Neuropsychological impact of cerebral microemboli in ablation of atrial fibrillation.

BACKGROUND: Clinically silent lesions on cerebral magnet resonance imaging have been found in larger numbers after pulmonary vein isolation (PVI) especially with phased radio frequency (pRF) using all ten electrodes. However, the neuropsychological effects of cerebral microembolism during the procedure remain unclear and data regarding this issue so far are inconsistent. METHODS: Between August 2011 and June 2012, 76 patients undergoing their first PVI were randomized to ablation with either phased (40) or irrigated (36) radio frequency (iRF). A comprehensive neuropsychological test battery was performed the day before and after PVI as well as 6 months after ablation. The occurrence of cerebral microemboli during the procedure was performed via a transcranial Doppler ultrasound device. RESULTS: PVI using pRF was associated with increased number of microembolic signals (MES) compared to iRF (1530.0 ± 979.8 vs. 645.7 ± 448.7; p < 0.001). Neuropsychological assessment did not reveal any changes in correlation with the used ablation technique. Besides an age-related effect there was a diffuse, sub-clinical impairment of neurologic function depending on age and the number of MES. CONCLUSIONS: There was no clinical overt cognitive deficit and no significant difference in cognitive function correlating with the used ablation technique. The number of MES correlated with a subtle, diffuse post-procedural impairment of neuropsychological function highlighting the need to reduce microemboli during ablation.

Importance of population structure at the time of toxicant exposure.

Populations in nature often consist of a mixture of stages and ages, yet toxicological studies even demographic studies, usually evaluate one starting life stage. In this study it was asked whether the starting age/stage structure of a population at the time of initial pesticide exposure influenced the impact that pesticides have on population growth rates. This question was answered by exposing differently structured populations of two terrestrial arthropod species, the two-spotted spider mite, Tetranychus urticae (Koch), and the pea aphid, Acrythosiphon pisum (Harris), to pesticides. The three structured populations tested were (1) eggs or neonates for A. pisum and T. urticae, respectively, (2) stable age distribution, and (3) young adult females only. Instantaneous rates of population increase (ri) for the three structured populations were determined over time without exposure to pesticides (control) and after exposure to pesticides. Populations of T. urticae were exposed to 100 ppm of the pesticide dicofol; populations of A. pisum were exposed to 200 ppm Neemix. The ri for the three control populations of T. urticae and A. pisum converged in a closed system 16 and 17 days after the start of the study, respectively. Unlike the control populations, the ri of the three treated populations did not converge by Day 16 for the mite species or Day 17 for the aphid species after exposure to pesticides. Growth rates of populations started as eggs (mites) or neonates (aphids) remained significantly lower than those of the adult or mixed-age populations (P

Substance dependence and personality disorders: comorbidity and treatment outcome in an inpatient treatment population.

OBJECTIVE: Personality disorders (PDs) are common among patients with substance dependence, and antisocial PD in particular has been found to have a significant impact on treatment outcomes. Relatively little is known about other comorbid PDs, however. This study was designed to clarify the distribution of PDs among substance dependent patients and assess their role in treatment outcome. METHOD: PDs and substance use disorders were diagnosed for 252 (181 male) consecutively admitted substance dependent inpatients using structured clinical interviews. A subsample of these (n = 104) were also followed for 1 year to monitor treatment outcome and relapse. RESULTS: Fifty percent of the patients were diagnosed with one or more personality disorders, but no consistent relationships between drug of choice and PDs were found. The likelihood of relapse, however, increased significantly with the diagnosis of a PD. Only 6% of the patients who received more than one PD diagnosis were maintaining sobriety at the end of 1 year compared with 44% of those with no PD diagnoses. A preference for cocaine was also a significant predictor of relapse. CONCLUSIONS: The low participation rate for the treatment outcome study and other methodological limitations render the study results tentative. Nevertheless, the findings suggest that more attention should be given to Axis II disorders in substance dependence research and treatment.

Brief cognitive behavior therapy in an undergraduate pilot student: a case report.

This is a case report of a male undergraduate pilot student referred from the aerospace medicine service because of difficulty coping with stresses associated with undergraduate pilot training (UPT). Two phases of a short-term cognitive-behavioral treatment program were undertaken. The initial phase of treatment involved assisting the student to become aware of cognitive, behavioral, and physiological cues that were associated with increased levels of stress, and relaxation training. The second treatment phase involved stress inoculation strategies and coping procedures that were competency based, rather than mastery based. The latter had previously been unsuccessfully used by the student. Results indicated increases in self-reported stress management skills and in objective reports of training performance. Although generalizability of this study is limited, short-term cognitive behavioral therapy procedures are felt to be an important tool for improving the performance of UPT students, and may also reduce the probability of self-initiated elimination due to subjective stress complaints.