, left middle temporal gyrus, and left superior frontal gyrus. Conclusions: Childhood adversity is associated with altered brain functioning during rumination and resting-state, even after controlling for tendency to ruminate. Our results shed light on the consequences of early adversity. People who experienced childhood adversities differ from those with no adverse experiences in brain functional connectivity when engaged in negative repetitive self-referential thinking.

Antecedentes: La adversidad en la infancia se ha asociado con un mayor riesgo de desarrollar psicopatología, alteración del procesamiento de estímulos emocionales y cambios en el funcionamiento neuronal. Aunque los correlatos neuronales de la rumiación se han descrito previamente, se sabe poco acerca de cómo las experiencias adversas en la infancia se relacionan con el funcionamiento del cerebro durante la rumiación.Objetivo: Este estudio exploró las diferencias en la conectividad neuro funcional entre participantes con y sin antecedentes de adversidad en la infancia, controlando la tendencia a rumiar, durante el estado de reposo y la inducción de la rumiación.Método: Participaron un total de 86 adultos (51 mujeres). Basado en una entrevista clínica de diagnóstico, los participantes se dividieron en grupos con y sin experiencias adversas en infancia. Todos los participantes se sometieron a imágenes en estado de reposo y a una resonancia magnética funcional en la que realizaron una tarea de inducción de la rumiación.Resultados: Los individuos con adversidades en la infancia diferían de aquellos sin experiencias adversas en la conectividad funcional basada en semillas de la circunvolución angular derecha y la circunvolución frontal superior izquierda durante la tarea de rumiación. También hubo diferencias de grupo durante el estado de reposo en la conectividad funcional basada en semillas de la circunvolución angular derecha, la circunvolución temporal media izquierda y la circunvolución frontal superior izquierda.Conclusiones: La adversidad en la infancia se asocia con un funcionamiento cerebral alterado durante la rumiación y el estado de reposo, incluso después de controlar la tendencia a rumiar. Nuestros resultados aclaran las consecuencias de la adversidad temprana. Las personas que experimentaron adversidades en la infancia difieren de aquellas que no tuvieron experiencias adversas en la conectividad funcional del cerebro cuando se dedican al pensamiento autorreferencial repetitivo negativo.

Brain activation during cognitive reappraisal depending on regulation goals and stimulus valence.

Neural bases of cognitive reappraisal may depend on the direction of regulation (up- or downregulation) and stimulus valence (positive or negative). This study aimed to examine this using a cognitive reappraisal task and conjunction analysis on a relatively large sample of 83 individuals. We identified regions in which activations were common for all these types of emotion regulation. We also investigated differences in brain activation between the 'decrease' and 'increase' emotional response conditions, and between the regulation of negative and positive emotions. The common activation across conditions involved mainly the prefrontal and temporal regions. Decreasing emotions was associated with stronger involvement of the dorsolateral prefrontal cortex, while increasing with activation of the amygdala and hippocampus. Regulation of negative emotions involved stronger activation of the lateral occipital cortex, while regulation of positive emotions involved stronger activation of the anterior cingulate cortex extending to the medial prefrontal cortex. This study adds to previous findings, not only by doing a conjunction analysis on both emotional valences and regulation goals, but also doing this in a bigger sample size. Results suggest that reappraisal is not a uniform process and may have different neural bases depending on regulation goals and stimulus valence.

The routine immunohistochemical evaluation in Paget disease of the nipple.

Paget disease (PD) of the nipple with coexisting intraductal (DCIS) and invasive carcinoma of the breast comprises 0.6-1.8% of all malignant epithelial neoplasms of this organ. Unlike invasive ductal carcinoma, there are many controversies concerning histological features of PD and the significance of the immunohistochemical characteristics of this neoplasm, which limits the optimal treatment protocols. Therefore, we decided to verify the immunohistochemical markers of PD basing on the retrospective analysis of postoperative material from 69 patients treated surgically. Microscopic examination revealed partial (7 cases) or total (62 cases) replacement of the squamous epithelium of the nipple with nests of atypical glandular cells spreading in an area ranging from 0.2 to 2.5 cm. DCIS coexisting with the PD lesions was present in all examined patients, and infiltrating carcinoma occurred in 31 (44.9%) patients. Both intraepidermal and DCIS components presented c-erbB2 overexpression. Positive estrogen and progesterone receptor staining was observed only in 7 (10.1%) and 2 (2.7%) tumours, respectively. Ki-67 proliferation index of PD cells ranged from 10% to 30%, whereas in DCIS it varied from 4% to 20%. The value of Ki-67 index exceeding 25% in the intraepidermal component of PD was associated with worse overall survival rate.

Clinico-morphological parameters affecting survival of patients with advanced cervical cancer.

The aim of the study was to investigate the prognostic significance of selected clinico-morphological parameters including Ki-67 antigen expression and microvessel density. The data of 122 patients with squamous cell carcinoma, FIGO stages IB-IIIB and treated with radiochemotherapy and brachytherapy were studied. Significant prognostic factors for disease-free survival in univariate analysis were the FIGO stage and the presence of atypical mitoses in carcinoma cells. Multivariate Cox analysis confirmed prognostic significance of the FIGO stage and Ki-67 expression with regard to disease-free survival. With regard to overall survival, the most important prognostic factor was Ki-67 antigen expression. The data concerning the pretreatment status of these parameters may be helpful in clinical practice.

[Smoking habits among women over 30 years old in Malopolska]. / Palenie tytoniu wsród kobiet powyzej 30. roku zycia w Malopolsce.

INTRODUCTION: The aim of the study was to estimate smoking habits and their intensity among women from urban and rural residents of Malopolska voivodship. MATERIAL AND METHODS: A structured questionnaire was used by trained nurses who conducted personal interview. Questions regarding smoking referred to age of starting smoking, duration of smoking, average daily number of cigarettes smoked. The total number of collected interviews was 840. Lifetime exposure to cigarette smoking was expressed in pack-years. RESULTS: Data were collected among 602 urban and 238 rural women from Malopolska voivodship. In Malopolska, there are 23.4% current smokers among women, 21.7% are ex-smokers, and about 55% never smoked. The percentage of never smokers in women is significantly higher among the rural women group (67.3%) than urban women group (50.0%). Currently smoking are 25.9% urban inhabitans and 17.2% women from rural population. There were no significant differences in smoking habits among younger group of women (below 50 years) living in urban and rural areas. CONCLUSION: The present results indicate that female population in urban and rural areas need effective educational strategy associated with presenting negative consequences of tobacco smoking and support in quitting the addiction.

Executive Dysfunctions in Schizophrenia: A Critical Review of Traditional, Ecological, and Virtual Reality Assessments.

In recent years, interest has grown in measuring executive function in schizophrenia with ecological and virtual reality (VR) tools. However, there is a lack of critical analysis comparing those tools with traditional ones. This paper aims to characterize executive dysfunction in schizophrenia by comparing ecological and virtual reality assessments with traditional tools, and to describe the neurobiological and psychopathological correlates. The analysis revealed that ecological and VR tests have higher levels of verisimilitude and similar levels of veridicality compared to traditional tools. Both negative symptoms and disorganization correlate significantly with executive dysfunction as measured by traditional tools, but their relationships with measures based on ecological and VR methods are still unclear. Although there is much research on brain correlates of executive impairments in schizophrenia with traditional tools, it is uncertain if these results will be confirmed with the use of ecological and VR tools. In the diagnosis of executive dysfunction, it is important to use a variety of neuropsychological methods-especially those with confirmed ecological validity-to properly recognize the underlying characteristics of the observed deficits and to implement effective forms of therapy.

Sex Differences in Verbal Fluency Among Young Adults.

Verbal fluency tasks have been used as tools to measure various cognitive processes, such as executive functions, memory, and language. Sex differences in verbal fluency performance have been mostly investigated in population studies. Little of this research has focused on young adults. The goal of this study was to assess the impact of sex and task category on word production and verbal strategies (i.e., cluster size and switches) in young adults. The phonemic (letter "k", letter "f") and semantic (animals, fruits, sharp objects) fluency measures were used. Men and women were compared in terms of the number of produced words and the use of verbal strategies (number of switches and mean cluster size controlled for produced words). Results revealed subtle sex differences in verbal fluency in young adults. Men performed slightly better in semantic fluency, producing more words, while there were no sex differences in verbal strategies. There were also no sex differences in word production and verbal strategies in the phonemic fluency tasks. Furthermore, there were differences in the number of produced words, mean cluster sizes, and switches between semantic tasks as well as between phonemic tasks. These results can be interpreted in the context of potential differences in mental lexicon and social roles. Moreover, our results suggest that assessment of verbal strategies and overall word production may be important in the context of sex differences in verbal fluency among young adults as well as in neuropsychological diagnosis.

Male sexual orientation, gender nonconformity, and neural activity during mental rotations: an fMRI study.

The cross-sex shift hypothesis predicts that gay men should perform more like heterosexual women on important neurocognitive tasks on which men score higher than women, such as mental rotation. Studies also suggest sex differences exist in the neural correlates of mental rotation. However, no studies have taken sexual orientation into account or considered within-group variation attributable to recalled gender nonconformity (a developmental trait reliably associated with human nonheterosexuality). We quantified the neural correlates of mental rotation by comparing two groups of gay men, gender conforming (n = 23) and gender nonconforming (n = 23), to gender conforming heterosexual men (n = 22) and women (n = 22). We observed a sex difference between heterosexual men and women in the premotor cortex/supplementary motor cortex and left medial superior frontal gyrus. We also observed a sex difference as well as a cross-sex shift in gay men who recalled being gender nonconforming as children in the right superior frontal gyrus, right angular gyrus, right amygdala/parahippocampal gyrus, and bilaterally in the middle temporal gyrus and precuneus. Thus, cross-sex shifts may be associated with underlying developmental factors which are associated with sexual orientation (such as gender nonconformity). The results also suggest that gay men should not be studied as a homogenous group.

Simple clinical scores to predict blood pressure and renal function response to renal artery stenting for atherosclerotic renal artery stenosis.

INTRODUCTION: There are no systematic tools to predict blood pressure (BP) or renal function (RF) improvement after stent­assisted percutaneous transluminal angioplasty (PTA) for atherosclerotic renal artery stenosis (ARAS). OBJECTIVE: This study aimed to develop simple, clinically applicable scores based on preprocedural clinical and renal ultrasonography parameters in order to predict BP and RF improvement following ARAS­PTA. PATIENTS AND METHODS: A total of 202 patients who underwent ARAS­PTA were categorized as RF responders (eGFR increase ≥11 ml/min/1.73 m2) or BP responders (systolic and diastolic BP decrease ≥20 mm Hg and ≥5 mm Hg, respectively) at 12 months following ARAS­PTA. The variables associated with the RF or BP response in univariable analysis were included in a multivariable logistic regression model. Point­based response scales were developed proportionally to odds ratios in each of the 2 models to embrace the maximum score of 10. RESULTS: The BP response to ARAS­PTA was 93.3% in the high­probability category (6-10 points), 66.7% in the medium­probability category (3-5 points), and 25.3% in the low­probability category (0-2 points), with the preprocedural variables of systolic BP ≥145 mm Hg (3 points), diastolic BP ≥83 mm Hg (4 points), PTA of a single functioning kidney (2 points), and bilateral PTA (1 point). The RF response was 77.3% in the high­probability category (8-10 points), 33% in the medium­probability category (4-7 points), and 10.9% in the low­probability category (0-3 points) for serum creatinine levels >122 µmol/l and eGFR >30 ml/min/1.73 m2 (3 points), index kidney length >98 mm (3 points), renal artery end­diastolic velocity >1.1 m/s (2 points), and arterial resistive index <0.74 (2 points). CONCLUSIONS: Models of favorable BP and RF response may improve patient selection for ARAS­PTA. Further insights are expected from prospective validation.

Metaphor Processing Dysfunctions in Schizophrenia Patients With and Without Substance Use Disorders.

BACKGROUND: Patients with schizophrenia have difficulties comprehending metaphors, which significantly impedes communication. However, this topic has not been thoroughly studied in people with a dual diagnosis. On this basis, we formulated two research aims: a) to compare the ability to comprehend metaphors in schizophrenia patients without (SZ) and with substance use disorder (SZ-SUD) and b) to determine the relationship between the processing of metaphorical content and the severity of psychopathological symptoms in both clinical groups. METHODS: A total of 40 individuals with SZ and 40 individuals with SZ-SUD took part in the study. The control group was composed of 40 individuals without a psychiatric or neurological diagnosis. Four subtests from the Right Hemisphere Language Battery (Picture Metaphor Test, Written Metaphor Test, Picture Metaphor Explanation Test, Written Metaphor Explanation Test) were used to measure the ability to understand and explain metaphors. RESULTS: Both groups of individuals with schizophrenia (SZ and SZ-SUD) scored lower than individuals from the control group on all tests of metaphor processing. However, no differences were observed between the two clinical groups. SZ-SUD patients had better results for Picture Metaphor Explanation than for Written Metaphor Explanation. Negative symptoms were found to be significant predictors of difficulties with understanding and explaining metaphors. CONCLUSION: Individuals with schizophrenia, regardless of their substance use disorder (SUD) status, exhibit impaired metaphorical content processing. SUD in schizophrenia is not associated with significant impairments in understanding and explaining metaphorical content. Moreover, impairments in processing metaphorical content are associated with more severe negative symptoms of schizophrenia.

Polyvascular extracoronary atherosclerotic disease in patients with coronary artery disease.

BACKGROUND: Cardiovascular diseases are the number one killer in the developed countries, accounting for approximately half of all deaths, with the leading causes being myocardial infarction and ischaemic stroke. In line with the ageing population, the prevalence of coronary artery disease (CAD), lower extremity peripheral arterial disease (PAD), supra-aortic arterial disease (SAD) and renal stenosis (RAS) is increasing. Polyvascular atherosclerosis (PVA) coexisting in several territories has an adverse effect on cardiovascular morbidity and mortality. AIM: To determine prevalence, coexistence and predictors of significant PAD, SAD and RAS in patients with suspected CAD. METHODS: Based on angiography, the frequency of coexisting CAD, SAD, PAD and RAS (stenosis > or =50%) was determined in 687 (487 male) consecutive patients, aged 63.5 +/- 9.1 years, referred for coronary angiography. RESULTS: Significant CAD was found in 545 (79.3%) patients (1-vessel in 164; 2-vessel in 157; 3-vessel in 224). SAD, RAS and PAD were found in 136 (19.8%), 55 (8%), and 103 (15%) patients, respectively. Of the 545 patients with confirmed CAD, 346 (63.5%) had stenoses limited to coronary arteries. 2-, 3- and 4-level PVA was found in 130 (23.8%), 61 (11.2%) and 8 (1.5%) patients, respectively. Of the 142 patients without CAD, 127 (89.4%) had no significant stenoses elsewhere, 12 (8.5%) had 1 extracoronary territory and 3 (2.1%) had 2-territory involvement. Backward stepwise binary logistic regression analysis showed the following independent predictors of at least 2-level PVA: 2- and 3-vessel CAD (p < 0.001), hyperlipidaemia (p = 0.067), smoking (p < 0.001), creatinine level > or = 1.3 ml/dl (p < 0.001), lower extremities claudication (p < 0.001) and female gender (p = 0.003). The relative risk of having at least 2-territory PVA was 15.7-fold higher in patients with claudication, 2.1-fold in patients with multivessel CAD, 2.8-fold for serum creatinine level > 1.3 mg/dl; and 1.9-fold, 2.4-fold and 2-fold in patients with hyperlipidaemia, smokers and women, respectively. CONCLUSIONS: Significant atherosclerosis in extracoronary arterial territories is present in 36% of patients with documented CAD. With advancing PVA, accumulation of atherosclerosis risk factors, previous atherothrombotic events and more severe CAD is observed.