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1.
Nat Commun ; 11(1): 87, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31911667

RESUMO

Bone remodeling consists of resorption by osteoclasts followed by formation by osteoblasts, and osteoclasts are a source of bone formation-stimulating factors. Here we utilize osteoclast ablation by denosumab (DMAb) and RNA-sequencing of bone biopsies from postmenopausal women to identify osteoclast-secreted factors suppressed by DMAb. Based on these analyses, LIF, CREG2, CST3, CCBE1, and DPP4 are likely osteoclast-derived coupling factors in humans. Given the role of Dipeptidyl Peptidase-4 (DPP4) in glucose homeostasis, we further demonstrate that DMAb-treated participants have a significant reduction in circulating DPP4 and increase in Glucagon-like peptide (GLP)-1 levels as compared to the placebo-treated group, and also that type 2 diabetic patients treated with DMAb show significant reductions in HbA1c as compared to patients treated either with bisphosphonates or calcium and vitamin D. Thus, our results identify several coupling factors in humans and uncover osteoclast-derived DPP4 as a potential link between bone remodeling and energy metabolism.

2.
Mol Psychiatry ; 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31745236

RESUMO

Alcohol misuse is a major public health problem originating from genetic and environmental risk factors. Alterations in the brain epigenome may orchestrate changes in gene expression that lead to alcohol misuse and dependence. Through epigenome-wide association analysis of DNA methylation from human brain tissues, we identified a differentially methylated region, DMR-DLGAP2, associated with alcohol dependence. Methylation within DMR-DLGAP2 was found to be genotype-dependent, allele-specific and associated with reward processing in brain. Methylation at the DMR-DLGAP2 regulated expression of DLGAP2 in vitro, and Dlgap2-deficient mice showed reduced alcohol consumption compared with wild-type controls. These results suggest that DLGAP2 may be an interface for genetic and epigenetic factors controlling alcohol use and dependence.

3.
World J Biol Psychiatry ; : 1-8, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31749403

RESUMO

Objectives: To investigate the effect of sample handling on inflammatory cytokines in serum and highlight challenges with using samples pre-collected from biobanks for biomarker research.Methods: Cytokine concentrations (IL-1ß, IL-2, IL-6, IL-8, IL-10, TNFα, and IFNγ) were measured in serum samples of 205 patients with bipoldar disorder (BD) from the Mayo Clinic Bipolar Disorder Biobank and 205 non-psychiatric controls from the Mayo Clinic Biobank. As cytokine concentrations varied by recruitment site, post-hoc models were used to test the effect of clinical variables and pre-processing time on cytokines. To evaluate the effect of pre-processing time experimentally, cytokines were assayed in serum and plasma from 6 healthy volunteers processed at different time points.Results: Cytokine levels were significantly higher in the BD group. However, both cytokine levels and pre-processing times differed by recruitment site, and post-hoc analyses revealed that pre-processing time was significantly associated with several cytokines. An experiment using samples from healthy volunteers confirmed that concentrations for most cytokines increased with longer pre-processing times.Conclusions: Delays in processing influence cytokine concentrations in blood samples. Given the increasing use of biobanks in research, this study highlights the need to carefully evaluate sample collection and handling methods when designing biomarker studies.

4.
Ultrasound Med Biol ; 45(11): 2887-2897, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488311

RESUMO

Nerve movement is decreased in patients with carpal tunnel syndrome and can be assessed with ultrasound. In addition to morphologic features, this study describes a novel approach in which nerve movement and the association with short-term patient-reported outcome are assessed. Ultrasound images at the carpal tunnel inlet were acquired during finger and wrist flexion. Linear regression models were used with the Boston Carpal Tunnel Questionnaire as main outcome. Eighty-five patients were included; 93% completed the 3-mo follow-up. Pre-surgical mean nerve area was 14.5 ± 4.2 mm2 and decreased to 13.3 ± 3.8 mm2 (p < 0.001). Displacement in dorsal direction with wrist flexion increased from 1.9 ± 1.3 to 2.4 ± 1.3 mm (p < 0.01). A pre-surgical larger nerve area was associated with more functional improvement (ß = -0.024, p = 0.02), but baseline mobility was not. Change in excursion with finger flexion was associated with symptomatic improvement, but with a small effect (ß = -0.05, p = 0.01). This indicates that there is limited prognostic potential for dynamic transverse ultrasound in carpal tunnel syndrome.

5.
Spine (Phila Pa 1976) ; 44(19): E1161-E1168, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261283

RESUMO

STUDY DESIGN: Retrospective matched cohort study. OBJECTIVE: To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP). SUMMARY OF BACKGROUND DATA: Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration. METHODS: Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed. RESULTS: Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05). CONCLUSION: Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients. LEVEL OF EVIDENCE: 3.

6.
Transl Psychiatry ; 9(1): 149, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31123248

RESUMO

Glutamatergic dysregulation is implicated in the neurobiology of mood disorders. This study investigated the relationship between the anterior cingulate cortex (AC) glutamate, as measured by proton magnetic resonance spectroscopy (1H-MRS), and single-nucleotide polymorphisms (SNPs) from four genes (GLUL, SLC1A3, SLC1A2, and SLC1A7) that regulate the extracellular glutamate in 26 depressed patients with major depressive disorder (MDD; n = 15) and bipolar disorder (BD; n = 11). Two SNPs (rs3812778 and rs3829280), in perfect linkage disequilibrium, in the 3' untranslated region of the EAAT2 gene SLC1A2, were associated with AC glutamate, with minor allele carriers having significantly higher glutamate levels (p < 0.001) in comparison with common allele homozygotes. In silico analysis revealed an association of minor allele carriers of rs3812778/rs382920 with an upregulation of the astrocytic marker CD44 localized downstream of SLC1A2 on chromosome 11. Finally, we tested the disease relevance of these SNPs in a large group of depressed patients [MDD (n = 458); BD (n = 1473)] and found that minor allele carriers had a significantly higher risk for rapid cycling (p = 0.006). Further work is encouraged to delineate the functional impact of excitatory amino acid transporter genetic variation on CD44 associated physiology and glutamatergic neurotransmission, specifically glutamate-glutamine cycling, and its contribution to subphenotypes of mood disorders.

7.
J Neurosurg Sci ; 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30942050

RESUMO

BACKGROUND: Identification of the central sulcus can require inspection of subtle differences or require certain pulse sequences. This study identifies the central sulcus by signal intensity on Double Inversion Recovery (DIR) images in multiple anatomic locations and imaging planes. METHODS: 49 patients (98 hemispheres) were retrospectively reviewed by three neuroradiologists and one radiology resident. The central sulcus was compared to the surrounding sulci for differences in signal intensity at axial hand knob, axial operculum, and lateral convexity sagittal images (294 locations) on DIR images. The use of the 'disappearing central sulcus sign' where the window level is increased at constant width and black/white inversion were also assessed. RESULTS: In 49 patients (22 female, 27 male; median age 36 years), the central sulcus cortex signal intensity was lower than adjacent sulci with a frequency of 90/98 (91.8%) at the axial hand knob level, 68/98 (69.4%) at the axial operculum level, and 76/98 (77.5%) at the sagittal level. With black and white inversion, the frequencies were of 96/98 (98%), 92/98 (94%), and 87/98 (89%). The central sulcus was the first to disappear at all three levels with high degrees of inter-reader agreement (86%-99%). Traditional anatomic landmarks were absent or conflicting in seven hemispheres (5 patients). The central sulcus was identified by DIR signal intensity in all seven hemispheres. CONCLUSIONS: The central sulcus can be identified by differences in signal intensity of the peri-rolandic cortex on DIR. Use of black/white inversion and the disappearing central sulcus sign may further facilitate identification.

8.
Front Pharmacol ; 10: 83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30837869

RESUMO

Background: Pharmacogenomic testing, specifically for pharmacokinetic (PK) and pharmacodynamic (PD) genetic variation, may contribute to a better understanding of baseline genetic differences in patients seeking treatment for depression, which may further impact clinical antidepressant treatment recommendations. This study evaluated PK and PD genetic variation and the clinical use of such testing in treatment seeking patients with bipolar disorder (BP) and major depressive disorder (MDD) and history of multiple drug failures/treatment resistance. Methods: Consecutive depressed patients evaluated at the Mayo Clinic Depression Center over a 10-year study time frame (2003-2013) were included in this retrospective analysis. Diagnoses of BP or MDD were confirmed using a semi-structured diagnostic interview. Clinical rating scales included the Hamilton Rating Scale for Depression (HRSD24), Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Adverse Childhood Experiences (ACE) Questionnaire. Clinically selected patients underwent genotyping of cytochrome P450 CYP2D6/CYP2C19 and the serotonin transporter SLC6A4. PK and PD differences and whether clinicians incorporated test results in providing recommendations were compared between the two patient groups. Results: Of the 1795 patients, 167/523 (31.9%) with BP and 446/1272 (35.1%) with MDD were genotyped. Genotyped patients had significantly higher self-report measures of depression and anxiety compared to non-genotyped patients. There were significantly more CYP2C19 poor metabolizer (PM) phenotypes in BP (9.3%) vs. MDD patients (1.7%, p = 0.003); among participants with an S-allele, the rate of CYP2C19 PM phenotype was even higher in the BP (9.8%) vs. MDD (0.6%, p = 0.003). There was a significant difference in the distribution of SLC6A4 genotypes between BP (l/l = 28.1%, s/l = 59.3%, s/s = 12.6%) and MDD (l/l = 31.4%, s/l = 46.1%, s/s = 22.7%) patients (p < 0.01). Conclusion: There may be underlying pharmacogenomic differences in treatment seeking depressed patients that potentially have impact on serum levels of CYP2C19 metabolized antidepressants (i.e., citalopram / escitalopram) contributing to rates of efficacy vs. side effect burden with additional potential risk of antidepressant response vs. induced mania. The evidence for utilizing pharmacogenomics-guided therapy in MDD and BP is still developing with a much needed focus on drug safety, side effect burden, and treatment adherence.

9.
Breast Cancer Res ; 21(1): 38, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30850011

RESUMO

BACKGROUND: High background parenchymal uptake (BPU) on molecular breast imaging (MBI) has been identified as a breast cancer risk factor. We explored the feasibility of offering a short-term intervention of low-dose oral tamoxifen to women with high BPU and examined whether this intervention would reduce BPU. METHODS: Women with a history of high BPU and no breast cancer history were invited to the study. Participants had an MBI exam, followed by 30 days of low-dose oral tamoxifen at either 5 mg or 10 mg/day, and a post-tamoxifen MBI exam. BPU on pre- and post-tamoxifen MBI exams was quantitatively assessed as the ratio of average counts in breast fibroglandular tissue vs. average counts in subcutaneous fat. Pre-tamoxifen and post-tamoxifen BPU were compared with paired t tests. RESULTS: Of 47 women invited, 22 enrolled and 21 completed the study (10 taking 5 mg tamoxifen, 11 taking 10 mg tamoxifen). Mean age was 47.7 years (range 41-56 years). After 30 days low-dose tamoxifen, 8 of 21 women (38%) showed a decline in BPU, defined as a decrease from the pre-tamoxifen MBI of at least 15%; 11 of 21 (52%) had no change in BPU (within ± 15%); 2 of 21 (10%) had an increase in BPU of greater than 15%. Overall, the average post-tamoxifen BPU was not significantly different from pre-tamoxifen BPU (1.34 post vs. 1.43 pre, p = 0.11). However, among women taking 10 mg tamoxifen, 5 of 11 (45%) showed a decline in BPU; average BPU was 1.19 post-tamoxifen vs. 1.34 pre-tamoxifen (p = 0.005). In women taking 5 mg tamoxifen, 2 of 10 (20%) showed a decline in BPU; average BPU was 1.51 post-tamoxifen vs.1.53 pre-tamoxifen (p = 0.99). CONCLUSIONS: Short-term intervention with low-dose tamoxifen may reduce high BPU on MBI for some patients. Our preliminary findings suggest that 10 mg tamoxifen per day may be more effective than 5 mg for inducing declines in BPU within 30 days. Given the variability in BPU response to tamoxifen observed among study participants, future study is warranted to determine if BPU response could predict the effectiveness of tamoxifen for breast cancer risk reduction within an individual. TRIAL REGISTRATION: ClinicalTrials.gov NCT02979301 . Registered 01 December 2016.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Mamografia/métodos , Imagem Molecular/métodos , Tamoxifeno/administração & dosagem , Administração Oral , Adulto , Mama/patologia , Densidade da Mama/efeitos dos fármacos , Neoplasias da Mama/patologia , Estudos de Viabilidade , Feminino , Câmaras gama , Humanos , Mamografia/instrumentação , Pessoa de Meia-Idade , Imagem Molecular/instrumentação , Projetos Piloto , Estudos Prospectivos , Cintilografia/instrumentação , Cintilografia/métodos , Compostos Radiofarmacêuticos/administração & dosagem , Tecnécio Tc 99m Sestamibi/administração & dosagem , Fatores de Tempo
10.
Drug Alcohol Depend ; 197: 183-190, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30840924

RESUMO

BACKGROUND: Sex-related differences in the susceptibility, progression, and treatment response in alcohol-dependent subjects have been repeatedly reported. In this study, we aimed to investigate the associations of the sex-related hormone/protein levels with alcohol dependence (AD) and alcohol craving in male and female subjects. METHODS: Plasma sex-related hormones (estradiol, estrone, total testosterone, progesterone, follicle stimulated hormone [FSH], luteinizing hormone), and sex hormone binding globulin were measured by mass spectrometry or automated immunoassays from 44 recently-abstained subjects (29 males and 15 females; mean age = 45.9 ± 15.6) meeting DSM-IV-TR criteria for AD and 44 age-, sex- and race-matched non-AD controls. Conditional logistic regression was conducted to examine the association of sex-related hormone and protein levels with AD risk, accounting for matching variables. Their associations with alcohol craving scales (Penn Alcohol Craving Scale and Inventory of Drug-Taking Situations) were assessed in AD subjects. RESULTS: Plasma FSH level was significantly higher in AD males (10.3 ± 9.8 IU/L) than control males (8.0 ± 15.9 IU/L; p = 0.005, pcorrected = 0.035). We also found a significant inverse correlation of FSH level with propensity to drink in negative emotional situations (Spearman's rho=-.540; p = 0.021) and positive correlations between progesterone level and craving intensity (Spearman's rho=.464; p = 0.020) and between total testosterone level and propensity to drink under temptations (adjusted for no-drinking days; ß=6.496; p = 0.041) in AD males. CONCLUSIONS: These results suggest that FSH, progesterone, and testosterone levels may be associated with AD and alcohol craving in AD males. Future research is needed to replicate these findings and investigate the underlying biological mechanisms.


Assuntos
Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/sangue , Alcoolismo/psicologia , Fissura/fisiologia , Hormônios Esteroides Gonadais/sangue , Adulto , Alcoolismo/epidemiologia , Biomarcadores/sangue , Emoções/fisiologia , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Progesterona/sangue , Autorrelato , Testosterona/sangue
11.
AJR Am J Roentgenol ; 212(4): 933-942, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30779664

RESUMO

OBJECTIVE: The purpose of this study is to compare the performance of dual-energy CT (DECT) with that of breast MRI for detection of silicone gel breast implant rupture and nodal spread of silicone. SUBJECTS AND METHODS: This prospective study enrolled consecutive patients with current or prior silicone gel implants and clinical suspicion of implant rupture or extra-capsular silicone. All patients underwent MRI followed by unenhanced DECT. A breast radiologist not participating in image evaluation established reference standards for implant rupture (intra- or extracapsular) and regional nodal silicone spread (to axillary nodes and internal mammary [IM] and mediastinal nodes) using MRI, surgical findings, and medical records. After undergoing reader training, two radiologists who were blinded to all medical records interpreted randomized images in two sessions, indicating confidence in diagnosis using a 100-point visual scale. RESULTS: A total of 46 patients who had a subpectoral silicone gel implant (n = 31), a subglandular silicone gel implant (n = 14), or a silicone gel implant that was removed (n = 1) underwent MRI and DECT (mean [± SD] volume CT dose index, 8.2 ± 2.0 mGy). Nineteen patients had implant rupture, and 13 of these patients had silicone within the IM or axillary nodes. Pooled data showed no significant difference between MRI and DECT interpretation of intra- or extracapsular rupture of implants (AUC value for intracapsular rupture, 0.958 [for MRI] vs 0.989 [for DECT]; p = 0.28; AUC value for extracapsular rupture, 0.864 [for MRI] vs 0.878 [for DECT]; p = 0.78). No difference was noted in the AUC value for silicone spread to regional lymph nodes: 0.823-0.866 [for MRI] vs 0.892-0.906 [for DECT]; p = 0.34-0.54). CONCLUSION: DECT performs similar to MRI for the detection of silicone gel implant rupture and the presence of silicone in regional lymph nodes, and it may be an alternative for patients who are unable or unwilling to undergo MRI.

12.
Alcohol Alcohol ; 54(2): 167-172, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30796778

RESUMO

AIMS: Replicate the previously reported association of elevated alcohol craving, measured by Penn Alcohol Craving Scale (PACS) during residential treatment, with post-treatment relapse and explore whether elevated craving scores 3 months post-treatment are also associated with subsequent relapse. METHODS: Alcohol craving was assessed with the PACS on admission and at several time points post-treatment in 190 subjects with DSM-IV diagnosis of alcohol dependence admitted to residential treatment. Data about relapse to any drinking (primary outcome measure) was collected at 3, 6, 9 and 12 months after treatment. Cox regression models were used to determine whether PACS scores were associated with relapse. Statistical models were adjusted for meaningful demographic and clinical covariates. RESULTS: Follow-up data was available for 149/190 (78%) of subjects. Elevated PACS scores at discharge were associated with increased relapse risk within the first 3 and 12 months after discharge (P = 0.032 and P = 0.045, respectively). Elevated PACS scores at 3 months were associated with increased risk of subsequent relapse within 12 months after treatment in contacted subjects (P = 0.034) and in the intent-to-treat analysis (P = 0.0001). CONCLUSIONS: Our findings indicate strong association of post-treatment relapse with elevated alcohol craving measured at treatment completion and at 3 months after treatment and justify the use of this measure to guide relapse-prevention efforts.


Assuntos
Alcoolismo/psicologia , Fissura , Valor Preditivo dos Testes , Tratamento Domiciliar , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Tempo
13.
JCO Clin Cancer Inform ; 3: 1-11, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30807208

RESUMO

PURPOSE: Background parenchymal uptake (BPU), which describes the level of radiotracer uptake in normal fibroglandular tissue on molecular breast imaging (MBI), has been identified as a breast cancer risk factor. Our objective was to develop and validate a deep learning model using image convolution to automatically categorize BPU on MBI. METHODS: MBI examinations obtained for clinical and research purposes from 2004 to 2015 were reviewed to classify the BPU pattern using a standardized five-category scale. Two expert radiologists provided interpretations that were used as the reference standard for modeling. The modeling consisted of training and validating a convolutional neural network to predict BPU. Model performance was summarized in data reserved to test the performance of the algorithm at the per-image and per-breast levels. RESULTS: Training was performed on 24,639 images from 3,133 unique patients. The model performance on the withheld testing data (6,172 images; 786 patients) was evaluated. Using direct matching on the predicted classification resulted in an accuracy of 69.4% (95% CI, 67.4% to 71.3%), and if prediction within one category was considered, accuracy increased to 96.0% (95% CI, 95.2% to 96.7%). When considering the breast-level prediction of BPU, the accuracy remained strong, with 70.3% (95% CI, 68.0% to 72.6%) and 96.2% (95% CI, 95.3% to 97.2%) for the direct match and allowance for one category, respectively. CONCLUSION: BPU provided a robust target for training a convolutional neural network. A validated computer algorithm will allow for objective, reproducible encoding of BPU to foster its integration into risk-stratification algorithms.

14.
Drug Alcohol Depend ; 196: 31-39, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30660937

RESUMO

BACKGROUND: We assessed the impact of comorbid depression and anxiety disorders as well as positive and negative emotional states on alcohol consumption in alcohol dependent men and women. METHODS: Per day alcohol consumption during 90 days before enrolment was assessed by the Time Line Follow Back (TLFB) in 287 men and 156 women meeting DSM-IV-TR criteria for alcohol dependence. Propensity to drink in negative/positive emotional states was assessed using the Inventory of Drug Taking Situations (IDTS). Psychiatric comorbidities, including major depressive disorder (MDD), substance-induced depression (SID), anxiety disorders (AnxD), or substance-induced anxiety (SIA) were identified by Psychiatric Research Interview of Substance and Mood Disorders (PRISM). RESULTS: In the combined group, increased number of drinks per day and number of heavy drinking days correlated with increased IDTS scores (all p < 0.0001), while the lifetime history of MDD was associated with fewer drinking days (p = 0.045) but not average number of drinks per day. Male sex was associated with higher alcohol consumption per day (p < 0.0001), but not with the number of drinking days (p > 0.05). Lifetime MDD history was associated with less drinking days (p = 0.0084) and less heavy drinking days (p = 0.021) in alcohol dependent men, while current MDD was associated with higher alcohol use per day in alcohol dependent women (p = 0.044). CONCLUSIONS: Our findings suggest that emotional states and lifetime MDD history have sex-specific impact on alcohol use in alcohol dependent men and women. The mechanisms underlying these findings and their relevance to treatment outcomes need to be examined in future studies.


Assuntos
Sintomas Afetivos/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Alcoólicos/psicologia , Alcoolismo/psicologia , Transtorno Depressivo Maior/psicologia , Caracteres Sexuais , Adulto , Sintomas Afetivos/diagnóstico , Sintomas Afetivos/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Emoções/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
J Clin Psychol Med Settings ; 26(4): 470-482, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30690670

RESUMO

This study explored the relationship between injury severity and depressive symptoms for treatment-seeking individuals with traumatic brain injury (TBI). The Mayo Classification System was used to classify TBI severity in 72 participants who completed the Patient Health Questionnaire at admission and at dismissal from rehabilitation. Patients with mild TBI reported more depressive symptoms than those with moderate or severe TBI at admission and at dismissal. Although injury severity groups differed by gender composition, gender had no effect on severity of depressive symptoms. All participants reported fewer depressive symptoms at dismissal from rehabilitation, including lower endorsement of dysphoria by discharge. Participants with mild TBI, however, continued to report depressive symptoms of a mild severity at dismissal, with residual problems with anhedonia. These findings underscore the benefit of interdisciplinary post-acute rehabilitation services for persons with TBI of any severity, including those with mild injury.

16.
J Magn Reson Imaging ; 49(7): e256-e264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30575193

RESUMO

BACKGROUND: There is no accurate method distinguishing different types of pulmonary nodules. PURPOSE: To investigate whether multiparametric 3T MRI biomarkers can distinguish malignant from benign pulmonary nodules, differentiate different types of neoplasms, and compare MRI-derived measurements with values from commonly used noninvasive imaging modalities. STUDY TYPE: Prospective. SUBJECTS: Sixty-eight adults with pulmonary nodules undergoing resection. SEQUENCES: Respiratory triggered diffusion-weighted imaging (DWI), periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) fat saturated T2 -weighted imaging, T1 -weighted 3D volumetric interpolated breath-hold examination (VIBE) using CAIPIRINHA (controlled aliasing in parallel imaging results in a higher acceleration). ASSESSMENT/STATISTICS: Apparent diffusion coefficient (ADC), T1 , T2 , T1 and T2 normalized to muscle (T1 /M and T2 /M), and dynamic contrast enhancement (DCE) values were compared with histology to determine whether they could distinguish malignant from benign nodules and discern primary from secondary malignancies using logistic regression. Predictability of primary neoplasm types was assessed using two-sample t-tests. MRI values were compared with positron emission tomography / computed tomography (PET/CT) to examine if they correlated with standardized uptake value (SUV) or CT Hounsfield unit (HU). Intra- and interreader agreements were assessed using intraclass correlations. RESULTS: Forty-nine of 74 nodules were malignant. There was a significant association between ADC and malignancy (odds ratio 4.47, P < 0.05). ADC ≥1.3 µm2 /ms predicted malignancy. ADC, T1 , and T2 together predicted malignancy (P = 0.003). No MRI parameter distinguished primary from metastatic neoplasms. T2 predicted PET positivity (P = 0.016). T2 and T1 /M correlated with SUV (P < 0.05). Of 18 PET-negative malignant nodules, 12 (67%) had an ADC ≥1.3 µm2 /ms. With the exception of T2 , all noncontrast MRI parameters distinguished adenocarcinomas from carcinoid tumors (P < 0.05). T1 , T2 , T1 /M, and T2 /M correlated with HU and therefore can predict nodule density. Combined with ADC, washout enhancement, arrival time (AT), peak enhancement intensity (PEI), Ktrans , Kep , Ve collectively were predictive of malignancy (P = 0.012). Combined washin, washout, time to peak (TTP), AT, and PEI values predicted malignancy (P = 0.043). There was good observer agreement for most noncontrast MRI biomarkers. DATA CONCLUSION: MRI can contribute to pulmonary nodule analysis. Multiparametric MRI might be better than individual MRI biomarkers in pulmonary nodule risk stratification. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.

17.
J Atten Disord ; 23(10): 1119-1125, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27138328

RESUMO

Objective: The objective was to assess the clinical utility of the Adult ADHD Self-Report Scale (ASRS-v1.1) in identifying ADHD in alcoholics using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) as the diagnostic "gold standard." Method: We performed a secondary analysis of data from 379 treatment-seeking alcoholics who completed the ASRS-v1.1 and the ADHD module of the PRISM. Data analysis included descriptive statistics. Results: The prevalence of ADHD was 7.7% (95% CI = [5.4, 10.8]). The positive predictive value (PPV) of the ASRS-v1.1 was 18.1% (95% CI = [12.4, 25.7]) and the negative predictive value (NPV) was 97.6% (95% CI = [94.9, 98.9]). The ASRS-v1.1 demonstrated a sensitivity of 79.3% (95% CI = [61.6, 90.2]) and a specificity of 70.3% (95% CI = [65.3, 74.8]). Conclusion: The ASRS-v1.1 demonstrated acceptable sensitivity and specificity in a sample of treatment-seeking alcoholics when compared with the PRISM as the reference standard for ADHD diagnosis.

18.
J Am Acad Child Adolesc Psychiatry ; 57(10): 786-791, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30274653

RESUMO

OBJECTIVE: Although suicide is the second most frequent cause of death in American youth, suicide research has heretofore been confined to convenience samples that represent neither psychiatric nor general populations and that fail to include individuals dying at their first attempts. These limitations were addressed by assembling a youth cohort followed from the first medically recorded attempt (index attempt [IA]). It was hypothesized this approach would more accurately represent the prevalence of completed suicide after an attempt and underscore lethality based on method. METHOD: This study draws from a previously reported retrospective-prospective all-age cohort identified through the Rochester Epidemiology Project. The original 1,490-subject sample included 813 Olmsted County youth 10 to 24 years old (n = 258 male, n = 555 female; 54.6% of total cohort) with IAs from January 1, 1986 through December 31, 2007 and followed until December 31, 2010. RESULTS: Twenty-nine of 813 subjects (3.6%) killed themselves during the study period, with 28 of 29 dying before their 25th birthday and 20 of 28 (71.4%) dying at their first attempt. Despite composing only 31.7% of the cohort (258 of 813), male subjects composed most suicides: 23 of 29 (79.3% of suicides; 8.9% of male subjects) versus 6 of 29 female subjects (20.7% of suicides; 1.1% of female subjects). Eighty-five percent of all IA deaths involved firearms. More than a third of youth-41.2%-lacked a psychiatric history prior to IA. CONCLUSION: These data show that more than half the IAs occurred in youth, with approximately three-fourths of completed youth suicides occurring at the IAs. In parsing cause of IA death in the all-age cohort, the contribution of firearms figured even more prominently in the subsample of youth (85.0%) than in those at least 25 years old (64.3%). The high IA lethality suggests that prevention efforts commencing after the IA are too late for most victims.


Assuntos
Armas de Fogo/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Adulto Jovem
19.
Clin Transplant ; 32(9): e13349, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29998506

RESUMO

Soluble ST2 (sST2) is a novel biomarker of inflammation and fibrosis. Elevated sST2 levels (≥35 ng/mL) are associated with worse outcomes in patients with heart failure (HF). There are sparse data regarding the significance of sST2 levels after heart transplantation (HTx). The study aims were to evaluate trends in soluble ST2 levels after the resolution of HF status with HTx and association between post-HTx sST2 levels and outcomes. Plasma sST2 levels were measured at baseline (median [IQR] of 118 days pre-HTx) and 12 months post-HTx in 62 subjects who were stratified into two groups by post-HTx sST2 levels < or ≥35 ng/mL: "Group 1" or "Group 2," respectively. Plasma sST2 levels were elevated in 58% of patients pre-HTx and in 50% of patients post-HTx. There was no association between elevated sST2 levels before and after HTx, and no significant differences in baseline characteristics between Group 1 and Group 2 patients. Group 2 as compared to Group 1 HTx recipients had significantly higher incidence of antibody-mediated rejection (AMR) for the entire post-transplant follow-up period (32% vs 4%, P = 0.006). There was no association between post-HTx sST2 level status and other post-HTx outcomes including survival. In conclusion, elevated plasma sST2 levels after HTx are associated with increased risk for AMR.


Assuntos
Biomarcadores/sangue , Rejeição de Enxerto/diagnóstico , Transplante de Coração/efeitos adversos , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Isoanticorpos/efeitos adversos , Complicações Pós-Operatórias , Estudos de Coortes , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto , Insuficiência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
20.
Psychol Serv ; 2018 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-30010360

RESUMO

Few children with mental health problems receive evidence-based psychotherapy, partly because of unsuccessful dissemination of evidence-based treatments (EBTs). Previous research suggests that the length and structure of EBT protocols for anxiety disorders may impede their adoption in community practice. To examine the potential discrepancy between EBT protocols and clinical practice across disorders, we examined patient diagnoses and average length of treatment for childhood psychiatric disorders in a regional medical center where child and adolescent patients from the community have access to mental health care. The findings suggest that although a large portion of youth seeking mental health care presented with symptoms consistent with those addressed by common evidence-based psychotherapy protocols, less than half of these patients ever met with a therapist and less than 10% of those attended a sufficient number of sessions to complete a full treatment protocol. These results underscore the need to develop brief and flexible EBT protocols, such as modular treatments, that introduce essential elements early in the course of treatment. (PsycINFO Database Record

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