Cerebral artery calcification in patients with acute cerebrovascular diseases: determinants and long-term clinical outcome.

BACKGROUND AND PURPOSE: Coronary artery calcium is an independent predictor of all-cause mortality. We sought to examine the determinants of intracranial cerebral artery calcification (CAC) and its association with long-term outcome in a large prospective cohort of stroke patients. METHODS: Consecutive patients hospitalized because of acute stroke (ischaemic and intracerebral hemorrhage) or TIA throughout a large medical center were systematically assessed and followed up for 1 year. Intracranial CAC was assessed from baseline brain CT blinded to clinical data. Patients were categorized to no, mild, and severe CAC according to their total CAC score. Determinants of CAC were studied with logistic regression analysis. Risk of death, Barthel Index ≤ 60 or death and living in a nursing facility or death were assessed. RESULTS: Amongst 1049 patients (mean age: 70 ± 13 years, 59% males) CAC was present in 727 (69%) patients. The main determinants of CAC were increasing age (OR 1.4, 95% CI 1.3-1.6, per 5 years), diabetes (OR: 2.1, 1.4-3.0), smoking (1.4, 1.0-2.2), hypertension (1.4, 1.0-2.1), and prior coronary heart disease (1.9, 1.3-2.9). CAC was associated with mortality and poor outcome amongst patients with ischaemic stroke; however, after adjusting for age and stroke severity, no significant association was observed. In patients with intracerebral hemorrhage, outcomes were not related to CAC. CONCLUSIONS: Intracranial CAC is highly prevalent in patients with acute stroke and its main determinants are older age, diabetes, smoking, hypertension, and prior coronary heart disease. Associations between CAC and mortality or poor functional outcome in the first year after ischaemic stroke are mainly age- and stroke severity-driven.

Minimal traumatic brain injury induce apoptotic cell death in mice.

In the United States, 1.4 million people suffer from traumatic brain injury (TBI) each year because of traffic, sports, or war-related injuries. The majority of TBI victims suffer mild to minimal TBI (mTBI), but most are released undiagnosed. Detailed pathologies are poorly understood. We characterized the microscopic changes of neurons of closed-head mTBI mice after increased unilateral trauma using hematoxylin and eosin (H&E) stain, and correlated it with the expression of the apoptotic proteins c-jun, p53, and BCL-2. Minimal damage to the brain increases the number of pyknotic appearing neurons and activates the apoptotic proteins in both hemispheres. Although minimal, increased impact was positively correlated with the increased number of damaged neurons. These results may explain the wide variety of behavioral and cognitive deficits closed-head mTBI causes in mice. Our cumulative results point to the pathological origin of post-concussion syndrome and may aid in the development of future neuroprotective strategies for the disease.

[Internal picture of the disease and its value for psychological diagnosis of neuroses]. / Vnutrenniaia kartina bolezni i ee znachenie dlia psikhologicheskoi diagnostiki pri nevrozakh.

The clinical and experimental psychological methods were employed to study the structure and mechanisms of the internal picture of the disease in 305 patients afflicted with neuroses. Four varieties of the internal picture of the disease were outlined depending on the characteristics of the emotional and cognitive aspects of the disease experiencing. Each of these varieties is marked by the originality of the personality mechanisms within the "I" system, neurotic conflict, and psychological defence. The described typology of the internal picture of the disease expands the possibilities of multidimensional diagnosis aimed at differentiated therapy of neurotic patients.

[Group psychotherapy in neuroses: styles of conducting psychotherapy groups (comparative study in the USSR and Czechoslovakia)]. / Gruppovaia psikhoterapiia pri nevrozakh: stili rukovodstva psikhoterapevticheskimi gruppami (sravnitel'noe issledovanie v SSSR i ChSSR).

Using an adapted psychologic technique, the authors considered the predominant types of therapeutic behaviour of 70 psychotherapists from the USSR and CSSR who employ methods of group psychotherapy in treating neuroses. The frequency of optimal variants of the therapeutic behaviour resorted to by psychotherapists in difficult situations arising in the course of group psychotherapy was established. Characteristic features of the therapeutic tactics used by psychotherapists from both countries are shown.

[Clinicopsychological study of the "internal picture of the disease" in neuroses in the process of their psychotherapy]. / Kliniko-psikhologicheskoe issledovanie "vnutrennei kartiny bolezni" pri nevrozakh v protsesse ikh psikhoterapii.

Using clinical and experimental psychological methods a number of characteristics of the disease insight was studied in 72 patients with neuroses. An analysis of the time course of the patients' attitude to their disease and treatment has enabled the author to disclose the peculiarities of understanding the disease cause by the patients as a criterion of psychotherapy efficacy. The most characteristic variants of psychological defence in various forms of the neuroses, as well as the inner personal conflicts in the patients and their self-estimation are described. On the basis of the data obtained peculiarities of the psychotherapeutic strategy contributing to improvement of the therapy efficacy are indicated.

[Physician-patient relations and their influence on the process of psychotherapy in neurotic patients]. / Vzaimootnosheniia vracha i bol'nykh i ikh vliianie na protsess psikhoterapii u bol'nykh nevrozami.

Using specially elaborated experimental psychological methods the author studied conditions of formation of a psychotherapeutical contact between a doctor and a patient and its influence on optimum and affective psychotherapy of neuroses. A total of 100 psychotherapeutical diads (100 patients and 11 psychoptherapeutists) were studied. On the basis of the analysis of patients' aims two types of a standard of a doctor-psychotherapeutist according to emotional attitude to a patient were depicted: "co-suffering" and "emotionally neutral", and according to volitional qualities--"directive" and "nondirective". According to a role characteristic a doctor's standard was determined in two variants--an instructor and a partner. The patients' choice of an ideal doctor correlated with certain forms of neuroses. The analysis of the material allowed one to distinguish 3 main forms of a psychotherapeutical contact. The most affective in a psychotherapeutical relation were two forms of such a contact--"co-suffering partnersnip" and "co-suffering instruction".