[Suicidal risk prevention in schizophrenia: Importance of family psychoeducation]. / Prévention du risque suicidaire dans la schizophrénie : importance de la psychoéducation des familles.

OBJECTIVES: Although mortality by suicide in schizophrenia seems to have decreased in some countries over the last 30 years, it remains much higher than in the general population. Studies have shown this risk to impact around 5% of patients, corresponding to a risk almost 2.5 times higher than in the general population. Family psychoeducation in schizophrenia has been demonstrated to lead to symptom reductions and to an improvement of the quality of life, two factors that should contribute to decreasing the suicidal risk. Therefore, if families attend an efficient psychoeducation program, we can expect a decrease in the patient suicidal risk. Attending a family psychoeducation program at the beginning of the disease would also be associated with a stronger preventive effect on suicidal mortality. The objective of this study is to describe the suicide attempt rate of patients who suffer from schizophrenia before and one year after one of their relatives participated to the family psychoeducation program Profamille. METHOD: We performed a retrospective study on 1209 people who attended the Profamille (V3.2 version) Family Psychoeducation Program. This program has 2 modules: an initial training module of 14 weekly or fortnightly sessions, and a consolidation module of 4 sessions over 2 years. Sessions last 4 hours and follow a precise and structured course. Data were collected from 40 different centers in France, Belgium and Switzerland and were based on participants assessed at the beginning and one year after the first module. Self-assessment from the relatives participating in the program provided the measure of patients' suicide attempts. An assessment at T0 explored the attempts over the 12 months before the beginning of the program while the assessment at T1 analyzed those during the 12 months following the end of the Program. The Chi2 test was used to compare the suicide attempt rates for each period, using a significance threshold of 0.05. Since the risk of suicide is greater in the first years of the illness, rates of attempts are also calculated according to the age of disorder. The analysis was carried out with the statistical software R. RESULTS: The number of participants reporting that their relative had attempted suicide in the previous 12 months decreased from 41 to 21. The annual attempts rate was evaluated at 6.4 % before the Profamille program and decreased to 2.4 % a year after the end of the program (P=0.0003). The reduction of the attempt rate was observed even for patients with schizophrenia for more than 10 years. CONCLUSION: This study shows the positive impact of Profamille on reducing the rate of suicide attempts in patients with schizophrenia. It has been shown that the risk is highest at the beginning of the disorder. Therefore, based on our results, it would seem appropriate to propose the Profamille program at an early stage.

Proximal radial artery ligation (PRAL) for reduction of flow in autogenous radial cephalic accesses for haemodialysis.

OBJECTIVE: Juxta-anastomosis proximal radial artery ligation (PRAL) is a new surgical technique for reduction of excessive blood flow of radial cephalic fistulas (RCFs). PATIENTS AND METHODS: This prospective study included 37 consecutive patients (eight children and 29 adults) who underwent PRAL of high-flow RCFs causing ischaemia (n = 2), aneurysmal degeneration of the vein (n = 14), and cardiac insufficiency (n = 7) or for prevention of cardiac overload (n = 14). Mean fistula age was 2.6 years for children and 7.4 years for adults. None had diabetes. Anatomical prerequisites (side-to-end anastomosis fistula and retrograde flow in the distal radial artery) were checked by ultrasound or angiography. Division and ligation of the juxta-anastomosis proximal radial artery were performed under regional anaesthesia. Patency following ligation was estimated according to the life table method. RESULTS: The success rate was 92% (34/37). The three failures included one excessive and two insufficient reductions of flow (<33%). Mean flow reduction rates were 50% in children and 53% in adults. Primary patency rates at 1 and 2 years were 88% +/- 6% and 74% +/- 9%, respectively. Secondary patency rates were 88% +/- 6% and 78% +/- 8%, respectively. CONCLUSION: PRAL is a simple, safe, and effective technique for reduction of flow in RCFs.

[State of the art: interventional radiology management of renovascular hypertension]. / Recommandations et bonnes pratiques en radiologie vasculaire interventionnelle: traitement de la maladie réno-vasculaire: sténoses de l'artère rénale (SAR).

The management of renal artery stenosis (RAS) has been the subject of numerous clinical studies and recommendations, most frequently with regards to atherosclerotic RAS. We present the current recommendations from the French Society of Cardiac and Vascular Imaging updated from a recent literature review (April 2008) with regards to medical, endovascular and surgical management of atheroscletotic and non-atherosclerotic RAS. The evidence-based recommendations are ranked by level.

Psychological predictors of success in a pediatric cognitive-behavioral weight-control program.

Carmen Mikhail, PhD, and her coauthors explore the relationship between psychological profiles and success in a pediatric cognitive-behavioral weight-control program.

Luteinizing hormone pulsatility in patients with major ovarian hyperandrogenism.

Hyperandrogenism and ovulatory dysfunction are common in women with either polycystic ovary (PCOS) or ovarian virilizing tumor. However, contrasting with the numerous studies that have extensively described gonadotropin secretory abnormalities, principally increased LH pulse amplitude and frequency, few studies have concerned gonadotropin secretion in patients with ovarian virilizing tumors; low gonadotropin levels have occasionally been reported, but never extensively studied. The goal of the present study was to further evaluate the pulsatility of LH secretion in women with ovarian virilizing tumor compared with that of PCOS patients. Eighteen women with major hyperandrogenism (plasma testosterone level >1.2 ng/ml) were studied (5 women with ovarian virilizing tumor, 13 women with PCOS, and 10 control women). Mean plasma LH level, LH pulse number and amplitude were dramatically low in patients with ovarian tumors when compared to both PCOS (p<0.001) and controls (p<0.001). In case of major hyperandrogenism, LH pulse pattern differs markedly between women with ovarian virilizing tumor or PCOS, suggesting different mechanisms of hypothalamic or pituitary feedback.

[Results of the French register of renal stenting: the Esternal study]. / Résultats du registre français du stenting rénal: étude Esternal.

Renal artery angioplasty using the same techniques employed for coronary arteries has developed considerably. A register was set up in France to evaluate the efficacy of this treatment for improving renal function and lowering blood pressure in cardiac patients. Between 2001 and 2005, 205 patients (234 lesions) were treated in 14 centres (mean age: 69.2 +/- 10.4 years, 59% male). All of the patients had hypertension and the majority of them (171) had renal failure (creatinine clearance<90 ml/min). Direct implantation of a stent was performed in 75.2% of the cases, successfully in 196 patients (96%) with 220 lesions (95.2%). The complications encountered were segmental renal infarction in two patients (0.9%), and four cases of minor vascular complications at the puncture site (2%). The mean value for pre-implantation creatinine clearance was 54.6 +/- 32.8 ml/min and 58.1 +/- 36.0 post- implantations. The duration of follow up was 5.9 +/- 2.7 months. Mortality was 3.5% (seven patients, of whom two died from renal causes). The mean systolic and diastolic blood pressure was 142.2 +/- 16.2 and 78.9 +/- 9.5 respectively versus 164.9 +/- 25.2 and 89.1 +/- 14.8 before treatment (p<0.0001). A non-significant improvement in creatinine clearance at six months was also observed in patients with renal failure prior to treatment: 48.7 +/- 17.1 ml/min vs. 69.2 +/- 160.3. Renal artery stenting in cardiac patients with renal artery stenosis is associated with a very high success rate, with few complications and an improvement in hypertension and renal function.

Enhanced conversion efficiency in Si solar cells employing photoluminescent down-shifting CdSe/CdS core/shell quantum dots.

Silicon solar cells have captured a large portion of the total market of photovoltaic devices mostly due to their relatively high efficiency. However, Silicon exhibits limitations in ultraviolet absorption because high-energy photons are absorbed at the surface of the solar cell, in the heavily doped region, and the photo-generated electron-hole pairs need to diffuse into the junction region, resulting in significant carrier recombination. One of the alternatives to improve the absorption range involves the use of down-shifting nano-structures able to interact with the aforementioned high energy photons. Here, as a proof of concept, we use downshifting CdSe/CdS quantum dots to improve the performance of a silicon solar cell. The incorporation of these nanostructures triggered improvements in the short circuit current density (Jsc, from 32.5 to 37.0 mA/cm2). This improvement led to a ∼13% increase in the power conversion efficiency (PCE), from 12.0 to 13.5%. Our results demonstrate that the application of down-shifting materials is a viable strategy to improve the efficiency of Silicon solar cells with mass-compatible techniques that could serve to promote their widespread utilization.

Developmental mechanism involved in the embryonic reduction of limbs in reptiles.

The purpose of the studies here reported was to explain the mechanisms responsible for the reduction of limbs in the serpentiform reptiles. Descriptive and experimental embryology, ultrastructural studies, chemical action (with Ara-C) on embryos and (3H) thymidine autoradiography of limb buds were used in this study; they provide evidence that defects in the morphogenetic mechanisms involved in the development of limbs (somitic deficiency, incomplete differentiation and premature degeneration of the apical ectodermal ridge) are responsible for the cessation of growth of the limb buds in these reptiles. At the biochemical level, a strong decline in the rate of DNA synthesis in the mesodermal cells of the limb bud (during and after the degeneration of the apical ridge) is the main causative factor of the evolutionary arrest of limb development in serpentiform reptiles.

DNA synthesis decline involved in the developmental arrest of the limb buds in the embryos of the slow worm, Anguis fragilis (L.).

The present study was carried out to try and detect the biochemical mechanism involved in the developmental arrest of the limb bud in a serpentiform Reptile. Autoradiograpy, following tritiated thymidine incorporation, in embryos of the slow-worm (Anguis fragilis, L.) reveals a strong decrease in the rate of DNA synthesis in the mesodermal cells of the limb bud, after the degeneration of the apical ectodermal ridge (AER); the curve (a function of Gompertz) visualizing this decline shows that the drop in DNA synthesis becomes accentuated just after the degeneration of the AER. This decrease precedes the reduction of the mitotic index, the cell degeneration in the mesoderm and the other regressive changes occurring in the limb bud; it thus appears as the main causative factor of the developmental arrest of the limb bud. Furthermore, these results suggest that one of the functions of the AER would be to maintain a high level of DNA synthesis in the mesoderm underlying the AER in a normal limb bud.

Blood pressure outcome of angioplasty in atherosclerotic renal artery stenosis: a randomized trial. Essai Multicentrique Medicaments vs Angioplastie (EMMA) Study Group.

Data for the effects on blood pressure of renal artery balloon angioplasty are mostly from uncontrolled studies. The aim of this study was to document the efficacy and safety of angioplasty for lowering blood pressure in patients with atherosclerotic renal artery stenosis. Patients were randomly assigned antihypertensive drug treatment (control group, n = 26) or angioplasty (n = 23). Twenty-four-hour ambulatory blood pressure, the primary end point, was measured at baseline and at termination. Termination took place 6 months after randomization or earlier in patients who developed refractory hypertension. In those allocated angioplasty, antihypertensive treatment was discontinued after the procedure but was subsequently resumed if hypertension persisted. Secondary end points were the treatment score and the incidence of complications. Two patients in the control group and 6 in the angioplasty group suffered procedural complications (relative risk, 3.4; 95% confidence interval, 0.8 to 15.1). Early termination was required for refractory hypertension in 7 patients in the control group. Antihypertensive treatment was resumed in 17 patients in the angioplasty group. Mean ambulatory blood pressure at termination did not differ between control (141+/-15/84+/-11 mm Hg) and angioplasty (140+/-15/81+/-9 mm Hg) groups. Angioplasty reduced by 60% the probability of having a treatment score of 2 or more at termination (relative risk, 0.4; 95% confidence interval, 0.2 to 0.7). There was 1 case of dissection with segmental renal infarction and 3 of restenosis in the angioplasty group. No patient suffered renal artery thrombosis. In unilateral atherosclerotic renal artery stenosis, angioplasty is a drug-sparing procedure that involves some morbidity. Previous uncontrolled and unblinded assessments of angioplasty overestimated its potential for lowering blood pressure.

Restenosis after a first percutaneous transluminal renal angioplasty.

The incidence of restenosis after a first successful percutaneous transluminal angioplasty of a native renal artery and the clinical and angiographic variables that may influence its occurrence were studied in 104 hypertensive patients. Angiograms obtained immediately before and after angioplasty and, in 92 patients, 8.8 +/- 6.0 months after angioplasty were interpreted separately by two observers. Stenosis severity was classified into five grades, and restenosis was defined by a stenosis one grade or more higher at follow-up than immediately after angioplasty. Interobserver concordance for etiology, stenosis grade, and other angiographic items yielded kappa coefficients in the range of 0.328-0.942. Sessions were organized to reach a consensus in each case. Ostial stenoses were more frequent in patients with atheromatous stenoses, and branch stenoses were more frequent in those with fibromuscular dysplasia. There was no significant difference between the 15 patients (16%) with restenosis and those without concerning sex distribution, mean age, mean blood pressure, plasma creatinine level, and etiology distribution. Truncal stenoses were less prone to restenosis than ostial or branch stenoses (12% versus 35%, respectively; 95% confidence interval of difference, -0.6% to 47%). In patients with atheromatous stenoses, aortitis or aortic ectasia were associated with a high restenosis incidence (35% when present versus 8% when absent; 95% confidence interval of difference, 5% to 48%). In conclusion, restenosis was observed in one sixth of patients after a first successful renal angioplasty; its incidence was low in patients with truncal stenoses and high in those with severe aortic atheroma. Automated renal artery stenosis quantification methods are needed to standardize stenosis description.

Diagnosis and treatment of renin-secreting tumors. Report of three cases.

During the past 10 years, we have found renin-secreting renal juxtaglomerular cell tumors in three hypertensive patients (two women, one man, aged 22, 69, and 21 years, respectively). The major chemical and biological findings revealed the association of severe hypertension with hypokalemia and increased plasma renin activity and plasma aldosterone. The diagnosis of such tumors is difficult, and two of the three patients were followed up for four and five years respectively before undergoing surgery. The pharmacological blockade of the renin system by various agents (beta-blockers, angiotensin II antagonists, and captopril) and its effects on blood pressure and plasma renin activity proved to be unreliable. Renal venous catheterization for renin measurements failed to provide adequate localization of the tumor. Direct radioimmunoassay, however, showed the total plasma renin to be markedly elevated. In addition, renal arteriography showed an avascular area corresponding to the renin-secreting tumor in each of the three patients. All three patients were cured of hypertension and hypokalemia by excision of the tumor.

Reelin expression during embryonic brain development in lacertilian lizards.

The expression of reelin mRNA and protein was studied during embryonic brain development in the lacertilian lizards L. viridis and L. galloti, by using radioactive in situ hybridization and immunohistochemistry. At all stages studied, high reelin expression was consistently found in the olfactory bulb, in the lateral cortex, and in neurons of the marginal zone and subplate of medial and dorsal cortical sectors. In the dorsal ventricular ridge (DVR), reelin expression was confined to deeply located, large cells which were more abundant in the caudal than the rostral part of the DVR. In the diencephalon, the ventral lateral geniculate complex and the perirotundal were strongly positive, whereas other nuclei were mostly negative. High reelin signal was associated with some layers in the tectum, with the torus semicircularis, cerebellar granule cell layers, and the ventral horn of the spinal cord. A more moderate signal was detected in the septal nuclei, striatum, retina, habenular nuclei, preoptic and periventricular hypothalamic components, and in reticular nuclei of the mid- and hindbrain. The medial and dorsal cortical plate and Purkinje cells were reelin-negative but expressed disabled-1 (Dab1) mRNA. When they are compared with reelin expression during mammalian brain development, our data reveal an evolutionarily conserved canvas of reelin expression, as well as significant differences, particularly in developing cortical fields. The developing lizard cortex differs from that of turtles, birds, crocodiles, and mammals in that it displays heavy reelin expression not only in neurons of the marginal zone that might be homologous to mammalian Cajal-Retzius cells, but also in subplate neurons. This difference in the pattern of reelin expression suggests that the elaborate radial organization of the lacertilian cortical plate, somewhat reminiscent of its mammalian counterpart, results from evolutionary convergence. Our data lend support to the hypothesis that the reelin signaling pathway played a significant role during cortical evolution.

Presentation and revascularization outcomes in patients with radiation-induced renal artery stenosis.

This study analyzed the initial presentation and revascularization outcomes of patients with radiation-induced renal artery stenosis, a rare complication of therapeutic irradiation. Of 11 patients with renal artery stenosis after irradiation, 7 patients fulfilled the following criteria: normotension before irradiation, radiation dose greater than 25 grays delivered to the renal arteries, associated perirenal radiation-induced lesions, and absence of arterial disease outside the radiation field. The median age at irradiation was 30 years, and the median local irradiation dose was 40 grays. The median time from irradiation to referral was 13 years. All patients were hypertensive at referral, with a median blood pressure (BP) of 171/102 mm Hg and median treatment score of two. The median glomerular filtration rate was 67 mL/min. Two patients had bilateral stenoses and 1 patient had stenosis affecting a single kidney. Stenoses were proximal in 6 patients and truncal in 1 patient, and all had the appearance of atherosclerotic stenosis. Percutaneous transluminal renal artery angioplasty (PTRA) was successful in 5 patients, but required multiple insufflations. PTRA failed in 1 patient, who subsequently underwent an aortorenal bypass. After a median follow-up of 36 months, 2 patients had died of noncardiovascular causes and 4 patients remained hypertensive, with a median BP of 136/85 mm Hg and median treatment score of two. No restenosis occurred, but aneurysms developed at the site of angioplasty in 1 patient. If hypertension occurs even decades after irradiation, a radiation-induced renal artery stenosis should be sought in patients who have undergone abdominal irradiation.

Long distance runners and body-builders exhibit elevated plasma levels of lipoprotein(a).

A one-point cross-sectional study of 20 sedentary individuals, 20 low-aerobic athletes (body-builders), and 20 high-aerobic athletes (long distance, endurance runners) was conducted in Mexico City, Mexico to determine the influence of these diverse life-styles on the plasma levels of Lp(a). Only non-obese male subjects, aged 23-33, who were nonsmokers, non-alcoholics, and had never used anabolic steroids were included in this study. Blood samples were drawn 24 h following the last period of physical activity, and after a 12-14-h fast-period and a 15-min sitting-rest. Plasma levels of Lp(a) and other parameters, including postheparin lipoprotein lipase (LPL) and hepatic lipase (HL) activities, triglycerides (TG), total cholesterol (TC), LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C), as well as % body fat and muscle mass, and maximum aerobic capacity (VO2max) were measured to determine possible correlations with Lp(a) and to serve as convenient internal standards. Mean Lp(a) concentrations were significantly higher in the runners (52 +/- 19 mg/dl) than in the body-builders (40 +/- 6.4 mg/dl, P < 0.05) and the sedentary subjects (24 +/- 5 mg/dl, P < 0.001). Positive correlations between Lp(a) and Vo2max (P < 0.001), HDL-C (P < 0.005) and HDL2-C subfraction (P < 0.005), and a negative correlation with TG were determined. Agglomerative cluster methods suggested three close-distance clusters and a fourth cluster which is composed of four runners who exhibited low LDL-C/HDL-C and high LPL/HL ratios, high mean Lp(a), HDL2-C, and Vo2max levels, but low TG levels. These data show that some individuals who maintain a life-style of very high level physical exertion may have remarkably elevated plasma Lp(a) concentrations. The highly increased concentrations of Lp(a) in high exercise athletes may represent a normal metabolic response to repeated small tissue injuries resulting from frequent and prolonged large muscle movement.

The benefit of STent placement and blood pressure and lipid-lowering for the prevention of progression of renal dysfunction caused by Atherosclerotic ostial stenosis of the Renal artery. The STAR-study: rationale and study design.

BACKGROUND: Atherosclerotic renal artery stenosis (ARAS) is associated with progressive loss of renal function and is one of the most important causes of renal failure in the elderly. Current treatment includes restoration of the renal arterial lumen by endovascular stent placement. However, this treatment only affects damage caused by ARAS due to the stenosis and ensuing post-stenotic ischemia. ARAS patients have severe general vascular disease. Atherosclerosis and hypertension can also damage the kidney parenchyma causing renal failure. Medical treatment focuses on the latter. Lipid-lowering drugs (statins) could reduce renal failure progression and could reduce the overall high cardiovascular risk. The additional effect on preserving renal function of stent placement as compared to medical therapy alone is unknown. Therefore, the STAR-study aims to compare the effects of renal artery stent placement together with medication vs. medication alone on renal function in ARAS patients. METHOD: Patients with an ARAS of > or = 50% and renal failure (creatinine (Cr) clearance < 80 mL/min/1.73 m2) are randomly assigned to stent placement with medication or to medication alone. Medication consists of statins, anti-hypertensive drugs and antiplatelet therapy. Patients are followed for 2 yrs with extended follow-up to 5 yrs. The primary outcome of this study is a reduction in Cr clearance > 20% compared to baseline. This trial will include 140 patients.

There is no highly conserved embryonic stage in the vertebrates: implications for current theories of evolution and development.

Embryos of different species of vertebrate share a common organisation and often look similar. Adult differences among species become more apparent through divergence at later stages. Some authors have suggested that members of most or all vertebrate clades pass through a virtually identical, conserved stage. This idea was promoted by Haeckel, and has recently been revived in the context of claims regarding the universality of developmental mechanisms. Thus embryonic resemblance at the tailbud stage has been linked with a conserved pattern of developmental gene expression - the zootype. Haeckel's drawings of the external morphology of various vertebrates remain the most comprehensive comparative data purporting to show a conserved stage. However, their accuracy has been questioned and only a narrow range of species was illustrated. In view of the current widespread interest in evolutionary developmental biology, and especially in the conservation of developmental mechanisms, re-examination of the extent of variation in vertebrate embryos is long overdue. We present here the first review of the external morphology of tailbud embryos, illustrated with original specimens from a wide range of vertebrate groups. We find that embryos at the tailbud stage - thought to correspond to a conserved stage - show variations in form due to allometry, heterochrony, and differences in body plan and somite number. These variations foreshadow important differences in adult body form. Contrary to recent claims that all vertebrate embryos pass through a stage when they are the same size, we find a greater than 10-fold variation in greatest length at the tailbud stage. Our survey seriously undermines the credibility of Haeckel's drawings, which depict not a conserved stage for vertebrates, but a stylised amniote embryo. In fact, the taxonomic level of greatest resemblance among vertebrate embryos is below the subphylum. The wide variation in morphology among vertebrate embryos is difficult to reconcile with the idea of a phyogenetically-conserved tailbud stage, and suggests that at least some developmental mechanisms are not highly constrained by the zootype. Our study also highlights the dangers of drawing general conclusions about vertebrate development from studies of gene expression in a small number of laboratory species.

Validation of a digital videodensitometric program analysis for measurement of left ventricular ejection fraction.

Left ventricular (LV) function was studied in 30 patients using digital subtraction angiography by the intravenous approach. Each ventriculogram was processed with a specific videodensitometric analysis to determine LV ejection fraction. The program was verified in an experimental set-up consisting of nine latex balloons filled with contrast medium. Its validation has been established by comparing videodensitometric results with classical results supplied by geometric methods. A good correlation was obtained (r = 0.9449) and, furthermore, with experimental models, videodensitometric analysis seemed to be more accurate than geometric analysis. Digital videodensitometry appears to be a valuable and accurate method for quantifying LV function, and a promising technique for determination of the real volumes.

Percutaneous transluminal angioplasty of stenotic lesions in dialysis vascular accesses.

Forty-five stenoses behind arteriovenous fistulas in 35' haemodialysed patients were treated with percutaneous transluminal angioplasty (PTA). Immediate stenoses dilatation results in relation to the AVF type were haemodynamically significant in 40 cases (88%), with poorer results on bovine heterograft stenoses. Dilatation results in relation to the site of the lesion showed haemodynamically efficient angioplasty on stenoses next to the anastomosis (67.5%) but a poor result on distal lesions (4 cases). We observed 4 cases of thrombosis but 2 recovered after treatment, one after local fibrinolytic perfusion one after surgical thrombectomy. Follow-up over a period of one to 18 months (mean 8 months) including angiography and appreciation of the dialysis quality were performed in 30 patients who had a successful dilatation. PTA appears to be a technically feasible and clinically effective method of treating stenoses lying on the venous limb fistula in patients on chronic haemodialysis.