Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities-a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting.

BACKGROUND: This protocol is for a feasibility study of a mindfulness-based stress reduction (MBSR) program adapted for pregnant women with psychosocial vulnerabilities. The rationale for the study is the need for a wider array of evidence-based options to address prenatal mental health care needs in pregnant women. MBSR is a promising mental health intervention but has not yet been adapted for pregnant women with the aim of addressing prenatal mental health. The purpose is thus to evaluate the feasibility, acceptability, and clinical outcomes of an adapted MBSR program, prenatal MBSR, compared to usual care to inform a randomized controlled trial. METHODS/DESIGN: Pregnant women (n = 60) referred to an outpatient clinic at Copenhagen University Hospital, Amager and Hvidovre, Denmark, will be recruited for the study. The design is a single-center feasibility trial, with prenatal MBSR, as an add-on to usual care. The primary outcome is to assess the feasibility of a full-scale randomized controlled trial. The secondary feasibility outcome includes possible effects of the adapted MBSR program estimated by self-report questionnaires measuring stress, anxiety, depression, well-being, decentering, reflective functioning, mindfulness, and compassion. Participants will be randomized in a 1:1 ratio to prenatal MBSR or usual care. DISCUSSION: The study is part of the Good Start to Family Life study anchored at Copenhagen University Hospital, Amager and Hvidovre, Denmark. Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to reduce stress, improve mental health, and provide support in the transition to parenthood. The outcomes of the feasibility study will inform the design of a fully powered randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04571190 . Registered on September 30, 2020.

Direct frequency comb spectroscopy of trapped ions.

Direct frequency comb spectroscopy of trapped ions is demonstrated for the first time. It is shown that the 4s ;{2}S_{1/2}-4p ;{2}P_{3/2} transition in calcium ions can be excited directly with a frequency comb laser that is up-converted to 393 nm. Detection of the transition is performed using a shelving scheme to suppress the background signal from nonresonant comb modes. The measured transition frequency of f=761 905 012.7(0.5) MHz presents an improvement in accuracy of more than 2 orders of magnitude.

Improved laboratory values of the H2 Lyman and Werner lines for constraining time variation of the proton-to-electron mass ratio.

Two distinct high-accuracy laboratory spectroscopic investigations of the H2 molecule are reported. Anchor lines in the EF1Sigmag+-X1Sigmag+ system are calibrated by two-photon deep-UV Doppler-free spectroscopy, while independent Fourier-transform spectroscopic measurements are performed that yield accurate spacings in the B1Sigmau+-EF1Sigmag+ and I1Pig-C1Piu systems. From combination differences accurate transition wavelengths for the B-X Lyman and the C-X Werner lines can be determined with accuracies better than approximately 5 x 10(-9), representing a major improvement over existing values. This metrology provides a practically exact database to extract a possible variation of the proton-to-electron mass ratio based on H2 lines in high-redshift objects. Moreover, it forms a rationale for equipping a future class of telescopes, carrying 30-40 m dishes, with novel spectrometers of higher resolving powers.

Ultrafast double-pulse parametric amplification for precision Ramsey metrology.

We demonstrate phase stable, mJ-level parametric amplification of pulse pairs originating from a Ti:Sapphire frequency comb laser. The amplifier-induced phase shift between the pulses has been determined interferometrically with an accuracy of approximately 10 mrad. Typical phase shifts are on the order of 50-200 mrad, depending on the operating conditions. The measured phase-relation can be as stable as 20 mrad rms (1/300(th) of an optical cycle). This makes the system suitable for Ramsey spectroscopy at short wavelengths by employing harmonic upconversion of the double-pulses in nonlinear media.

Phase stability of terawatt-class ultrabroadband parametric amplification.

The phase stability of broadband (280 nm bandwidth) terawatt-class parametric amplification was measured, for the first time to our knowledge, with a combination of spatial and spectral interferometry. Measurements at four different wavelengths from 750 to 900 nm were performed in combination with numerical modeling. The phase stability is better than 1/23 rms of an optical cycle for all the measured wavelengths, depending on the phase-matching conditions in the amplifier.

A source of 2 terawatt, 2.7 cycle laser pulses based on noncollinear optical parametric chirped pulse amplification.

We demonstrate a noncollinear optical parametric chirped pulse amplifier system that produces 7.6 fs pulses with a peak power of 2 terawatt at 30 Hz repetition rate. Using an ultra-broadband Ti:Sapphire seed oscillator and grating-based stretching and compression combined with an LCD phase-shaper, we amplify a 310 nm wide spectrum with a total gain of 3x10(7), and compress it within 5% of its Fourier limit. The total integrated parametric fluorescence is kept below 0.2%, leading to a pre-pulse contrast of 2 x10(-8) on picosecond timescales.

[Prevalence of prenatal exposure to cocaine in a sample of newborns from a university teaching hospital] / Prevalência da exposição pré-natal à cocaína em uma amostra de recém-nascidos de um hospital geral universitário.

OBJECTIVE: To assess the prevalence of prenatal exposure to cocaine in a sample of newborns using two methods: fluorescence polarization immunoassay and interview with the mother. METHODS: This cross-sectional study was carried out in a university teaching hospital. The population included all live births between March 23, 1999 and June 01, 1999 (n=847). Exposure was determined by a benzoylecgonine-positive meconium specimen and/or by a positive interview with the mother. RESULTS: The prevalence of prenatal exposure to cocaine in this sample was 2.4% (16 cases) according to the interviews, and 3.4% (25 cases) according to the meconium analysis. A rate of 4.6% (34 cases) was found when both methods were associated. CONCLUSIONS: We observed that the meconium test was more effective than the maternal interview for the diagnosis of prenatal exposure to cocaine. The meconium analysis enhanced diagnostic chances by 53.4%, compared to 26% in the case of maternal interview.

Brain metastases in renal cell carcinoma: management with gamma knife radiosurgery.

PURPOSE: The purpose of this study was to evaluate survival and local control of brain metastases in patients with renal cell carcinoma. METHODS AND MATERIALS: From November 1993 through March 1999, 38 radiosurgical treatments using the Leksell gamma knife unit were performed on 22 patients with renal cell carcinoma. The indications for treatment were failure after whole-brain radiation therapy or de novo treatment. All radiosurgical treatments were given on an outpatient basis. The workup included computed tomography and magnetic resonance imaging. The age of the patients ranged from 38 to 80 years (median age, 60 years). The mean minimum tumor dose was 18 Gy, and the mean volume was 3.9 cc. Previous whole-brain radiation therapy was used in 11/22 (50%) patients. Four of 22 patients presented with single metastasis. Thirteen patients were treated once, one patient was treated four times and one patient seven times for new lesions. The number of lesions treated ranged from one to 21. RESULTS: One patient is al ive at 63 months of fol low-up. Twenty-one patients died, with a median survival of 8 months (range, 1-38 months). Eighteen of 21 patients died of nonneurologic causes. Overall local control was 98.5%. One patient developed radiation necrosis. CONCLUSIONS The long-term survival achieved in patients with renal cell carcinoma requires aggressive management, even in the presence of multiple brain metastases. Gamma knife radiosurgery for renal cell carcinoma is an effective noninvasive modality of treatment. It offers high local control rate and improved quality of life and survival.

Gamma knife radiosurgery in the treatment of patients with single and multiple brain metastases from carcinoma of the breast.

PURPOSE: The purpose of the study was to evaluate the results of gamma knife radiosurgery for treatment of brain metastases from carcinoma of the breast. MATERIALS AND METHODS: From December 1993 to July 1998, 68 women with breast carcinoma metastatic to the brain were treated with gamma knife radiosurgery at Miami Neuroscience Center in Coral Gables, Florida. The ages ranged from 25 to 80 years, with a median age of 52 years. Thirty-eight patients had previously received conventional modalities of treatment for brain metastases including whole-brain irradiation. A total of 110 treatments were given to the 68 women to an average of eight tumor sites per patient. Minimum doses ranged from 6 to 25 Gy to the 35% to 85% isodose line, with 95% of the prescribed minimum doses ranging from 15 to 24 Gy. Patients were treated for one to three lesions (n = 26), four to seven lesions (n = 18), and eight or more lesions (n = 24). RESULTS: The median overall actuarial survival for the entire group was 7.8 months. The actuarial survival was 32% at 1 year. The median follow-up was 7.8 months. Overall local control by lesion was 94% (485/518 lesions), and average tumor volume was 3.3 cm3. Twenty-seven (40%) of 68 eligible patients survived 1 year, nine (13%) survived 2 years, and two (3%) survived more than 3 years. Fifty-one of 56 documented deaths (91%) were unrelated to brain metastases. In a subgroup of 15 patients with single brain metastases, the average tumor volume was 16.6 cm3, and local control was 73% (11/15 lesions). The 15 patients who died had a median survival of 7.7 months (range, 3 to 45.7 months). CONCLUSIONS: Gamma knife radiosurgical treatment of patients with brain metastases from carcinoma of the breast has shifted the question of survival to that of systemic control. There was no radiation-induced dementia, and a remarkably low incidence of local failure was seen. Survival has been found to be independent of the number of lesions treated.

The effects of naltrexone on alcohol and cocaine use in dually addicted patients.

Concurrent dependence on cocaine and alcohol is common among patients seeking addiction treatment. This study was undertaken to explore the effectiveness of naltrexone (150 mg) as a potential treatment for patients who are alcohol and cocaine dependent. Of 15 subjects enrolled in the 12-week, open medication trial, 7 subjects did not complete the study. Relapse to clinically significant drinking occurred in 7 subjects (47%). There was a reduction in the average daily amount of alcohol consumed from pretreatment to treatment (p < .001) and the percentage of days engaged in drinking behavior (p < .001). Similarly, there was a reduction in the average weekly amount spent on cocaine from pretreatment to treatment (p = .001) and the percentage of days using cocaine (p < .001). This preliminary study suggests that naltrexone (150 mg) may be tolerable in patients dependent upon alcohol and cocaine and may be effective in reducing both cocaine and alcohol use. The results of this study provide a rationale for a double-blind placebo-controlled study of the efficacy of naltrexone in this difficult to treat but prevalent population.

Gender differences in comorbidly depressed alcohol-dependent outpatients.

UNLABELLED: Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (50 males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period. RESULTS: depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.

Focal cortical resections for the treatment of extratemporal epilepsy in children.

Epilepsy in children is a common and disabling disorder. Approximately 10% to 20% of patients who develop seizures will have medically intractable epilepsy. This group of patients may be candidates for epilepsy surgery. Unlike adults, epilepsy in children frequently arises in extratemporal sites. The surgical treatment of this extratemporal epilepsy is discussed in this article.

Thoracic epidural abscess.

Twenty-one cases of thoracic spinal epidural abscess occurring over a 10-year period were retrospectively reviewed. Diagnosis was made by MRI or myelography and confirmed in the operative cases. A bacterial agent was isolated in 18 of the cases (86%). When measured, the erythrocyte sedimentation rate was elevated in all cases. Four patients who presented without neurologic deficits remained intact. All patients who presented with neurological deficits underwent surgical intervention in addition to intravenous antibiotics. Of the 15 patients who presented with a paraparesis of less than antigravity strength, five eventually were independent ambulators and continent. A good outcome resulted in 80% of those who underwent decompression within 24 h, as opposed to only 10% of the patients decompressed after 24 h. Good results can be obtained despite severe neurologic compromise when treated by rapid diagnosis and decompression of the spinal canal.

Epidural abscess in the cervical spine.

A ten-year retrospective review of 23 cases of documented spinal epidural abscess in the cervical spine was undertaken to define the clinical features and establish current diagnostic and therapeutic criteria. Diagnosis was made by magnetic resonance imaging or myelography. Risk factors included intravenous drug abuse, diabetes mellitus, previous trauma, and a positive serologic test for the human immunodeficiency virus. A bacterial agent was isolated in 21 cases (91%). Neurologic deficits were present in 20 of the cases (87%) at the time of diagnosis. Erythrocyte sedimentation rate was elevated in all patients in whom it was measured. All patients were treated with appropriate antibiotics, usually for 6 to 8 weeks. Twenty-one patients underwent operative procedures using percutaneous aspiration (1 patient), the anterior approach (14 patients) or the posterior approach (4 patients), or a combination of the two approaches (2 patients). Four of ten patients who initially had less than antigravity strength were eventually ambulatory and continent; in each case, operative decompression was performed within 36 hours of initial consultation. Three patients who had no initial neurologic deficits remained intact.

Melanoma arising in a cervical spinal nerve root: report of a case with a benign course and malignant features.

A 20-year-old caucasian woman with a 5-year history of right arm, neck, and back pain sought treatment when an automobile accident (4 months before admission) exacerbated her pain. Magnetic resonance imaging revealed an intra- and extradural mass compressing the spinal cord at the C5-C6 level. It also extended into and widened the neural foramen, mimicking a neurofibroma. A single cafe-au-lait spot was discovered in the inguinal region. A two-staged surgical resection was performed on an apparent hemorrhagic C6 nerve root mass. The mass exhibited diagnostic features of a malignant melanoma histologically, immunocytochemically, and ultrastructurally. A search for a primary lesion outside the nervous system or other metastases during an 8-year period from the onset of symptoms has been negative. The patient's chronic history, evidence of neural foraminal enlargement, and the absence of other malignant melanoma lesions or subsequent metastases indicates that this lesion may be a primary melanoma of the nerve root with a benign course.

Cytokine-gene expression in measles-infected adult human glial cells.

The expression of interleukin (IL)-1 beta, IL-6 and tumor necrosis factor (TNF) alpha transcripts in cultured human glial cells was examined using reverse transcription followed by polymerase chain reaction (PCR) amplification and Southern blot quantitation. Microglial cultures derived from brain biopsy specimens from three different individuals expressed transcripts for the three cytokines under basal culture conditions. This expression was enhanced in response to measles virus (MV) infection (IL-1 beta, 2.2-8.8-fold; IL-6, 2.5-8.4-fold; TNF alpha, 2.2-3.2-fold). Neither IL-1 beta nor TNF alpha transcripts were detectable in undissociated brain tissue from two individuals, suggesting that the basal expression of these cytokines in culture may have been induced by tissue dissociation or by the culture conditions. Oligodendrocytes did not express cytokine transcripts under basal culture conditions, and IL-1 beta and IL-6 but not TNF alpha transcripts could be induced by MV. Similarly, meningeal fibroblasts expressed IL-1 beta and IL-6 but not TNF alpha in response to MV-infection, suggesting that the production of TNF alpha is more cell type-restricted than either IL-1 beta or IL-6. The results indicate that adult human microglia can participate in the inflammatory response to MV infection in the CNS by producing cytokines that contribute to inflammation and demyelination. In addition, besides their role in myelination, oligodendrocytes can potentially influence immunoreactivity in the CNS by producing IL-1 beta and IL-6.

Effect of THAM upon outcome in severe head injury: a randomized prospective clinical trial.

Although mortality and morbidity rates from head injury have been reduced substantially by improved prehospital interventions, intensive care, and aggressive management of intracranial pressure (ICP), successful treatment of the primary brain injury has been elusive. In experimental models, tromethamine (THAM) has been effective in treating head injury; this drug acts by entering the cerebrospinal fluid compartment, reducing cerebral acidosis and ICP, and reversing the adverse effects of prophylactic hyperventilation on early recovery. In this randomized prospective clinical trial, THAM was studied to determine if it had beneficial effects in the early management of severe head injuries and if the adverse effects of hyperventilation could be prevented. A total of 149 patients with severe head injury (Glasgow Coma Scale scores of < or = 8) were randomly assigned to either a control or a THAM group. Both groups of patients matched in terms of clinical parameters, including age, sex, number of surgical mass lesions, number in each Glasgow Coma Scale stratum, and first ICP measurement. All patients were treated by a standard management protocol, intubated, mechanically ventilated, and maintained in the pCO2 range of 32 to 35 mm Hg for 5 days. Tromethamine was administered as a 0.3-M solution in an initial loading dose (body weight x blood acidity deficit, average 4.27 cc/kg/hr) given over 2 hours, followed by a constant infusion of 1 ml/kg/hr for 5 days. Outcome was measured at 3, 6, and 12 months postinjury. Although analysis indicated no significant difference in outcome between these two groups at 3 months, 6 months, and 1 year, there was a difference regarding ICP. The time that ICP was above 20 mm Hg in the first 48 hours postinjury was less in patients treated with THAM (p < 0.05). Also, the number of patients requiring barbiturate coma was significantly less in the THAM group (5.48% vs. 18.4%, p < 0.05). The authors conclude that THAM ameliorates the deleterious effect of prolonged hyperventilation, may be beneficial in ICP control, and warrants further study as to the dosage and timing of administration.

Human T-cell leukemia virus type I infection of monocytes and microglial cells in primary human cultures.

The pathogenesis of progressive spastic paraparesis [HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP)], a serious consequence of human T-cell leukemia virus type I (HTLV-I) infection, is unclear. T and B lymphocytes can be naturally infected by HTLV-I, but the susceptibility to HTLV-I infection of other cell types that could contribute to the pathogenesis of HAM/TSP has not been determined. We found that a human monocyte cell line (THP-1), primary human peripheral blood monocytes, and isolated microglial cells but not astrocytes or oligodendroglial cells derived from adult human brain were infected by HTLV-I in vitro. Infection with HTLV-I enhanced the secretion of interleukin 6 in human microglial cell-enriched cultures but did not stimulate the release of interleukin 1 from monocytes or microglial cells. Tumor necrosis factor alpha production was stimulated by HTLV-I infection of monocytes and microglial cells and could be enhanced by suboptimal amounts of lipopolysaccharide. Since both tumor necrosis factor alpha and interleukin 6 have been implicated in inflammatory demyelination and gliosis, our findings suggest that human microglial cells and monocytes infected with and activated by HTLV-I could play a role in the pathogenesis of HAM/TSP.

Spinal epidural abscess: a report of 40 cases and review.

Despite modern medical advances, the morbidity and mortality rates associated with spinal epidural abscess remain significant, and the diagnosis often is elusive. A retrospective study was undertaken to define better the incidence and clinical features of this infection, and to establish current diagnostic and therapeutic guidelines. Forty cases of spinal epidural abscess were encountered at our institution between July 1979 and March 1991. All medical records and radiological images were reviewed. We report a significant increase in the incidence of epidural abscess after June 1988 (p = 0.0195). Sixteen patients used drugs intravenously, and six had undergone spinal procedures. Twelve patients were misdiagnosed in various emergency rooms or clinics and discharged. Localized back pain, fever, and neurological deficit remained the typical clinical manifestations. Erythrocyte sedimentation rate was elevated uniformly when measured (21 cases). Magnetic resonance imaging was diagnostic specifically in 23 of 24 instances. The majority of patients underwent surgical drainage, but five selected patients were managed nonoperatively. The highly variable presentation of spinal epidural abscess may confuse the diagnosis and delay indicated surgical intervention. Localized back pain in a febrile patient at significant risk for epidural abscess warrants erythrocyte sedimentation rate measurement. The presence of erythrocyte sedimentation rate elevation or evidence of spinal cord compression on physical examination are indications for immediate magnetic resonance imaging examination with contrast enhancement. Surgical drainage with sustained intravenous antibiotic treatment remains the cornerstone of therapy. Nonoperative management may be considered in selected cases.