New structural brain imaging endophenotype in bipolar disorder.

Neuroimaging studies suggest anterior-limbic structural brain abnormalities in patients with bipolar disorder (BD), but few studies have shown these abnormalities in unaffected but genetically liable family members. In this study, we report morphometric correlates of genetic risk for BD using voxel-based morphometry. In 35 BD type I (BD-I) patients, 20 unaffected first-degree relatives (UAR) of BD patients and 40 healthy control subjects underwent 3 T magnetic resonance scanner imaging. Preprocessing of images used DARTEL (diffeomorphic anatomical registration through exponentiated lie algebra) for voxel-based morphometry in SPM8 (Wellcome Department of Imaging Neuroscience, London, UK). The whole-brain analysis revealed that the gray matter (GM) volumes of the left anterior insula and right inferior frontal gyrus showed a significant main effect of diagnosis. Multiple comparison analysis showed that the BD-I patients and the UAR subjects had smaller left anterior insular GM volumes compared with the healthy subjects, the BD-I patients had smaller right inferior frontal gyrus compared with the healthy subjects. For white matter (WM) volumes, there was a significant main effect of diagnosis for medial frontal gyrus. The UAR subjects had smaller right medial frontal WM volumes compared with the healthy subjects. These findings suggest that morphometric brain abnormalities of the anterior-limbic neural substrate are associated with family history of BD, which may give insight into the pathophysiology of BD, and be a potential candidate as a morphological endophenotype of BD.

Brazilian psychiatric brain bank: a new contribution tool to network studies.

There is an urgent need for expanding the number of brain banks serving psychiatric research. We describe here the Psychiatric Disorders arm of the Brain Bank of the Brazilian Aging Brain Study Group (Psy-BBBABSG), which is focused in bipolar disorder (BD) and obsessive compulsive disorder (OCD). Our protocol was designed to minimize limitations faced by previous initiatives, and to enable design-based neurostereological analyses. The Psy-BBBABSG first milestone is the collection of 10 brains each of BD and OCD patients, and matched controls. The brains are sourced from a population-based autopsy service. The clinical and psychiatric assessments were done by an expert team including psychiatrists, through an informant. One hemisphere was perfused-fixed to render an optimal fixation for conducting neurostereological studies. The other hemisphere was comprehensively dissected and frozen for molecular studies. In 20 months, we collected 36 brains. A final report was completed for 14 cases: 3 BDs, 4 major depressive disorders, 1 substance use disorder, 1 mood disorder NOS, 3 obsessive compulsive spectrum symptoms, 1 OCD and 1 schizophrenia. The majority were male (64%), and the average age at death was 67.2 ± 9.0 years. The average postmortem interval was 16 h. Three matched controls were collected. The pilot stage confirmed that the protocols are well fitted to reach our goals. Our unique autopsy source makes possible to collect a fairly number of high quality cases in a short time. Such a collection offers an additional to the international research community to advance the understanding on neuropsychiatric diseases.

A randomized controlled trial of cognitive behavioral group therapy for bipolar disorder.

BACKGROUND: This study evaluated the effectiveness of adjunctive cognitive behavioral group therapy (CBGT) to prevent recurrence of episodes in euthymic patients with bipolar disorder. METHODS: A randomized controlled single-blind trial was conducted with 50 patients with bipolar disorder types I and II followed up for at least 12 months in an outpatient service and whose disease was in remission. An experimental CBGT manual was developed and added to treatment as usual (TAU), and results were compared with TAU alone. RESULTS: Intention-to-treat analysis showed that there was no difference between groups in terms of time until any relapse (Wilcoxon = 0.667; p = 0.414). When considering type of relapse, there was still no difference in either depressive (Wilcoxon = 3.328; p = 0.068) or manic episodes (Wilcoxon = 1.498; p = 0.221). Although occurrence of episodes also did not differ between groups (χ(2) = 0.28; p = 0.59), median time to relapse was longer for patients treated with CBGT compared to TAU (Mann-Whitney = -2.554; p = 0.011). CONCLUSIONS: Time to recurrence and number of episodes were not different in the group of patients treated with CBGT. However, median time to relapse was shorter in the TAU group. Studies with larger samples may help to clarify whether our CBGT approach prevents new episodes of bipolar disorder. Our findings also indicated that CBGT is feasible in euthymic patients with bipolar disorder and should be investigated in future studies. To our knowledge, this is the first publication of a controlled trial of CBGT for euthymic patients with bipolar disorder.

Soil attributes drive nest-site selection by the campo miner Geositta poeciloptera.

Substrate type is a key-factor in nest-site selection and nest architecture of burrowing birds. However, little is known about which factors drive nest-site selection for these species, especially in the tropics. We studied the influence of soil attributes on nest-site selection by the campo miner Geositta poeciloptera, an open grassland bird that builds its nests within soil cavities. For all nests found, we measured the depth of the nest cavity and the resistance of the soil to penetration, and identified the soil horizon in which the nest was located. In soil banks with nests, we collected soil samples for granulometric analysis around each nest cavity, while in soil banks without nests we collected these samples at random points. From 43 nests found, 86% were located in the deeper soil horizons (C-horizon), and only 14% in the shallower horizons (B-horizon). Granulometric analysis showed that the C-horizons possessed a high similar granulometric composition, with high silt and low clay contents. These characteristics are associated with a low degree of structural development of the soil, which makes it easier to excavate. Contrarily, soil resistance to penetration does not seem to be an important criterion for nest site selection, although nests in more resistant the soils tend to have shallower nest cavities. Among the soil banks analyzed, 40% of those without cavities possessed a larger proportion of B-horizon relative to the C-horizon, and their texture was more clayey. On the other hand, almost all soil banks containing nest cavities had a larger C-horizon and a silty texture, indicating that soil attributes drive nest-site selection by G. poeciloptera. Thus, we conclude that the patchy distribution of G. poeciloptera can attributed to the infrequent natural exposure of the C-horizon in the tropical region, where well developed, deep and permeable soils are more common.

Storage of Calophyllum brasiliense Cambess. seeds.

Calophyllum brasiliense is a species native to Brazil and has potential for use in the timber industry, in the reforestation of degraded areas, besides having medicinal properties. Its propagation is mainly by seeds which, depending on their recalcitrant characteristics, leads to difficulty in conservation, due to changes in its physiological potential during storage. Aiming to contribute to the expansion of its cultivation, rational use and conservation, the objective of this study was to investigate the behavior of C. brasiliense seeds during storage. Different packings (paper, aluminum and polyethylene) and environmental conditions (room temperature and cold chamber) were quarterly tested over 12 months, by evaluating germination viability and vigor. Based on the results, it was concluded that packaging in polyethylene and freezer storage provided the best conditions for the conservation of seeds, keeping them viable for a period of nine months.

The CACNA1C risk allele rs1006737 is associated with age-related prefrontal cortical thinning in bipolar I disorder.

Calcium channels control the inflow of calcium ions into cells and are involved in diverse cellular functions. The CACNA1C gene polymorphism rs1006737 A allele has been strongly associated with increased risk for bipolar disorder (BD) and with modulation of brain morphology. The medial prefrontal cortex (mPFC) has been widely associated with mood regulation in BD, but the role of this CACNA1C polymorphism in mPFC morphology and brain aging has yet to be elucidated. One hundred seventeen euthymic BD type I subjects were genotyped for CACNA1C rs1006737 and underwent 3 T three-dimensional structural magnetic resonance imaging scans to determine cortical thickness of mPFC components (superior frontal cortex (sFC), medial orbitofrontal cortex (mOFC), caudal anterior cingulate cortex (cACC) and rostral anterior cingulate cortex (rACC)). Carriers of the CACNA1C allele A exhibited greater left mOFC thickness compared to non-carriers. Moreover, CACNA1C A carriers showed age-related cortical thinning of the left cACC, whereas among A non-carriers there was not an effect of age on left cACC cortical thinning. In the sFC, mOFC and rACC (left or right), a negative correlation was observed between age and cortical thickness, regardless of CACNA1C rs1006737 A status. Further studies investigating the direct link between cortical thickness, calcium channel function, apoptosis mechanism and their underlying relationship with aging-associated cognitive decline in BD are warranted.

Influence of birth cohort on age of onset cluster analysis in bipolar I disorder.

PURPOSE: Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database. METHODS: The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared. RESULTS: There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups. CONCLUSION: These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Storage of Calophyllum brasiliense Cambess. seeds / Armazenamento de sementes de Calophyllum brasiliense Cambess

Abstract Calophyllum brasiliense is a species native to Brazil and has potential for use in the timber industry, in the reforestation of degraded areas, besides having medicinal properties. Its propagation is mainly by seeds which, depending on their recalcitrant characteristics, leads to difficulty in conservation, due to changes in its physiological potential during storage. Aiming to contribute to the expansion of its cultivation, rational use and conservation, the objective of this study was to investigate the behavior of C. brasiliense seeds during storage. Different packings (paper, aluminum and polyethylene) and environmental conditions (room temperature and cold chamber) were quarterly tested over 12 months, by evaluating germination viability and vigor. Based on the results, it was concluded that packaging in polyethylene and freezer storage provided the best conditions for the conservation of seeds, keeping them viable for a period of nine months.

Resumo Calophyllum brasiliense é uma espécie nativa do Brasil e está na lista de espécies recomendadas para o reflorestamento de áreas degradadas, além de possuir propriedades medicinais e madeireiras. Sua propagação se dá principalmente via sementes, as quais, em função das suas características recalcitrantes, apresentam dificuldade de conservação, devido a alterações no seu potencial fisiológico ao longo do armazenamento. Visando contribuir com a ampliação de seu cultivo, uso racional e conservação, objetivou-se investigar o comportamento das sementes de C. brasiliense durante 12 meses de armazenamento. Testou-se diferentes embalagens (papel, alumínio e polietileno) e condições ambientais (câmara fria e temperatura ambiente), avaliando-se trimestralmente a germinação, viabilidade e vigor. Com base nos resultados obtidos conclui-se que o acondicionamento em embalagem de polietileno e o armazenamento em câmara fria proporcionou a melhor condição para a conservação das sementes, mantendo essas viáveis por um período de nove meses.

Risk of hepatitis B virus reactivation in patients treated with anti-TNFalfa agents for immune-mediated inflammatory diseases / Riesgo de reactivación de la hepatitis B en los pacientes tratados con agentes anti-TNFalfa para enfermedades inflamatorias inmuno-mediadas

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Adjunctive zonisamide for treatment refractory anxiety.

The aim of the study was to assess the use of a novel anticonvulsant, zonisamide, in patients with treatment refractory anxiety. Pilot and open study of a cohort of patients with anxiety (n = 10), who were deemed partial or non-responders to anxiolytic therapy, and received adjunctive zonisamide in a naturalistic fashion. The primary outcome measures were the Hamilton Anxiety Scale (HAM-A), the Clinical Global Impression of Severity (CGI-S) and the Clinical Global Impression of Improvement (CGI-I). Patients included were markedly ill with a mean number of previous medication trials of 4.9 +/- 1.9, a baseline HAM-A score of 27.9 +/- 3.8, and a baseline CGI-S score of 5.7 +/- 0.5. Patients improved significantly with an end-point HAM-A score of 12.6 +/- 7.4 (p < 0.001), CGI-S score of 3.6 +/- 1.3 (p < 0.002) and CGI-I score of 2.5 +/- 1.3. Zonisamide at a mean +/- SD dose of 160 +/- 70 mg/day for 9.2 +/- 4.5 weeks was generally well tolerated. Adverse events were generally mild, and no patients discontinued zonisamide because of side effects. Six patients (60%) met responder criteria at end-point (CGI-I

Fosfatase ácida resistente ao tartarato como biomarcador do metabolismo ósseo no cão / Tartrate-resistant acid phosphatase as a biomarker of bone turnover in dog

Values of serum tartrate-resistant acid phosphatase ( TRAP) activity were obtained in adult dogs and its biological variability was assessed. Nine healthy skeletally mature Portuguese Podengo dogs were used for the determination of TRAP, total and bone alkaline phosphatase serum activities, and also to study their relationship with serum minerals, namely calcium (Ca), phosphorous (P), and magnesium (Mg). The serum TRAP activity was 2.19±0.56IU/mL, with intra-individual variation of 18.3 percent and inter-individual variation of 25.6 percent. Significant correlations were observed between serum TRAP activity and Ca (r=-0.3431; P<0.05), Ca and Mg (r=-0.787; P<0.01), and TRAP and Mg (r=0.397; P<0.05). The results indicate that serum TRAP activity in dog could be of great value in research and in clinical practice, providing complementary non-invasive information on bone metabolism.

Determinaram-se os valores da atividade da fosfatase ácida resistente ao tartarato (FART) e avaliou-se a sua variabilidade biológica. Neste estudo, foram utilizados nove cães adultos e saudáveis de raça Podengo Português para as determinações das atividades da FART, da fosfatase alcalina total, da isoenzima óssea da fosfatase alcalina e da concentração dos minerais séricos - cálcio, fósforo e magnésio. A atividade sérica obtida da FART foi de 2,19±0,56 UI/mL, com uma variação intra-individual de 18,3 por cento e interindividual de 25,6 por cento. Foram observadas correlações significativas ao longo do tempo entre FART e cálcio (r=-0,3431; P<0,05), entre FART e magnésio (r=0,3974; P<0,05) e entre cálcio e magnésio (r=-0,787; P<0,01). Os resultados indicam que este marcador de reabsorção óssea pode ser de grande valor na prática clínica e na investigação e, ainda, ser utilizado como um método auxiliar não invasivo para avaliação do metabolismo ósseo.

Narcolepsia: relato de um caso clínico de hipersonolência diurna / Narcolepsy: a case report of dayly hipersleepiness

Os autores apresentam o caso clínico de um homem de 36 anos de idade que recebeu o diagnóstico de narcolepsia após propedêutica anterior inconclusiva e tentativas terapêuticas infrutíferas. O paciente teve os seus sintomas melhorados com o tratamento adequado para a referida doença. Após o relato do caso, os AA empreendem discussäo teórica sobre o diagnóstico diferencial da narcolepsia com outras condiçöes clínicas caracterizadas por hipersonolência diurna, tais como a síndrome da apnéia obstrutiva do sono e depressäo atípica, considerando-se que têm fisiopatologia, evoluçäo, prognóstico e tratamento diferentes

Informe preliminar sobre el uso de octreotida (Sandostatín, Sandoz) en el manejo inicial (24 hrs) de la hemorragia, gastrointestinal superior masiva / Preliminary inform about the use of octreotide (Sandostatín, Sandoz) in the initial treatment (24hrs)of the superior gastrointestinal bleeding

El presente estudio constituye un informe preliminar sobre la efectividad de la administración IV de Octreotida (Sandostatín, Sandoz) en el control de la Hemorragia Gastrointestinal Superior Masiva (HGISM).Metodología:A todos los pacientes adultos que ingresaron al Hospital General de Enfermedad Común del IGSS [IGSS] y a un Hospital Privado [PRIV] con HGISM (pérdida de sangre severa por el tracto GI superior + hipovolemia-shock + Hemoglobina <8 G/dl a pesar de la administración de 2,000 ml de sangre) se les administró por vía IV 25 ug/hra de Sandostatina (6 amps. de 0.1 mg diluidas en 240 ml de D/A al 5 o Salino al 0.9 para una concentración final de 600 ug/240 ml; 12 ml/hra=25ug/hra) por un período de 24-48 hrs. Todos recibieron sangre y/o cristaloides, Vitamina K y/o plasma fresco y otras medidas generales de soporte. La actividad del sangrado se monitereo a través del aspirado continuo por sonda nasogástrica y el control periódico clínico y de laboratorio tradicional. La causa etiológica del sangrado se determinó efectuándose una gastroscopía en las 24-36 hrs iniciales de tratamiento...

Grado de erradicación logrado por diferentes esquemas de triple terapia en adultos guatemaltecos con infección gástrica por H. pylori y de diferente condición socio-económica: superiodad de la triple terapia conteniendo subcitrato de Bi / H. pilory erradication by three treatments in Guatemala

Objetivo: Se investigó la efectividad de diferentes esquemas de triple terapia para erradicar la infección gástrica por H. pylori en adultos sintomáticos pertenecientes a distinto estado socio-económico [ESEC]. Diseño: Un total de 70 pacientes de uno y otro sexos entre 17 y 70 años fueron estudiados: 33 sujetos con ESEC bajo [Grupo IGSS] atendidos en el Hospital General de Enfermedad Común del IGSS y 37 sujetos con ESEC alto [Grupo PRIV] atendidos en una Clínica Médica Privada. La triple terapia usada contenía 2 componentes estables, Amoxicilina (Amox, 500 mg PO c/8 hrs.) y Tinidazol (250 mg PO c/12 hrs), a los que se les agregó una sal de Bi fuera Subsalicilato de Bi (SSB, 525 mg PO qid) o Subcitrato de Bi (SCB 120 mg POD qid).Se usaron 4 esquemas terapéuticos: SSB20 [Amox + SSB + Tin x 20 días], SSB30 [(Amox + SSB x 30 días) + (Tin x 20 días)], SSB20 [Amox + SCB + Tin x 20 días], SCB30 [(Amox +SCB x 30 días) + (Tin x 20 días)]. Resultados: Se observó una estrecha relación entre la infección gástrica por H. pylori y la Gastritis Crónica Activa desapareciendo esta última al erradicarse la bacteria. El grado de erradicación del H.pylori gástrico logrado con los esquemas de tratamiento usado varió según a) los grupos de estudio: dicho porcentanje fue menor en el Grupo IGSS que en el Grupo PRIV; b) su duración: la erradicación fue mayor en los esquemas que duraron 30 días que en los de 20 días; c) la sal de Bi incorporada: los esquemas conteniendo SCB se asociaron de un grado mayor de erradicación que aquellos con SSB. Conclusión: Aunque diferente en cada grupo de estudio, el mayor porcentaje de erradicación de H. pylori gástrico se logró con el esquema SCB30, alcanzándose un 78 países industrializados