Supportive relationships within ongoing families: cross-lagged effects between components of support and adjustment in parents and young adult children.

Italy is the first country in which the phenomenon of cohabitation of parents and young adult children was examined. From the earliest studies, it seemed clear that the transition to adulthood occurs within the family of origin: indeed, the successful outcome of this transition depends on the quality of family relationships. Using the Social Relations Model, this study examines the importance of the components of support within family relationships during the transition of young adults from university to job contexts (Kenny & La Voie, 1984). The cross-lagged influence among the components of perceived support and the adjustment of family members has also been investigated. Findings show that family components of support are significant for perception in both parents and young adults. Furthermore, cross-lagged models reveal different results for parents than for young adults. Discussion of results regarding the transition to adulthood and family theory is provided.

[Anorexia and bulimia: the canton of Vaud's experience of an interdisciplinary approach]. / Anorexie mentale et boutimie: I'expérience vaudoise d'une prise en charge interdisciplinaire.

As psychiatric disorders attacking the body, anorexia and bulimia may have severe psychological, physical and social consequences, often requiring a long-standing interdisciplinary, coordinated and individualized approach. Recently the canton of Vaud has initiated and developed an interinstitutional structure--between the University Hospital (CHUV) and the hospitals of the Northern region of the canton (eHnv)--for the care of patients suffering from eating disorders. This structure, allowing the above mentioned approach for the treatment of eating disorders, consists of an outpatient facility located in the CHUV and an inpatient unit in the hospital of Saint Loup of the eHnv. Within this structure, the general practitioner plays a crucial role in the prevention of the chronification of these disorders by means of their early detection and management.

Opsonization by anti-dsDNA antibodies of apoptotic cells in systemic lupus erythematosus.

In order to asses the role of the soluble mediators of serum from patients with SLE in the apoptotic cell clearance, we measured the in vitro phagocytosis of apoptotic Jurkat cells by normal healthy donor macrophages in the presence of SLE patients' sera. A significant increase of the phagocytic index (NHD = 1.0 +/- 0.3; SLE = 1.9 +/- 0.6; p < 0.01) was to be observed in the presence of serum from patients with SLE. The increased phagocytic index correlated to the anti-dsDNA antibodies titers. We conclude that anti-dsDNA antibodies present in sera of patients with SLE favor the apoptotic cell phagocytosis by opsonization of the target cells. This may represent a deviation of the clearance process towards inflammation and a new pathologic feature of these autoantibodies in SLE.

SCA17 caused by homozygous repeat expansion in TBP due to partial isodisomy 6.

An expanded polyglutamine domain in the TATA-binding protein (TBP) has been described in patients with spinocerebellar ataxia type 17 (SCA17) characterized by cerebellar ataxia associated with dementia. TBP is a general transcription initiation factor that regulates the expression of most eukaryotic genes transcribed by RNA polymerase II. SCA17, as an autosomal dominantly inherited progressive neurodegenerative disorder, is caused by heterozygous expansion of a CAG repeat coding for glutamine. Alleles with 27 to a maximum of 44 glutamine residues were found as the normal range, whereas expansions above 45 repeat units were considered pathological. Here, we present a patient with a very severe phenotype with a late onset but rapidly progressing ataxia associated with dementia and homozygous 47 glutamine residues caused by an apparent partial isodisomy 6. This extraordinary case has important implications for the insights of TBP and SCA17. The expanded polyglutamine domain in both TBP copies is not correlated with embryonic death indicating that the normal function of the protein is not disrupted by this kind of mutation but may account for the dementia seen in this patient.

Aminoborohydrides. 11. Facile reduction of N-alkyl lactams to the corresponding amines using lithium aminoborohydrides.

[reaction: see text] Various five- and six-membered N-alkyl lactams were reduced to the corresponding cyclic amines using lithium N,N-dialkylaminoborohydrides (LAB). Most of the reductions were essentially complete after refluxing in THF for 2 h. The cyclic amine products were easily isolated after an aqueous workup in very good to excellent yields. It is possible to selectively reduce most functional groups, such as esters, in the presence of a lactam using LAB reagents.

Exhaled nitric oxide before and after montelukast sodium therapy in school-age children with chronic asthma: a preliminary study.

Exhaled nitric oxide (ENO) is a surrogate marker of airway inflammation in asthma. In 12 children aged 6-11 years with mild to moderate persistent asthma, ENO concentrations were measured before and after 4 weeks of treatment with montelukast sodium, a leukotriene receptor antagonist, and 2 weeks after withdrawal of therapy. Baseline ENO levels (mean and 95% confidence interval) were significantly elevated in patients with asthma compared to age-matched nonasthmatic control subjects, with levels of 83 (42-123) vs. 13 (11-15) ppb (P < 0.001). After treatment with montelukast sodium, there was a significant (P < 0.01) reduction in ENO to 58 (27-89) ppb which again rose to 69 (38-99) ppb 2 weeks after treatment was withdrawn. During treatment, the fall in ENO was accompanied by nonsignificant improvements in prebronchodilator forced expiratory volume in 1 s (FEV(1)) from 81-85% predicted or reductions in use of albuterol from a mean of 2.5 to 1.6 puffs/day. Individual ENO measurements and change in ENO concentrations with treatment did not correlate with either pulmonary function changes or use of bronchodilator. These data show that ENO is elevated in children with relatively mild asthma treated with bronchodilator alone, and that treatment with montelukast sodium for 4 weeks results in a significant reduction in ENO concentrations, even in the absence of significant changes in pulmonary function. These findings suggest an anti-inflammatory role for leukotriene D(4) receptor antagonism in the treatment of children with mild to moderate asthma.

Comparison of exhaled nitric oxide, serum eosinophilic cationic protein, and soluble interleukin-2 receptor in exacerbations of pediatric asthma.

The hypotheses tested in this study were that during acute asthma exacerbations (1) exhaled nitric oxide concentrations [eNO] are a more sensitive, noninvasive indicator of asthma disease activity than serum markers of inflammation such as eosinophil cationic protein (ECP) or soluble interleukin 2 receptor (sIL2R), and (2) elevated [eNO] are reduced after treatment with glucocorticoids (GC). Peak eNO levels were measured by chemiluminescence during slow expiration. Seven asthmatic subjects (mean age 11 yrs; mean morning FEV1 65% predicted) receiving inhaled GC, and with no radiographic evidence of acute sinusitis, were studied before and after a course of oral GC. Measurements of [eNO], ECP and sIL2R levels, and FEV1% were obtained before and after a course of GC. Six atopic nonasthmatic subjects (mean age 12 years; mean FEV1 94% predicted) and seven normal subjects (mean age 13 years; mean FEV1 100% predicted) were studied. The mean peak [eNO] level (parts per billion: ppb) for the asthma subjects before treatment (52 +/- 5 ppb SEM) was greater than the value for both nonasthmatic atopic and normal subjects (16 +/- 2 ppb and 14 +/- 2 ppb SEM, respectively; P < 0.0001). There was no significant difference in ECP or sIL2R values between asthmatic subjects and either atopic or normal subjects (P > 0.05). Baseline pre-GC treatment ECP levels in the asthmatic subjects were significantly higher (P < 0.002) than post-GC treatment values. The mean peak [eNO] level in the asthmatic subjects declined after oral GC treatment to 14 +/- 1 ppb (P < 0.0002) and was less than 2 ppb different from either control group (P > 0.75). We conclude that [eNO] is a more sensitive marker of asthma disease activity than ECP and sIL2R levels. In addition, [eNO] appears to be a more useful indicator of the beneficial response to GC therapy than these other measurements in pediatric asthma.

Comparative evaluation of the powder properties and compression behaviour of a new cellulose-based direct compression excipient and Avicel PH-102.

This study compares the compression behaviour of a new cellulose-based tableting excipient, hereinafter referred to as UICEL-A/102, and Avicel PH-102, a commercial direct compression excipient commonly referred to as microcrystalline cellulose (MCC). UICEL-A/102 shows the cellulose II lattice, while Avicel PH-102 belongs to the cellulose I polymorphic form. The median particle diameters of UICEL-A/102 and Avicel PH-102 fractions used in the study were 107 and 97 microm, respectively. Compared with Avicel PH-102, UICEL-A/102 was more dense; the relative poured and tapped densities were: 0.277 and 0.327 (vs 0.195 and 0.248 for Avicel PH-102), respectively. The true density, rhotrue, of the two materials was comparable ( approximately 1.56 g cm(-3)). The slopes of the in-die and out-of-die Heckel curves for Avicel PH-102 were steeper than for UICEL-A/102. The relative density versus applied pressure plot was in good agreement with the modified Heckel equation. The out-of-die and in-die minimal pressure susceptibility (chipmin) values calculated were 3.36 x 10(-3) and 8.09 x 10(-3) MPa(-1) for UICEL-A/102 and 8.00 x 10(-3) and 16.12 x 10(-3) MPa(-1) for Avicel PH-102, respectively. The elastic recovery profiles showed UICEL-A/102 to be more elastic than Avicel PH-102. In conclusion, UICEL-A/102 and Avicel PH-102 differ in their compression behaviour under pressure. The different polymorphic forms could provide a possible explanation.

Neuropsychiatric thalamocortical dysrhythmia: surgical implications.

Clearly, more clinical experience must be amassed to define in detail the possibilities of this surgical approach in disabling neuropsychiatric disorders. We propose, however, that the evidence for benign and efficient surgical intervention against the neuropsychiatric TCD syndrome is already compelling. The potential appearance of strong postoperative reactive manifestations requires a close association between surgery and psychotherapy, with the latter providing support for the integration of the new situation as well as the resolution of old unresolved issues.

Capillary electrophoresis in clinical toxicology.

During the past decade, capillary electrophoresis (CE) emerged as a promising, effective and economic approach for separation of a large variety of substances, including those encountered in clinical toxicology. Reliable and automated CE instruments became commercially available and promoted the exploration of an increasing number of CE methods for illicit and licit drugs in body fluids. The widespread applicability of CE, its enormous separation power and high-sensitivity detection schemes make this technology an attractive and promising tool. This review provides an overview of the key achievements encountered with CE in clinical toxicology, including (i) the rapid assessment of drug intoxications via direct sample injection, (ii) the screening for and determination of illicit and licit drugs in body fluids with drug extraction, drug concentration (stacking) and chiral discrimination, (iii) the application of immunological single and multianalyte assays in the capillary format to the screening for drugs in body fluids, and (iv) drug confirmation by on-column multiwavelength absorbance and fluorescence detection and/or CE coupled to mass spectrometry. With its distinct features (automation, small sample size, minimal sample preparation, requirement of almost no organic solvents, ease of buffer change and method development, speed of analysis, low cost of capillaries and chemicals) CE has a bright future and the twenty-first century will witness the widespread use of a large number of simple and reliable CE based assays for drugs, methods that will be employed in clinical toxicology, therapeutic drug monitoring and forensic science.

Qualitative assessment of blood washing with the continuous autologous transfusion system (CATS)

A number of different blood-processing methods can be used at the end of cardiopulmonary bypass (CPB) to improve the quality of autologous blood. They include centrifugation, hemofiltration and cell-washing. They differ in processing time required, cost of disposables and the quality of the processed autologous blood product. The newly developed continuous auto-transfusion system (CATS: Fresenius AG, Bad Homburg) uses a continuous cell-washing method. In a prospective study, the oxygenator blood of 10 patients was processed at the end of cardiac surgery with CATS and the quality of autologous blood before and after processing was compared. The processing volumes and the time required were recorded. The concentrations and elimination rates of blood parameters and waste products such as activated coagulation and complement products were measured. At the end of CPB a mean volume of 1,010 +/- 174 ml diluted oxygenator blood was processed and concentrated to 310 +/- 88 ml in 11.0 +/- 2.2 mins. Cellular elements such as erythrocytes and leucocytes were mostly retained and their concentration showed a significant increase after processing (250% and 210% respectively; p < 0.01). Thus, the blood processing with CATS resulted in an excellent hemoconcentration (hematocrit 62 +/- 3 vs. 24 +/- 4% before processing) with a consistent reproducibility. On the other hand, the CATS concentrate showed a significant loss of autologous plasma proteins. Likewise, all water soluble elements such as waste products are significantly lower in concentration after processing and, if calculated by quantity, they show a high elimination rate (> 93%). In conclusion, the continuous autologous transfusion system permits an automated, rapid and continuous processing of autologous blood yielding a standardised high quality erythrocyte concentrate.

Significant others: Italian adolescents' rankings compared with their parents.

In a study of social context in which adolescents live from an intergenerational perspective, the purpose was comparison of significant others of the generation of Italian adolescents (n = 595) and their parents' recalled others significant during adolescence (397 fathers and 416 mothers). Analysis showed the predominance of parents and above all the mother as the most significant others for both generations during adolescence. Further, today's adolescent generation attributed less importance to other unrelated adults than their parents recalled.

[Duodenal duplications in adults. Apropos of 3 cases]. / Duplications duodénales de l'adulte. A propos de 3 observations.

Duodenal duplication is a rare congenital malformation and it is quite exceptional for it to be discovered in adult life. Three recently observed cases are discussed and used as a basis for reviewing diagnostic and surgical therapeutic problems. Pathology provides confirmation of diagnosis.

Seizure induced cardiac asystole in epilepsy patients undergoing long term video-EEG monitoring.

Ictal-related cardiac asystole is supposed to be a risk factor for sudden unexpected death in epilepsy (SUDEP). We retrospectively analyzed the occurrence of ictal asystole in 2003 epilepsy patients undergoing long-term video EEG/ECG monitoring from 1/1999 to 6/2010 at the Freiburg epilepsy centre. Seven patients had cardiac arrest with a duration of at least 3s; 6 ictal, one postictal. In all patients, the temporal lobe was involved in ictal activity based on neurophysiological investigations or morphological lesion. Whereas asystole was self-limited in six cases, one patient with insular seizure origin had to undergo cardiopulmonary resuscitation. Interestingly, also patients with a short history of epilepsy, low seizure frequency and under treatment in monotherapy showed episodes of asystole. In all cases, even with brief cardiac arrest, asystole was associated with subsequent EEG flattening. In conclusion, ictal asystole is a rare event even in a population undergoing major changes in antiepileptic medication. Temporal lobe epilepsy was associated with a risk for asystole; cardiac arrest also occurred in patients who, based on their history, might have not been considered at elevated risk for SUDEP.

Further description of early clinically silent lupus nephritis.

Thirty silent lupus nephritis (SLN) patients were compared to 16 individuals bearing overt lupus nephritis (OLN). Results included: years of systemic lupus erythematosus (SLE) diagnosis were significantly earlier (4.6 +/- 2.8 years) in SLN than in OLN (7.18 +/- 3.61) (P < 0.05). Neurological compromise, hypertension, normocitic anemia and lymphopenia were significantly prevalent in OLN than in SLN (P < 0.05). Beside normal urinary sediment and renal function tests, the SLN group showed a moderate increase of both activity (AI) and chronicity (CI) renal pathology index when compared to highly increased AI and CI in OLN (P < 0.05). Seventy percent of SLN patients were ISN/RPS Classes I (6.6%) and II (63.3%) while 81% of OLN cases were Classes III, IV (37.5%) and V. IgG, IgA, IgM, lambda chain, C3 and fibrinogen immune deposits were found in 90% or over in both SLN and OLN individuals while in 60% or over, both groups also showed kappa chain, Clq and C4 deposits. While prevalence of ANA, anti-dsDNA and anti-C1q antibodies were similar in both groups, anti-histone, anti-RNP, CIC and CH50 serum levels were significantly different in OLN versus SLN (P < 0.05). We strongly suggest that indeed SLN is the earliest stage in the natural history of lupus nephritis.

Characterization of the stereoselective metabolism of methadone and its primary metabolite via cyclodextrin capillary electrophoretic determination of their urinary enantiomers.

Using capillary zone electrophoresis with a phosphate buffer at pH 3, containing 4.3 mM hydroxypropyl-beta-cyclodextrin as chiral selector, the simultaneous separation of the enantiomers of methadone and its primary metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), is reported. After solid-phase extraction and analysis of the reconstituted extracts in a 60 cm fused-silica capillary of 50 microns ID within about 25 min, the mean S/R enantiomeric ratio of methadone in the urines of eight patients undergoing methadone therapy is shown to be 0.653 (range: 0.502-0.842). The mean enantiomeric ratio for the metabolite is 0.630 (range: 0.517-0.729). These data document the stereoselectivity of the methadone metabolism. Finally, the EDDP/ methadone ratio is shown to vary between 0.357 and 2.917 with a mean value of 1.731. The capillary electrophoretic assay described is simple, inexpensive and neither requires any sample derivatization, nor large amounts of organic solvents or expensive separation columns.