A profile approach to impulsivity in bipolar disorder: the key role of strong emotions.

OBJECTIVE: Bipolar disorder has been associated with elevated impulsivity - a complex construct subsuming multiple facets. We aimed to compare specific facets of impulsivity in bipolar disorder, including those related to key psychological correlates of the illness: reward sensitivity and strong emotion. METHOD: Ninety-one individuals diagnosed with bipolar I disorder (inter-episode period) and 80 controls completed several well-validated impulsivity measures, including those relevant to reward (Fun-seeking subscale of the Behavioral Activation System scale) and emotion (Positive Urgency and Negative Urgency scales). RESULTS: Bipolar participants reported higher impulsivity scores than did controls on all of the impulsivity measures, except the Fun-seeking subscale of the Behavioral Activation System scale. Positive Urgency - a measure assessing the tendency to act impulsively when experiencing strong positive emotion - yielded the largest group differences: F(1,170) = 78.69, P < 0.001, partial η(2)  = 0.316. Positive Urgency was also associated with poorer psychosocial functioning in the bipolar group: ΔR(2)  = 0.24, b = -0.45, P < 0.001. CONCLUSION: Individuals with bipolar I disorder appear to be at particular risk of behaving impulsively when experiencing strong positive emotions. Findings provide an important first step toward developing a more refined understanding of impulsivity in bipolar disorder with the potential to inform targeted interventions.

Microneedling versus microcoring: A review of percutaneous collagen induction for the face and neck.

BACKGROUND: Microneedling (MN) and microcoring (MCT) are both methods used for percutaneous collagen induction. This minimally invasive technique involves creating controlled damage in cutaneous tissue to induce neocollagenesis and neoelastogenesis. MN utilizes solid microneedles and is commonly combined with radiofrequency (RF) to add thermal energy, while MCT involves hollow microneedles capable of removing excess tissue without inducing scar formation. AIMS: The purpose of this review was to summarize recent literature for MN and MCT, with the goal of assisting clinical decision making regarding the use of these technologies. METHODS: PubMed search was conducted for relevant articles published within the last 10 years. Scoping literature review was then performed with pertinent findings reported. RESULTS: Existing literature investigating MCT is sparse. Limited data on in vivo, human effects of this technology exist. Two out of 14 studies in this review pertained to MCT. CONCLUSION: Additional high-powered clinical studies are needed to guide future cosmetic treatments with MN and MCT.

Analysis of the coding regions of VEGFR3 and VEGFC in Milroy disease and other primary lymphoedemas.

Milroy disease (hereditary lymphoedema type I, MIM 153100) is a congenital onset primary lymphoedema with autosomal dominant inheritance. Mutations in the gene, vascular endothelial growth factor receptor 3, VEGFR3 (FLT4), are known to cause Milroy disease, but there is uncertainty about the prevalence of VEGFR3 mutations in patients with primary lymphoedema and more specifically in those with a phenotype that resembles Milroy disease. This study aims to address this issue and thereby delineate the Milroy disease phenotype. Fifty-two patients with primary lymphoedema were analysed for mutations in the coding regions of VEGFR3. Patients were divided into four groups: Typical Milroy disease with family history (group I), typical Milroy disease with no family history (group II), atypical Milroy disease (group III), and complex primary lymphoedema (group IV). Results demonstrated that with rigorous phenotyping the likelihood of detecting VEGFR3 mutations is optimised. Mutation prevalence is 75% in typical Milroy patients with a family history (group I) and 68% if positive family history is not a diagnostic criterion. A positive family history is not essential in Milroy disease. The likelihood of detecting VEGFR3 mutations in patients who have a phenotype which is not typical of Milroy disease is very small (<5%). For the 22 mutation positive patients, 14 novel VEGFR3 mutations were identified, two of which were in exon 22 and one in exon 17, confirming that these exons should be included in VEGFR3 analysis. No mutations were found outside the kinase domains, showing that analysis of this part of the gene is not useful for Milroy disease patients. VEGFC, which encodes the ligand for VEGFR3, was sequenced in all patients with typical Milroy disease (groups I and II) and no mutations were identified.

Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery.

PURPOSE: Procedure (mastectomy v lumpectomy) and choice of procedure were examined as predictors of adjustment to breast cancer in a prospective study of the experiences of the first year after surgery. PATIENTS AND METHODS: Breast cancer patients were interviewed the day before surgery, 10 days after surgery, and at the 3-month, 6-month, and 12-month follow-ups. Patients included 24 women who received mastectomy on strong recommendation, 24 who chose mastectomy for other reasons, and 15 who chose lumpectomy. Subjective well-being was assessed in terms of mood disturbance, perceived quality of life, life satisfaction, marital satisfaction, perceptions of social support, and self-rated adjustment. RESULTS: Surgical groups differed in well-being in only one respect: lumpectomy patients reported a higher-quality sex life at 6 and 12 months postsurgery than mastectomy patients. Choice of surgical procedure predicted higher levels of life satisfaction at 3 months. CONCLUSION: The lack of difference between surgical groups in areas other than sexual adjustment replicates previous findings, but extends them by (1) using a fully prospective design, (2) providing data on the period surrounding the surgery (as well as later periods), and (3) examining a broader range of indices of well-being than usual.

Optimism and rehospitalization after coronary artery bypass graft surgery.

OBJECTIVE: To determine whether optimism predicts lower rates of rehospitalization after coronary artery bypass graft surgery for the 6 months after surgery. METHODS: A prospective, inception cohort design was used. The sample consisted of all consenting patients (N=309) from a consecutive series of patients scheduled for elective coronary artery bypass graft surgery at a large, metropolitan hospital in Pittsburgh, Pa. To be eligible, patients could not be scheduled for any other coincidental surgery (eg, valve replacement) and could not be in the cardiac intensive care unit or experiencing angina at the time of the referral. Participants were predominantly men (69.9%) and married (80.3%), and averaged 62.8 years of age. Recruitment occurred between January 1992 and January 1994. RESULTS: Compared with pessimistic persons, optimistic persons were significantly less likely to be rehospitalized for a broad range of aggregated problems (including postsurgical sternal wound infection, angina, myocardial infarction, and the need for another bypass surgery or percutaneous transluminal coronary angioplasty) generally indicative of a poor response to the initial surgery (odds ratio=0.50, 95% confidence interval=0.33- 0.76; P=.001). The effect of optimism was independent of traditional sociodemographic and medical control variables, as well as independent of the effects of self-esteem, depression, and neuroticism. All-cause rehospitalization also tended to be less frequent for optimistic than for pessimistic persons (odds ratio=0.77, 95% confidence interval=0.57-1.05; P=.07). CONCLUSIONS: Optimism predicts a lower rate of rehospitalization after coronary artery bypass graft surgery. Fostering positive expectations may promote better recovery.

7-alkylidenecephalosporin esters as inhibitors of human leukocyte elastase.

A series of 7-alkylidenecephalosporins and 7-vinylidenecephalosporins, as their benzhydryl esters, have been tested as inhibitors of both porcine pancreatic elastase and human leukocyte elastase. Selected 7-alkylidenecephalosporin esters are found to be potent inhibitors of HLE. One category of new inhibitors is the 7-(haloalkylidene)cephalosporins. In contrast to previously reported cephalosporin-based elastase inhibitors, these haloalkylidene cephems show optimum inhibitory activity as sulfides, rather than as sulfones. They are efficient and irreversible inhibitors. A second class of active compounds is represented by the benzhydryl ester 7-(cyanomethylidene)cephalosporin sulfone. In contrast to the activity of these new inhibitors, the benzhydryl ester of the mechanism-based beta-lactamase inhibitor, 7-[(2'-pyridyl)methylidene]-cephalosporin sulfone showed little inhibitory activity as an elastase inhibitor. 7-Vinylidenecephalosporins were also relatively poor inhibitors, although the terminally unsubstituted allene sulfide showed activity as an inhibitor of PPE. A modeling analysis suggests the 7-alkylidene substituents can be readily accommodated in the S1 pocket. A potential mechanism of inhibition is proposed.

Synthesis and biological activity of 7-alkylidenecephems.

Several 7-alkylidenecephalosporins were synthesized and biologically evaluated as beta-lactamase inhibitors. The three beta-lactamase enzymes used in this study included two type C beta-lactamases, derived from Enterobacter cloacae P99 and E. cloacae SC12368, and one type A beta-lactamase, derived from Escherichia coli WC3310. Of the cephalosporins prepared, compound 7e, the sodium salt of 7-[(Z)-(2'-pyridyl)methylene]cephalosporanic acid sulfone, was found to have excellent inhibitory properties against both type C enzymes. Also, compound 7f, the sodium salt of 7-[(Z)-(tert-butoxycarbonyl)methylene]cephalosporanic acid sulfone showed high activity as an inhibitor of the type A enzyme. The inhibition kinetics of 7e were further explored. The IC50 value of 7e indicated that this compound was approximately 20-fold more active than tazobactam against the enzyme derived from E. cloacae P99 and 167-fold more active than tazobactam against the enzyme derived from E. cloacae SC12368. A plot of enzymatic activity vs incubation time with stoichiometric amounts of inhibitor reveals a rapid deactivation of the enzyme followed by an extremely slow reactivation. 7e exhibited a second-order rate constant of k3' = 5.3 x 10(6) L/mol.min, and a partition ratio of approximately 20:1 inhibitor:enzyme was determined for this inhibitor. After separation of excess inhibitor with Sephadex filtration, a rate constant of enzyme reactivation was measured at kreactiv = 1.0 x 10(-3) s-1. Following 24 h of incubation of enzyme with a large excess of inhibitor and sephadex filtration to remove excess inhibitor, the enzyme was able to recover only 43% of its original activity, indicating an irreversible component to the inhibition. Potential mechanisms of inhibition for both 7e and 7f are suggested.

Molecular cloning and characterization of cDNA encoding tryptophan hydroxylase from rat central serotonergic neurons.

Tryptophan hydroxylase (TPH) from central serotonergic neurons in the dorsal raphe nucleus (DRN) and that from the endocrine pineal gland (PG) have been shown to exhibit difference biochemical characteristics. We further report here that the isoelectric point determined by chromatofocusing differs between TPH from the rat brainstem and PG. In addition, the levels of TPH mRNA are much greater in the PG than the DRN despite a higher enzymatic activity in the DRN. These data raise the question as to whether different forms of TPH may exist in the DRN and the PG. To address this question, we amplified TPH cDNAs by the polymerase chain reaction (PCR) using poly(A)+ RNA purified from both tissues. Several combinations of oligonucleotide primers encompassing different regions of the published coding sequence of rat pineal TPH were employed for this purpose. Subsequent analysis by gel electrophoresis and Southern blotting of PCR products indicated that DNA fragments of identical length were amplified from both sources. Furthermore, the nucleotide sequences of three independent subclones containing the putative full-length coding region of DRN TPH were determined and found to be identical to that of PG. In situ hybridization using the amplified cDNA as a probe demonstrated specific labeling within the DRN of the rat brain. These data support the hypothesis that tissue-specific differences in TPH characteristics result from differential post-translational events and clearly indicate that a TPH mRNA transcript identical in coding sequence to the PG form is expressed in the DRN.

Optimism, coping, and health: assessment and implications of generalized outcome expectancies.

This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale's psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer.

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.

Associations of blood pressure with self-report measures of anger and hostility among black and white men and women.

This study examined associations between blood pressure (BP) and dispositional variables pertaining to anger and hostility. Black and White 25- to 44-year old male and female normotensives and unmedicated mild to moderate hypertensives completed four reliable self-report scales--the Cook-Medley Hostility (Ho) Scale, the Trait Anger subscale of the State-Trait Anger Scale (STAS-T), and the Cognitive Anger and Somatic Anger subscales of the Cognitive-Somatic Anger Scale--plus the Framingham Anger Scale and the Harburg Anger Scale. They also engaged in three laboratory tasks--Type A Structured Interview (SI), a video game, and a cold pressor task--that elicit cardiovascular reactivity. Ambulatory BP readings at home and at work were also obtained from most subjects. Blacks had significantly higher Ho and lower STAS-T scores than did Whites. Women reported higher levels of somatic anger than did men. White women showed significant positive correlations between STAS-T and systolic BP (SBP) and diastolic BP (DBP) both at rest in the laboratory and during the SI. Black women revealed significant positive relationships between STAS-T and SBP and DBP at rest in the laboratory and at work as well as with DBP during the cold pressor test. For Black men, cognitive anger and DBP at rest were positively related. In contrast, White men revealed significant negative correlations between Ho scores and SBP at rest and during the video game; these men also showed significant negative relationships between somatic anger and SBP and DBP reactivity during the cold pressor test. Women, but not men, showed significant positive relationships between all four anger measures and ambulatory BP at work. Whereas main effects relating anger and cardiovascular measures were not apparent as a function of race, Blacks demonstrated significantly greater SBP and DBP reactivity than Whites during the cold pressor test, with the converse occurring during the SI. Men demonstrated significantly greater DBP reactivity than women during the video game. The present findings indicate that self-reports on anger/hostility measures and cardiovascular responses to behavioral tasks differ as a function of race but that relationships between anger and BP regulation need to take into account possible race-sex interactions and selection of anger/hostility measures.

Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients.

Much work on psychosocial sequelae of breast cancer has been guided by the assumption that body image and partner reaction issues are focal. In a tri-ethnic sample of 223 women treated for early-stage breast cancer within the prior year, the authors assessed a wider range of concerns and relations to well-being. Strongest concerns were recurrence, pain, death, harm from adjuvant treatment, and bills. Body-image concerns were moderate; concern about rejection was minimal. Younger women had stronger sexual and partner-related concerns than older women. Hispanic women had many stronger concerns and more disruption than other women. Life and pain concerns and sexuality concerns contributed uniquely to predicting emotional and psychosexual disruption; life and pain concerns and rejection concerns contributed to predicting social disruption. In sum, adaptation to breast cancer is a process bearing on several aspects of the patient's life space.

Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer.

The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.

Histopathologic analysis of intraarterial polyvinyl alcohol microemboli in rat cerebral cortex.

Polyvinyl alcohol (PVA) foam particles have been used with success in both experimental and clinical embolization of vascular lesions. Cellular response to PVA has been well documented outside, but not within, the central nervous system. This study was directed specifically at the cellular response to PVA in rat brain vasculature. By using small numbers of microparticles, an effort was made to define the response to PVA alone, rather than associated occlusions or infarctions. It was determined that PVA elicited no significant inflammatory response in the embolized vessels nor in the surrounding tissue. The isolated fragments did not appear to alter the blood-brain barrier. The PVA microemboli were extremely adherent to vascular endothelium, lodging in vessels of larger diameter and in relatively high-flow locations without actually wedging within the vessel lumen. On the basis of this analysis, it was determined that PVA foam has properties suitable for an intracerebral vascular embolic agent.

Responsiveness to threats and incentives, expectancy of recurrence, and distress and disengagement: moderator effects in women with early stage breast cancer.

Models of neurobiological systems linking personality, motivation, and emotion can be integrated with the expectancy construct to suggest hypotheses about distress and giving up in response to adversity. In 220 women with breast cancer, threat responsiveness-sensitivity of the behavioral inhibition system (BIS)-and incentive responsiveness-sensitivity of the behavioral activation system (BAS)-and expectancies about cancer recurrence were measured. It was predicted and found that high BIS sensitivity interacted with recurrence expectancy to predict elevated distress and disengagement. Low BAS sensitivity (reward responsiveness) also interacted with expectancy of recurrence to predict elevated disengagement. In contrast, high BAS sensitivity (fun seeking) interacted with recurrence expectancy to predict elevated distress. Discussion centers on theoretical implications and possible applications.

Microsurgical anatomy of the middle cerebral artery.

The microsurgical anatomy of the middle cerebral artery (MCA) was defined in 50 cerebral hemispheres. The MCA was divided into four segments: the M1 (sphenoidal) segment coursed posterior and parallel to the sphenoid ridge; the M2 (insular) segment lay on the insula; the M3 (opercular) segment coursed over the frontoparietal and temporal opercula; and the M4 (cortical) segment spread over the cortical surface. The Sylvian fissure was divided into a sphenoidal and an operculoinsular compartment. The M1 segment coursed in the sphenoidal compartment, and the M2 and M3 segments coursed in the operculoinsular compartment. The main trunk of the MCA divided in one of three ways; bifurcation (78% of hemispheres), trifurcation (12%), or division into multiple trunks (10%). The MCA's that bifurcated were divided into three groups: equal bifurcation (18%), inferior trunk dominant (32%), or superior trunk dominant (28%). The MCA territory was divided into 12 areas: orbitofrontal, prefrontal, precentral, central, anterior parietal, posterior parietal, angular, temporo-occipital, posterior temporal, middle temporal, anterior temporal, and temporopolar. The smallest cortical arteries arose at the anterior end and the largest one at the posterior end of the Sylvian fissure. The largest cortical arteries supplied the temporo-occipital and angular areas. The relationship of each of the cortical arteries to a number of external landmarks was reviewed in detail.

How should multifaceted personality constructs be tested? Issues illustrated by self-monitoring, attributional style, and hardiness.

Two or more dimensions unintentionally varied simultaneously are said to be confounded, but several theories in personality intentionally combine 3 or more distinct qualities. Researchers using these theories sum the qualities before testing predictions. How wise is this practice? The practice appears to derive from 2 distinct lines of reasoning. One of them assumes that the component dimensions converge on a single underlying quality (latent variable) that each reflects imperfectly. The other assumes a synergy among dimensions. Issues arising from each line of reasoning are illustrated by examining self-monitoring, attributional style, and hardiness. Conclusions are that (a) information is lost whenever a latent variable theory is tested solely by a composite and (b) a synergistic theory can be tested only through a statistical interaction.

Type A behavior pattern, sex role orientation, and psychological adjustment.

It was argued that the Type A "coronary-prone" behavior pattern is adaptive within the context of a highly masculine sex role orientation, but that it interferes with successful functioning among persons for whom such an orientation is lacking. This interference was expected to predominate in areas of behavior that are interpersonal in nature. Based on this reasoning, it was predicted that the combination of a Type A behavioral style and a sex role orientation low in masculinity would be associated with low social self-esteem, high social anxiety, and depression. Furthermore, because our culture expects women to be more socially adept than men, it was expected that these tendencies toward maladjustment would be more pronounced among women than men. A study of 213 college students yielded results that were consistent with these predictions.

Self-focusing effects of heartbeat feedback.

Two studies tested the hypothesis that auditory heartbeat feedback leads to an increase in self-directed attention. In Experiment 1, subjects exposed to a sound representing their heartbeat made greater self-attributions for hypothetical outcomes than did subjects exposed to the same sound identified as an extraneous noise. Furthermore, subjects in the heartbeat condition showed a pattern of color-naming latencies (on a color-word test) that was consistent with the hypothesis that self-related information was being activated in memory. In contrast, no such pattern was observed among subjects in the noise condition. In Experiment 2, comparisons with appropriate control groups indicated that neither an extraneous noise nor the attachment of a heartbeat-recording device influenced self-attribution, but that the presence of either a constant or an accelerating heartbeat increased self-attribution. The latter two conditions did not differ from each other. Discussion centers on the findings' methodological and theoretical implications.

Self-focused attention and the experience of emotion: attraction, repulsion, elation, and depression.

Four experiments were conducted to study the effect of self-focused attention on affective reactions. In addition, the research was also intended to help resolve the controversy over attentional versus arousal explanations of self-awareness research. In Experiment 1, undergraduate men were asked to view and rate slides of nude women in the presence of a mirror or with no mirror. In Experiment 3, subjects were either exposed or not exposed to a mirror and read a set of mood statements which became either increasingly positive or increasingly negative. Experiments 2 and 4 conceptually replicated Experiments 1 and 3 by selecting subjects on the basis of private self-consciousness. In each study, self-focused attention increased the person's responsiveness to his transient affective state. The convergence between mirror-manipulated self-awareness and private self-consciousness was offered as support for an attentional interpretation of the findings. The implications of the research for self-awareness theory are discussed.