Are individual levels of pain anxiety related to negative interpretation bias? An examination using an ambiguous word priming task.

BACKGROUND: Cognitive processes like attentional and interpretation biases have been suggested to play a vital role in the onset and exacerbation of chronic pain. Research consistently supports the occurrence of interpretation bias (IB) in pain patients and healthy individuals high in pain anxiety. Nevertheless, studies on the indirect assessment of IB or the relation between IB and responses to pain are limited. The present studies examined the association between indirect assessed IB and pain anxiety, while Study 2 additionally examined IB as a mediator in the relation between pain anxiety and pain responses. METHOD: In Study 1 (N = 125) and Study 2 (N = 73), anxiety sensitivity, injury/illness sensitivity (IS) and pain catastrophizing were assessed with questionnaires. IB was indirectly derived from performance on an ambiguous word priming task. In Study 2, an experimental heat pain induction was used to assess pain responses (i.e. tolerance and subjective pain experience). RESULTS: Results showed a positive correlation between pain anxiety and IB, albeit that the strength of the observed associations differed between both studies. Furthermore, IB was inversely related to pain tolerance, and found to mediate the relation between IS and pain tolerance in Study 2. CONCLUSIONS: Current findings underscore the importance of interpretational processes in the context of physical health threat. Furthermore, the ambiguous word priming task is proposed as a suitable paradigm for further research on the indirect assessment of IB. Nevertheless, further research is warranted to deepen our understanding of IB and its contribution to the experience of (chronic) pain.

[Intracardiac mass: Why not a liquefaction necrosis of a mitral annulus calcification?]. / Masse cardiaque: et si c'était une liquéfaction caséeuse de calcification mitrale?

We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication.

Prediction of neonatal outcome in women with gestational hypertension or mild preeclampsia after 36 weeks of gestation.

BACKGROUND: There is little knowledge about neonatal complications in GH and PE and induction at term, we aim to assess whether they can be predicted from clinical data. METHODS: We used data of the HYPITAT trial and evaluated whether adverse neonatal outcome (Apgar score < 7, pH < 7.05, NICU admission) could be predicted from clinical data. Logistic regression, ROC analysis and calibration were used to identify predictors and evaluate the predictive capacity in an antepartum and intrapartum model. RESULTS: We included 1153 pregnancies, of whom 76 (6.6%) had adverse neonatal outcome. Parity (primipara OR 2.75), BMI (OR 1.06), proteinuria (dipstick +++ OR 2.5), uric acid (OR 1.4) and creatinine (OR 1.02) were independent antepartum predictors; In the intrapartum model, meconium stained amniotic fluid (OR 2.2), temperature (OR 1.8), duration of first stage of labour (OR 1.15), proteinuria (dipstick +++ OR 2.7), creatinine (OR 1.02) and uric acid (OR 1.5) were predictors of adverse neonatal outcome. Both models showed good discrimination (AUC 0.75 and 0.78), but calibration was limited (Hosmer-Lemeshow p = 0.41, and p = 0.20). CONCLUSIONS: In women with GH or PE at term, it is difficult to predict neonatal complications, possibly since they are rare in the term pregnancy. However, the identified individual predictors may guide physicians to anticipate requirements for neonatal care.

FemoSeal Evaluation Registry (FER). Prospective study of femoral arterial closure with a mechanical system on 100 patients who underwent angioplasty procedures.

BACKGROUND: The objective of this study is to evaluate the effectiveness and the safety of the FemoSeal mechanical closure system in order to obtain hemostasis of the puncture site following angioplasty procedures performed through femoral arterial approach. METHOD: A single-centre prospective registry was conducted from November 2010 to April 2011, comparing the results of manual compression (n=111 patients), hemostatic bandages compression (n=43 patients) and FemoSeal mechanical closure (n=100 patients). The end points evaluated were the following: successful hemostasis, major and minor complications right after the procedures and major and minor complications at 1 month follow-up. The patients' feedback about their comfort was also collected right after the procedure and after one month. RESULTS: Successful hemostasis with FemoSeal was obtained in 93% of the patients (n=93). Seven patients required additional slight manual compressions or compression bandages. The use of FemoSeal was not associated with any major complications, significantly reducing (P<0.05) the number of complications compared to other compression techniques over the studied period. Only one minor complication was observed with FemoSeal (a 1.5-cm-hematoma, which reabsorbed spontaneously without any issue). CONCLUSION: In our experience, the use of FemoSeal is effective in achieving hemostasis performed through femoral arterial approach up to 7F and is associated with a very low rate of complications.

Systematic review and collaborative recalculation of 133,693 incident cases of schizophrenia.

BACKGROUND: This systematic review and collaborative recalculation was set up to recalculate schizophrenia incidence rates from previously published studies by age and sex. METHOD: PubMed, EMBASE and PsycINFO databases were searched (January 1950 to December 2009) for schizophrenia incidence studies. Numerator and population data were extracted by age, sex and, if possible, study period. Original data were requested from the authors to calculate age- and sex-specific incidence rates. Incidence rate ratios (IRRs) with their 95% confidence intervals (CIs) were computed by age and sex from negative binomial regression models. RESULTS: Forty-three independent samples met inclusion criteria, yielding 133 693 incident cases of schizophrenia for analysis. Men had a 1.15-fold (95% CI 1.00-1.31) greater risk of schizophrenia than women. In men, incidence peaked at age 20-29 years (median rate 4.15/10,000 person-years, IRR 2.61, 95% CI 1.74-3.92). In women, incidence peaked at age 20-29 (median rate 1.71/10,000 person-years, IRR 2.34, 95% CI 1.66-3.28) and 30-39 years (median rate 1.24/10,000 person-years, IRR 2.25, 95% CI 1.55-3.28). This peak was followed by an age-incidence decline up to age 60 years that was stronger in men than in women (χ² = 57.90, p < 0.001). The relative risk of schizophrenia was greater in men up to age 39 years and this reversed to a greater relative risk in women over the age groups 50-70 years. No evidence for a second incidence peak in middle-aged women was found. CONCLUSIONS: Robust sex differences exist in the distribution of schizophrenia risk across the age span, suggesting differential susceptibility to schizophrenia for men and women at different stages of life.

[Value of cardiac MRI for intraventricular thrombi's diagnosis]. / Intérêts et valeur de l'IRM cardiaque pour la recherche des thrombus intraventriculaires.

BACKGROUND: Intraventricular thrombosis is a serious event, generally complicating a wide myocardial infarction. It requires an adapted therapy, based on the oral anticoagulants. The diagnosis is generally carried out by trans-thoracic echocardiography but with an insufficient sensitivity and a specificity. In this context, the place of cardiac MRI remains to be explored. PATIENTS AND METHOD: We carried out a retrospective registry of all cardiac MRI done in our hospital since 2003, for assessment of an intracardiac mass or an cerebral stroke. The aim was to compare the results of cardiac MRI with those of echocardiography and contrast ventriculography. RESULTS: Our registry includes 26 cases of intraventricular thrombi, confirmed by cardiac MRI. Our results confirm the lack of sensitivity of echocardiography and the ventriculography. The Kappa correlation coefficient of echocardiography and ventriculography, with respect to the MRI, are very weak, respectively of -0.08 and 0.16. CONCLUSIONS: The values of echocardiography and contrast ventriculography seem limited. The realization of a complementary cardiac MRI must be recommended as often as possible in case of doubt or high risk disease.

[From the standard coronary angiography to the double rotational angiography: results of a retrospective mono-centric registry]. / De la coronarographie standard à la double angiographie rotationnelle : résultats d'un registre mono-centrique rétrospectif.

X-ray doses (delivered) to the patients during coronary angiography (CA) and percutaneous coronary intervention (PCI) show ability of one certain deterious effects and can be sometimes at very high level. According to the European directives, all the equipments allowing to make diagnostic and interventional procedure integrate a unit of measure of the Dose Area Product. This measure is associated in a linear way with the effective dose and allows to measure the stochastic risk, the indicator also of good practices. Stemming from general vascular rotational acquisition technology, the cardiac rotational angiography is potentially beneficial for the patients and the operators concerning the exposure in ionizing radiations. The purpose of this study is to measure retrospectively the various dominating indicators in the irradiation of the patients on a series of case realized from January, 2009 till May, 2009 further to the implementation of this technique of acquisition. The dose area product, the duration of fluoroscopy as well as the number of acquired images were measured after coronary angiogram at 250 consecutive patients between January, 2009 and May, 2009. The procedures were realized by four operators, using the femoral access. The dose area product, the durations of fluoroscopy as well as the number of images has been respectively of 39,3 Gy cm(2) [4,7-210,65 Gy cm(2)], 8,4 minutes [0,8-38 minutes] and 575 frames [175-1427 frames] in standard coronary angiogram; 33,64 Gy cm(2) [4,95-85,6 Gy cm(2)], 2,8 minutes [1,1-26 minutes], 503 frames [314-836 frames] in single rotational coronary angiogram; 24,26 Gy cm(2) [5,74-51,1 Gy cm(2)], 3,9 minutes [1,3-14 minutes], 272 frames [127-429 frames] in double rotational coronary angiogram. In conclusion, the exposure of the patient to the X-rays, the practitioners and paramedical in interventional cardiology depends on the operator, on the fluoroscopy time and on the number of acquired images. The double rotational angiography is one of the solution to achieve these objectives.

[Elevation of cardiac biomarkers after strenuous physical exertion]. / Elévation des biomarqueurs cardiaques après un effort physique intense.

We present the case of a patient who felt faint after a strenuous exercise. A coronary angiography was performed because of an elevated level of troponin, but it failed to demonstrat any significant coronary stenosis. We discuss the effect of strenuous exercise on cardiac biomarkers. Most previous published studies involved young trained populations. The frequency of these abnormalities in older, less trained people is unknown. Moreover, the possible impact of these abnormalities on mid- or long-term outcome is a matter of debate. Seniors practising intensive sport activities should systematically be submitted to a cardiological evaluation.

[Identification of anomalous coronary arteries and their anatomic course by multidetector computed tomography coronarography. A retrospective registry]. / L'utilisation du scanner cardiaque multibarrettes pour l'exploration des anomalies coronaires. Analyse d'une série rétrospective monocentrique.

BACKGROUND: The coronary anomalies are generally asymptomatic and rare. However, their potential complications are serious and mainly represented by the risk of sudden death. The coronarography appears insufficient to carry out the complete assessment of these anomalies, and in particular to study the arterial course. The endpoint of our series is to evaluate the interest of the coronary computed tomography (CT) in this indication. PATIENTS AND METHODS: We report the results of a 16-slice coronary-CT monocentric retrospective series among 12 patients presenting coronary anomalies diagnosed in coronarography. RESULTS: Coronary-CT has confirmed the diagnosis, specified the coronary course and the relation with the great vessels in 100% of the cases. CONCLUSIONS: Multislice coronary-CT seems an examination of choice for the diagnosis and the presurgical assessment of the coronary aberrations, like for the distinction of the benign and malign forms. Its effectiveness and its "non-invasive" character are strong arguments to include it in the assessment of syncopes linked to effort in the young adult.

[Multidetector computed tomography coronarography: preliminary experience in real life settings]. / Scanner coronaire: bilan d'une expérience préliminaire dans le cadre de la vraie vie.

UNLABELLED: Multidetector computed tomography coronarography (MDCT) is a promising tool, offering non invasive anatomic evaluation of coronary arteries. We relate in this article our impressions after our first two years experience. METHODS: Retrospective study of the 328 patients who underwent MDCT examination between January 2005 and December 2006 at our community hospital. Per patient comparative analysis of the anatomical findings versus percutaneous angiography (PCA) in 61 cases. RESULTS: Out of 328 patients 61 (18.5%) underwent PCA. In these patients we found a sensibility, specificity, positive predictive value and negative predictive value of 100%, 54%, 59% and 100% for MDCT. The main factor responsible for inconclusive vessel analysis was excessive calcification. CONCLUSION: In routine use, MDCT enables one to rule out significant stenosis non invasively, with high sensitivity in an unselected patient population.

[Long-term outcome of acute myocardial infarction treated with primary angioplasty. Experience of a public center in Alsatia-France]. / Devenir à long terme de patients traités par angioplastie primaire à la phase aiguë d'un infarctus du myocarde. Experience d'un centre hospitalier général alsacien.

OBJECTIVES: Estimation of long-term outcome for patients suffering from acute myocardial infarction treated with primary angioplasty in an alsatian public center. PATIENTS AND METHODS: Two-hundred and ninety-eight patients who underwent an urgent coronarography in a non-university center, with a view to immediate angioplasty, between January 1999 and December 2001. RESULTS: Two-hundred and sixty-four patients (88.6%) were actually treated with urgent angioplasty, which has been successful in 87.1% of cases. Hospital mortality was of 7.7%. The population was composed of 16.4% patients older than 75 and of 11.7% patients with Killip 3 or 4 at admission. Mean follow-up was 34 months, lost to follow-up rate was of 4.7%. The global survival rate was of 78.9% and event-less survival rate of 41.9%. CONCLUSION: Our results confirm the efficiency of angioplasty in real-life conditions as well at short-term as at long-term.

Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population.

OBJECTIVE: General population longitudinal cohort studies have demonstrated the prognostic validity of self-reported psychotic experiences, but data on reliability and cross-validation with interview-based measures of these experiences are sparse. This study tested the reliability and validity of the Community Assessment of Psychic Experiences (CAPE42). METHOD: At baseline, the CAPE42 was used to measure the subclinical psychosis phenotype in a general population sample (n = 765). At follow-up (mean interval: 7.7 months), the Structured Interview for Schizotypy, Revised (SIS-R), the Brief Psychiatric Rating Scale (BPRS), and the CAPE42 were administered (n = 510). RESULTS: Baseline self-reported dimensions of psychosis were specifically and independently associated with their equivalent interview-based dimension at follow-up (standardized effect sizes of 0.4-0.5) and with their equivalent self-reported measure (standardized effect sizes of 0.6-0.8). CONCLUSION: The results indicate that self-reported dimensions of psychotic experiences in general population samples appear to be stable, reliable and valid.

Evidence for instrument and family-specific variation of subclinical psychosis dimensions in the general population.

It is unknown to what degree dimensions of schizotypy (subclinical psychosis) show independent, family-specific variation in the general population. Psychologists administered the Community Assessment of Psychic Experiences, the Structured Interview for Schizotypy-Revised (SIS-R), and the Brief Psychiatric Rating Scale to 257 subjects pertaining to 82 general population families. All 3 instruments showed family-specific variation for positive and negative subclinical psychosis dimensions with between-families proportions of total variance between 10% and 40%. However, only the SIS-R showed family-specific variation of the negative dimension independent of its correlation with the positive dimension. The positive dimension of subclinical psychosis shows familial-specific variation in samples unselected for psychiatric disorder, suggesting dimensional liability in the population. The SIS-R additionally captures family-specific variation in the negative domain.

[Primary angioplasty in acute coronary syndromes with ST-segment elevation: experience of three Alsacian centers]. / Angioplastie primaire dans les syndromes coronaires aigus avec sus-decalage du segment ST: experience de 3 centres alsaciens.

The guidelines of the European Society of Cardiology, published in 2003, consider primary angioplasty as the preferred treatment strategy in acute coronary syndromes with ST-segment elevation, if the procedure can be performed within 90 min after first medical contact. We report the experience of three Alsacian centers running a common prospective registry with 2504 consecutive patients enroled between January 1999 and December 2004. The average age of the patients was 62 years with a proportion of 24% women. The time delay "pain to admission" was > or =3 hours in 55.9% of the cases. The treatment delay "door to catheterisation needle" was 59 min and the mean delay "door-to-reperfusion" was 79 min. The study population was representative of the real world including subsets of patients with a particulary high risk profile: age > or =70 years in 33%, a Killip grade > or =3 in 11.5%, rescucitated sudden death in 6.6% and cardiogenic shock in 10.9% of the patients respectively. The immediate procedural success rate (Timi 3 flow) in the treated coronary artery was 96.5%. The overall inhospital mortality-rate was 9.3%. The combinations of rescucitated sudden death--cardiogenic shock or age > or =75 years--cardiogenic shock were associated with a poor clinical outcome and mortality rates of 69% and 72.6% respectively, where as in the absence of abovementioned clinical high risk settings, the mortality rate was as low as 1.4%. The overall bleeding complication rate was 1.4%. The policy of systematic primary angioplasty in acute coronary syndromes with ST-Segment elevation appears to be coherent. The procedural complications and the in-hospital mortality rates were low, except in the presence of above mentioned clinical high risk settings.

[Acute ST-elevation myocardial infarction in the elderly (>75 years). Results from a regional multicenter study]. / Infarctus du myocarde du sujet de plus de 75 ans. Données d'un registre multicentrique régional.

OBJECTIVES: This prospective multicenter study assessed the prevalence and feasibility of percutaneous coronary angioplasty (PTCA) in the acute phase of ST-elevation myocardial infarction (STEMI) in 3 nonacademic interventional cardiology centers (Alsace, France). METHODS: We studied the clinical characteristics, angiographic data, and PCTA results of all STEMI patients and analyzed the revascularization rates and adverse events during hospitalization. We compared patients at least 75 years of age and younger patients for these data and with the literature. RESULTS: Of the 1672 patients admitted for STEMI, 342 (20.45%) were at least 75 years of age. Half the patients in this high-risk subgroup were women. These patients had more co-morbidities (e.g., hypertension and diabetes mellitus) than younger patients, and more of them had three-vessel disease. Mortality rate was high in this subgroup and always higher than for comparable younger subjects, but it varied according to the initial clinical profile. Their global mortality rate was 20.47%, but it fell to 5.41% when we excluded patients with cardiogenic shock or in Killip stage ill, and those who were resuscitated. PTCA is a coronary reperfusion technique especially indicated for elderly patients with STEMI. It is an effective revascularization technique, with a reperfusion rate (exclusively TIMI III flow) reaching 93.88% in the elderly group, only slightly lower than among younger patients (97.18%). CONCLUSION: PTCA is a technique particularly indicated in the elderly in Alsace because of regional geographic and medical specificities: nearby emergency services are available to virtually the entire population of Alsace, and most interventional cardiology teams apply a strategy of exclusive primary PTCA.

Are apparent associations between parental representations and psychosis risk mediated by early trauma?

OBJECTIVE: It was investigated whether the reported association between representations of parental rearing style and psychosis does not represent a main effect, but instead is a proxy indicator of the true underlying risk factor of early trauma. METHOD: In a general population sample of 4045 individuals aged 18-64 years, first ever onset of positive psychotic symptoms at 3-year follow-up was assessed using the Composite International Diagnostic Interview and clinical interviews if indicated. Representations of parental rearing style were measured with the Parental Bonding Instrument (PBI). RESULTS: Lower baseline level of PBI parental care predicted onset of psychotic symptoms 2 years later. However, when trauma was included in the equation, a strong main effect of trauma emerged at the expense of the effect size of PBI low care. CONCLUSION: The results suggest that associations between representations of parental rearing style and psychosis may be an indicator of the effect of earlier exposure to childhood trauma.

[Drug eluting stents in 2005: have the initial expectations been met?]. / Le stent "actif" en 2005: remplit-il ses promesses?

Drug eluting stent is a new technology aimed to prevent the development of neointimal hyperplasia and restenosis following percutaneous coronary intervention. This review describes the direction for their use at the present time and the future of their utilization with the summary of the principals clinicals trials.