Wnt (canonical and non canonical) pathways in breast carcinoma with extensive vascular invasion and inflammatory breast carcinoma.

BACKGROUND: Breast carcinoma with extensive peritumoral vascular invasion (ePVI-BC) is a cancer with massive vascular invasion (>10) detected in more than one slide. This neoplasm shows clinic-pathological affinity with inflammatory breast carcinoma (IBC). In this paper we evaluate their biological relationship through the study of surrogate markers (ß-catenin and NFAT5) of Canonical (cWnt) and non-canonical (nWnt) Wnt pathways activation. METHODS: By immunoistochemistry, we investigate ß-catenin and NFAT5 in 39 IBC, 74 ePVI-BC and 84 control cases (CG-BC). RESULTS: cWnt was activated in 100 % of ePVI-BC, in 64 % of IBC and 10 % of CG-BC. nWnt was activated in 20 % of ePVI-BC, 50 % of IBC and 1% of CG-BC. The prognosis of carcinomas with nWnt activated was poor similar to IBC. The statistical analysis evidences as both the pathways are synergistic in malignant progression and survival time. ß-catenin show an important association with prognostic factors and NFAT5 shows a relevant prognostic role on OS (p = 1.5*10-6) and DFS (P = 1,2*10-4). nWnt is associated with a worse prognosis independently of cWnt. cWnt is associated with adverse prognosis (DFS p = 0.0469; OS p = 0.004891) but its prognostic role is indifferent in carcinoma with nWnt activated. CONCLUSIONS: Canonical Wnt pathway is involved in malignant progression with dominant role for vascular invasion whereas non canonical Wnt pathway plays an important role on survival time including the capacity to identify carcinomas with IBC-like prognosis. Furthermore ePVI may represent a "prodromal form of IBC" as demonstrated by its clinicopathological and biological similarity with IBC.

Are personality disorders more frequent in early onset geriatric depression?

This preliminary study evaluates the prevalence of personality disorders (PD) in a sample of 37 elderly recovered depressed and non-demented patients, using the French version of the Vragenlijst voor Kenmezken van de Persoonlijkheid (VKP) or Questionnaire on Personality Traits (QPT). The prevalence of definite personality disorder was 65% with predominance of Cluster C and particularly dependent and avoidant PD. The rate of PDs was higher in early onset (73%) than in late onset (45%) geriatric depression, even though there is only a trend towards statistical significance (Chi square = 2.588, p = 0.107). These results are consistent with those of previous reports using different PD assessment methods, supporting evidence that the QPT could be useful in PD assessment of elderly French speaking patients.

Etiologic and outcome profiles in hypoactive and hyperactive subtypes of delirium.

The existence of hyperactive, hypoactive, or mixed clinical subtypes of delirium is widely accepted. But relationships between these motor profiles and etiology or outcome remain unclear. The aim of this study was to compare etiologic and outcome profiles in a case series of 183 elderly patients (mean age = 84.1 years, SD = 5.9) consecutively admitted into the geriatric wards of two French university hospitals or referred to a geriatric psychiatry consultation-liaison unit within a Swiss university hospital. All patients met DSM-III-R criteria for delirium and were classified into clinical subtypes according to the results of a previous factor analysis of scores on a 19-item checklist rating a wide range of delirium symptoms. The hyperactive subtype was more frequent (n = 85, 46.5%) than the unspecified (n = 50, 27.3%) and hypoactive subtypes (n = 48, 26.2%). There was no significant difference in terms of etiologic or outcome profile between clinical subtype groups. The presence of acute metabolic disorders, cardiovascular disease, and hyperthermia as etiologic factors was significantly associated with full recovery of the episode at 3 weeks follow-up, whereas probable preexisting dementia was significantly associated with partial recovery or failure to recover.

[A plan for a randomized evaluation study for improving the memory of the aged]. / Plan d'une étude d'évaluation randomisée de l'entraînement de la mémoire chez les personnes âgées.

The training is realised through exercises carried out during courses and at home. The effectiveness of this training is assessed by psychometric tests (before/after) and a questionnaire for self evaluation (after). An equal number of subjects to be trained and controls are selected among 100 or so voluntary participants.

[Confusion syndromes in hospitalized aged patients: polymorphism of symptoms and course. Prospective study of 183 patients]. / Les syndromes confusionnels du sujet âgé hospitalisé: polymorphisme sémiologique et évolutif. Etude prospective de 183 patients.

Using explicit criteria contained in the DSM III R, we collected in a prospective cohort study clinical features, outcome and risk factors from two cohorts of delirium in hospitalized elderly patients: 138 hospitalized in geriatric department and 45 patients admitted to an acute and comprehensive care hospital. The clinical features were assessed using a quantitative scale (developed by Derouesné). Delirium was unrecognized or misdiagnosed by physicians in 34% of the cases. The onset was known only two thirds of cases. The incidence of hyperactive type, prolonged hospital stay, poor outcomes (persistent delirium leading up to dementia) were highest in subjects admitted in comprehensive hospital. The etiology of delirium is complex and multifactorial. An underlying cause was identified in 80% of patients. The length or the worsening of delirium was significantly higher in patients with psychiatric or dementia comorbidity (OR: 0.2; IC 95%: 0.1-0.5). The prognosis was better in patients without psychoactive medications (OR: 0.2; IC 95%: 0.1-0.4) or with metabolic abnormalities or acute diseases and disorders (OR: 3.3; IC 95%: 1.5-7.6). The predisposing factors to the development of dementia were prior use of psychoactive medications and signs of prior cognitive impairment. This article suggests delirium in elderly patients is associated with several outcomes. The prognosis should be improved at admission by specific scale and an evaluation of predisposing and precipitating factors.

[Psychodynamic aspects of behavioral disorders in the senescent patient and their psychodynamic approach]. / Les aspects psychodynamiques des troubles de comportement chez le sujet sénescent et leur approche psychodynamique.

Melanie Klein's therapy is comprised of elements likely to be transposed to senescence for a better understanding of certain disorders in pathological aging. To this day, several clinical states that appear for the first time at an advanced stage in life, such as certain forms of depression, deliria or intellectual deficiency, have not been satisfactorily explained psychodynamically. The author attempts to create a new approach with a Kleinien perspective.

[The dimensions of isolation in the elderly]. / Les dimensions de l'isolement chez les personnes âgées.

For the aged, social isolation and loneliness are among the most frequent causes of hospitalization or placement in homes. A survey of 730 people over 65 shows that cohabitation becomes rarer with advancing age, a phenomenon that has grown increasingly important during the twentieth century. Social isolation, characterized by extremely infrequent contacts with other people, affects approximately one out of ten elderly people. Most at risk are those who retired from lower positions in employment, divorced people and widowers. The main causes are the absence of children and relatives in the immediate area, the fact of being divorced, the lack of professional apprenticeship and, above all, a psychological disposition to introversion. These concepts should form the basis for working out ways of preventing the generalization of a phenomenon which, in the absence of appropriate measures, might become a serious threat to the future of out society.

[Enduring loneliness. An interview survey of aged widows]. / Vivre sa solitude. Une enquête par interviews auprès de veuves âgées.

Interviews with 32 widows have given a clearer picture of the different ways of adaptation to solitude. The following types are distinguished: 1. the tormented (6 cases), who are crushed by loneliness and depression, even though they have the support of friends and relations 2. the isolated (7 cases), who may go for several days without seeing anyone 3. the misanthropes (3 cases): 'The less I see of my friends, the better I feel' 4. those who have found the answer to the problem of solitude in outside activities and contacts (5 cases) 5. those who have found tranquility after a lifetime of struggle (4 cases) 6. those with a naturally harmonious temperament who have overcome solitude and demonstrate the way to face it with courage, good sense and optimism (7 cases). This attempt at typology, which describes six different ways of living with solitude, has made possible a better analysis of the problem, its causes and its effects. Though solitude is often considered a negative aspect of growing old, it can also be a source of happiness, even of fulfillment. The capacity to live alone is something that has to be learned.

[Social networks of the elderly]. / Les réseaux relationnels des aînés.

The results of a survey conducted among 535 elderly people living in their own homes in urban areas make it possible to analyse the familiar and social relationship of this population. Cohabitation becomes rare as age increases and as most people, especially women, lose their spouses. More than half of the elderly people surveyed had good contacts with family and/or friends, but, for about a quarter of them, social relations were extremely rare. The authors of this article try to define the influence of age, sex, matrimonial status and the socio-professional milieu on the various forms of relationship. These data lead to the identification of a number of groups of people particularly exposed to the risk of isolation: former manual workers or persons having had very subordinate functions (this generally corresponds to a low level of schooling); people who were divorced or separated; men having lost their spouses (overall, men have somewhat fewer contacts than women with family and friends). Widows, though 25% of them were very isolated, generally had good family and social relationships; nevertheless, they often felt at a disadvantage in social life. Practically, the aim of the authors will not be to tackle isolation and solitude of the aged in general, but to design specific measures which will meet the real needs of the various groups at risk.

[The demented patient: his family, social and therapeutic environment]. / La personne démentifiée: son environnement familial, social et thérapeutique.

The patient's environment determines to a large extent the evolution of his illness. His family, which is almost always thrown into a state of confusion by the patient's illness, has the crucial role of providing support and protection even if they are overwhelmed by his needs. The support of the community is indispensable in order to assure the continuity of the parental role; therefore the need to create specialized services such as geriatric hospitals, hospices, special residences, out-patient therapeutic units, and social and medical services for care at home. The Geneva geriatric and gerontological experience is presented to better illustrate these needs.

Factor analysis supports the evidence of existing hyperactive and hypoactive subtypes of delirium.

OBJECTIVE: The aim of this study was to examine whether delirium has specific clinical subtypes. METHOD: One hundred and eighty-three elderly subjects meeting DSM-IIIR criteria for delirium were evaluated using a 19-item symptom check-list assessing different dimensions of delirium symptomatology. Exploratory factor analysis was conducted in order to examine which symptoms clustered. RESULTS: Factor analysis confirmed the existence of two different clusters of symptoms: first, symptoms of hyperalert/hyperactive features (agitation, hyper-reactivity, aggressiveness, hallucinations, delusions); and second, symptoms of hypoalert/hypoactive features (decreased reactivity, motor and speech retardation, facial inexpressiveness). CONCLUSION: This preliminary study seems to support the evidence of hypoactive and hyperactive subtypes of delirium, even though their aetiology and prognostic values need to be further examined.

Chemiluminescence activity in whole blood phagocytes of dogs naturally infected with Leishmania infantum.

Dogs are the domestic reservoir of Leishmania infantum, a vector-borne intracellular protozoan agent of human visceral leishmaniasis. The role of polymorphonuclear leukocytes (PMNs) in the immune defence against this parasite has been poorly studied. We have investigated the function of peripheral blood PMNs in naive beagle dogs that have been naturally exposed to phlebotomine vectors in an area highly endemic for canine leishmaniasis, and found infected by Leishmania at the end of the transmission season. Whole blood phagocyte oxidative metabolism was assessed by a rapid method that determines a luminol-amplified chemiluminescence (CL) emission. This was evaluated using either a soluble stimulant, phorbol mirystate acetate (PMA), or phagocytic stimuli, such as zymosan unopsonized (ZYM) or opsonized with autologous serum (OPZ). In blood samples taken 2 months after exposure to Leishmania transmission, data on CL emission revealed a significant decrease of reactive oxygen intermediates (ROI) production in the presence of both PMA and ZYM, compared with blood samples obtained from dogs before exposure. On the contrary, no variations in CL emission were detected in presence of OPZ. Our data indicate that immunological changes occur early in canine leishmaniasis and confirm that the role of PMNs and their products need to be clarified.