Long-term outcome predictors after functional remediation in patients with bipolar disorder.

BACKGROUND: Improving functioning in patients with bipolar disorder (BD) is one of the main objectives in clinical practice. Of the few psychosocial interventions that have been specifically developed to enhance the psychosocial outcome in BD, functional remediation (FR) is one which has demonstrated efficacy. The aim of this study was to examine which variables could predict improved functional outcome following the FR intervention in a sample of euthymic or subsyndromal patients with BD. METHODS: A total of 92 euthymic outpatients were included in this longitudinal study, with 62 completers. Partial correlations controlling for the functional outcome at baseline were calculated between demographic, clinical and neurocognitive variables, and functional outcome at endpoint was assessed by means of the Functioning Assessment Short Test scale. Next, a multiple regression analysis was run in order to identify potential predictors of functional outcome at 2-year follow-up, using the variables found to be statistically significant in the correlation analysis and other variables related to functioning as identified in the previous scientific literature. RESULTS: The regression model revealed that only two independent variables significantly contributed to the model (F(6,53): 4.003; p = 0.002), namely verbal memory and inhibitory control. The model accounted for 31.2% of the variance. No other demographic or clinical variable contributed to the model. CONCLUSIONS: Results suggest that patients with better cognitive performance at baseline, especially in terms of verbal memory and executive functions, may present better functional outcomes at long term follow-up after receiving functional remediation.

The evolution of physical and technical performance parameters in the English Premier League.

This study examined the evolution of physical and technical soccer performance across a 7-season period in the English Premier League. Match performance observations (n=14 700) were analysed for emergent trends. Total distance covered during a match was ~2% lower in 2006-07 compared to 2012-13. Across 7 seasons, high-intensity running distance and actions increased by ~30% (890±299 vs. 1 151±337 m, p<0.001; ES: 0.82) and ~50% (118±36 vs. 176±46, p<0.001; ES: 1.41), respectively. Sprint distance and number of sprints increased by ~35% (232±114 vs. 350±139 m, p<0.001; ES: 0.93) and ~85% (31±14 vs. 57±20, p<0.001; ES: 1.46), respectively. Mean sprint distance was shorter in 2012-13 compared to 2006-07 (5.9±0.8 vs. 6.9±1.3 m, p<0.001; ES: 0.91), with the proportion of explosive sprints increasing (34±11 vs. 47±9%, p<0.001; ES: 1.31). Players performed more passes (35±17 vs. 25±13, p<0.001; ES: 0.66) and successful passes (83±10% vs. 76±13%, p<0.001; ES: 0.60) in 2012-13 compared to 2006-07. Whereas the number of short and medium passes increased across time (p<0.001; ES>0.6), the number of long passes varied little (p<0.001; ES: 0.11). This data demonstrates evolution of physical and technical parameters in the English Premier League, and could be used to aid talent identification, training and conditioning preparation.

Prevalence of clozapine-induced sialorrhea and its effect on quality of life.

RATIONALE: Clozapine has proven to be superior to other antipsychotic drugs in the treatment of schizophrenia but is under-prescribed due to its potentially severe side effects. Clozapine-induced sialorrhea (CIS) is a frequent and extremely uncomfortable side effect, which remains understudied. OBJECTIVES: To examine the prevalence of diurnal and nocturnal CIS in a sample of patients treated with clozapine, and to evaluate its impact on quality of life. METHODS: We conducted a cross-sectional, observational study of 130 patients with schizophrenia spectrum disorders treated with clozapine. The prevalence of CIS was evaluated via specific sialorrhea scales. None of the patients included in the study was receiving a specific treatment for hypersalivation during the study period. Possible associations between sialorrhea and clinical and quality of life variables were analyzed. RESULTS: Of 130 subjects, 120 (92.3%) suffered from CIS. Eighty-one (62.31%) suffered from diurnal CIS, 115 (88.56%) from nocturnal CIS, and 85 (65.38%) suffered from both. Significant positive associations between quality of life and diurnal CIS (B = 0.417; p = 2.1e - 6, R2 = 0.156) and nocturnal CIS (B = 0.411; p = 7.7e - 6, R2 = 0.139) were detected. Thirty per cent of the subjects reported a moderate to severe negative impact of sialorrhea on their quality of life. CONCLUSIONS: The present study suggests that CIS is highly prevalent in patients with schizophrenia and has an important impact on quality of life in one-third of our sample. Therefore, the inclusion of a systematic evaluation and treatment of CIS in standard clinical practice is highly recommended. TRIAL REGISTRATION: Clinical Trials ( https://clinicaltrials.gov ) under reference NCT04197037.

Augmentation of EMDR with multifocal transcranial current stimulation (MtCS) in the treatment of fibromyalgia: study protocol of a double-blind randomized controlled exploratory and pragmatic trial.

BACKGROUND: Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS. METHODS: Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing. DISCUSSION: This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.

Fluorescence imaging of reactive oxygen metabolites generated in single macrophage cells (NR8383) upon phagocytosis of natural zeolite (erionite) fibers.

In this paper we address the phenomenon of reactive oxygen metabolite generation subsequent to phagocytosis of mineral fibers by macrophages. Natural erionite fibers were chosen because of their established toxicity. Macrophages (cell line NR8383) were loaded with the dye 5-(and 6)-carboxy-2',7'-dichlorodihydrofluorescein diacetate and exposed to erionite particles by centrifuging cells and fibers together to effect adherence. Reactive oxygen metabolite generation was examined by monitoring the fluorescence of oxidized dye formed via the reaction with oxygen species produced during phagocytosis. Individual cells were repeatedly scanned for up to 2 hr to monitor the evolution of this fluorescence. It was found that erionite-exposed cells had a mean total fluorescence of three times that of controls during the first 35 min, declining to two times that of controls at 35-60 min and about the same level as that of controls at 60-80 min. Ultrastructural studies of similarly treated aliquots of cells showed marked variation in size and numbers of the phagocytized particles. This study demonstrates that intracellular oxidation can be monitored on a single cell basis over a period of time. Quantitative studies are in progress to establish the relationship between the phagocytized particulate load and the extent of fluorescence.

The incidence of actinomyces-like organisms in Papanicolaou-stained smears of copper- and levonorgestrel-releasing intrauterine devices.

Actinomyces-like organisms (ALOs) are a common finding in Papanicolaou-stained cervico-vaginal smears (PAP smears) of women using an intrauterine device (IUD). The incidence of ALOs positive PAP smears depends on the type of IUD. Pelvic actinomycosis is a severe disease that may require hysterectomy and salpingo-oophorectomy. In a retrospective study we compared the incidence of ALOs positive PAP smears in users of the new levonorgestrel-releasing intrauterine device (LNG-IUD) (n = 52) with the incidence in Multiload Copper IUD (ML375) users (n = 104). All IUDs had been inserted from 1996-1998. Women with a follow-up period of more than 9 months were included into the final analysis (LNG-IUD: n = 34; ML375: n = 65). The incidence of ALOs in LNG-IUD users (2.9%) was significantly lower than in ML375 users (20%). Clinical consequences of ALOs positive PAP smears are discussed controversially. The low incidence in the LNG-IUD users probably leads to less IUD-removals, reinsertions and less pelvic-inflammatory-diseases.

A neural network regulator for turbogenerators.

A neural network (NN) based regulator for nonlinear, multivariable turbogenerator control is presented. A hierarchical architecture of an NN is proposed for regulator design, consisting of two subnetworks which are used for input-output (I-O) mapping and control, respectively, based on the back-propagation (BP) algorithm. The regulator has the flexibility for accepting more sensory information to cater to multi-input, multioutput systems. Its operation does not require a reference model or inverse system model and it can produce more acceptable control signals than are obtained by using sign of plant errors during training I-O mapping of turbogenerator systems using NNs has been investigated and the regulator has been implemented on a complex turbogenerator system model. Simulation results show satisfactory control performance and illustrate the potential of the NN regulator in comparison with an existing adaptive controller.

Ultrasonic, needle, and carcass measurements for predicting chemical composition of lamb carcasses.

Three groups (n = 147) of New Zealand mixed breed lambs averaging 170 d of age and 31.7 kg in weight were killed after a diet of pasture to determine whether the total depth of soft tissues over the 12th rib 11 cm from the dorsal midline (GR) could be measured in live lambs with sufficient accuracy to warrant its use as a selection tool for breeding flock replacements. Relationships among live and carcass measurements and carcass chemical composition also were determined. An ultrasonic measurement of GR in the live lambs was a more accurate predictor of carcass GR (r = .87) and percentage carcass fat (r = .80) than was a measurement of GR made with a needle (r = .80 and .67, respectively). Both measurements were sufficiently accurate to permit culling of over-fat lambs from breeding flock replacement prospects. The best single indicator of percentage carcass fat (r = .87) was a shoulder fat measurement, followed closely by carcass GR (r = .85). Both were superior to USDA yield grade for estimating carcass chemical composition in these young, lightweight lambs. These two measurements also were most highly related to percentage carcass protein (r = -.78 and r = -.77, respectively). These results indicate possibilities for improving the method of evaluating the composition of U. S. lamb carcasses.

Meat composition in genetically selected a control cattle from a serial slaughter experiment.

Young bulls from an Angus yearling-weight selection herd (ASl) and from the contemporary control herd (ACO), differing in average slaughter weight by 16·8%, were allocated for slaughter on one or six occasions between 7·5 and 25 months of age. The M. longissimus lumborum from the left side of each animal was measured for cholesterol, fatty acid composition, and protein, fat and ash contents in both raw and cooked samples; the pH and tenderness were also recorded. All meat was generally lean, averaging 4% fat in raw samples and 2·4% fat in cooked samples. There was a trend, though not significant, for a slightly lower percentage of fat at a fixed age in raw and cooked meat from the AS] herd than from the A CO herd. There were no significant selection effects on cholesterol content or fatty acid content, in either raw or cooked meat samples. The pH was significantly, higher in meat from the ASl than the A CO herd, although the difference was small (0·11 units), and there were no significant herd differences in tenderness. Overall, the herd effects on chemical composition and tenderness were very small and unlikely to be detected by consumers.

Carcass composition and meat quality of brush-tail possums (Trichosurus vulpecula).

One-hundred-and-thirty-nine possums, balanced as far as possible for sex (68 male, 71 female) and age (1 year, 42; 2-4 years, 61; 5+ years, 36), were slaughtered and the dissected carcass composition, muscle, and cooked meat composition measured. Possums were slaughtered at time in captivity TIC 0 (n = 58), TIC 14 days (n = 20) and TIC 28 days (n = 61). Compared with the 5+ years (mature) age group the 1 year olds (juveniles) were 67% and the 2-4 year olds (immature) 96% of the live weight of the mature possums. Carcass composition was characterised by high lean (78-80%) and low fat (around 1-2%). The cooked meat from possums is very high in protein (∼ 25%) and low in fat, suggesting it should be a valuable source of animal protein with a low total fat, high unsaturated fat content. In all cases cooked meat was rated as tender, based on shear force values, despite having a pH of around 6·3.

[Therapeutic effects of magnesium in dysmenorrhea]. / Therapeutische Wirkung von Magnesium bei Dysmenorrhöe.

Primary dysmenorrhea is a common gynaecological symptom complex characterized by a painful syndrome occurring predominantly on the first and the second day of the cycle and associated with concomitant autonomic phenomena. In a randomized double-blind study, the therapeutic effect of magnesium has been investigated in 32 women (16 to 42 years old) who have been treated in the gynaecological outpatient-department at our clinic because of primary dysmenorrhea. The dosage of Magnesiocard comprised 3 X 5 mmol granulate orally on the day preceding menstruation and on the first and the second day of the cycle. At the end of the study, which covered six cycles, we were able to analyze the results in 21 patients, 11 having been treated with magnesium and 10 with placebo. While in the magnesium group only a slight effect was noted on the first day of the cycle under therapy when compared to both the placebo group and the dysmenorrhea disturbances persisting before therapy was started, magnesium had a therapeutic effect on both back pain and lower abdominal pain on the second and the third day of the cycle. Parallel to this therapeutic influence on the symptomatology of dysmenorrhea, a marked reduction in absences from work due to the dysmenorrhea was also noted. The possibilities of magnesium therapy in dysmenorrhea should be investigated further in multicentre studies.

Autologous blood donation with placenta previa: is it feasible?

Autologous blood donation has been recommended for patients with placenta previa. We hypothesized that premature delivery, preexisting anemia, and bleeding would limit its utilization. We reviewed the charts of all patients admitted with placenta previa between July 1, 1989, and April 30, 1992. To be eligible for autologous donation we assumed that the patient would need to be asymptomatic with a hematocrit 34% or higher at 32 weeks' gestation. Eighty-eight patients were admitted with placenta previa, 12 (14%) of whom were eligible for autologous donation. Two eligible patients required transfusion at delivery and four delivered prior to 34 weeks. Few patients with placenta previa are eligible for autologous donation and although two would have used their autologous units, twice as many may have been compromised by recent autologous donation. We conclude that autologous donation is not feasible in a majority of patients with placenta previa and is of limited usefulness in its management.

Are oral contraceptives masking symptoms of chlamydial cervicitis and pelvic inflammatory disease?

Tubal factor infertility is often diagnosed without any documented history of pelvic inflammatory disease. Chlamydial infection is one of the most common causes of pelvic inflammatory disease and likely also of infertility and ectopic pregnancy. Oral contraceptives may alter the course of chlamydial infections which may mask the clinical expression of the disease. This paper considers a number of unresolved matters related to oral contraceptive use and its possible influence on the epidemiology and course of chlamydial pelvic inflammatory disease.

Laminaria versus extra-amniotic saline solution infusion for cervical ripening in second-trimester labor inductions.

OBJECTIVE: The aim of this study was to determine which cervical ripening method, laminaria placement or extra-amniotic saline solution infusion, was associated with the shorter interval from induction to delivery in the second trimester. STUDY DESIGN: Women admitted for indicated second-trimester labor induction with an unfavorable cervix were randomly assigned to receive either intracervical placement of laminaria (n = 25) or extra-amniotic saline solution infusion (n = 25) with concurrent concentrated oxytocin and vaginally administered prostaglandin E2 (10 mg every 6 hours). Treatment success was defined as an interval from induction to delivery of < or =24 hours. RESULTS: Maternal age, race, parity, gestational age, and initial cervical dilatation were similar between the groups. Indications for uterine evacuation were also similar and included fetal death (n = 7), aneuploidy (n = 20), fetal structural anomaly (n = 18), and maternal indications (n = 4). There was no difference in the mean intervals from induction to delivery (laminaria, 16 +/- 8 hours, vs extra-amniotic saline solution infusion, 17 +/- 10 hours) or the number of treatment successes (laminaria, n = 23, vs extra-amniotic saline solution infusion, n = 21). Retained placenta, live birth, and hemorrhage occurred with similar frequencies in the two groups. CONCLUSION: Relative to laminaria, extra-amniotic saline solution infusion did not shorten the induction-to-delivery interval in women undergoing indicated second-trimester labor induction with concentrated oxytocin and low-dose vaginally administered prostaglandin E2.

Attenuated proestrous luteinizing hormone surges in middle-aged rats are associated with decreased pituitary luteinizing hormone-beta messenger ribonucleic acid expression.

OBJECTIVE: This study determined whether attenuated preovulatory luteinizing hormone surges in aging rats are associated with a decrease in pituitary luteinizing hormone content or luteinizing hormone beta-messenger ribonucleic acid expression on proestrus. STUDY DESIGN: Blood samples were taken every 90 minutes from 1:30 to 10:30 PM on proestrus in young (n = 8) and middle-aged (n = 12), regularly cyclic rats for plasma luteinizing hormone determination. On the next proestrus at 12 noon, rats were killed and the pituitaries were removed for luteinizing hormone content determination by radioimmunoassay and luteinizing hormone beta-messenger ribonucleic acid expression by dot blot analysis. Results were analyzed by one-way analysis of variance. RESULTS: Seven of the middle-aged rats had attenuated luteinizing hormone surges while the remaining five females had surges similar to those of young rats. On the next proestrus, all rats had similar quantities of pituitary luteinizing hormone. However, luteinizing hormone beta-messenger ribonucleic acid expression in middle-aged rats with attenuated luteinizing hormone surges was lower (p less than 0.05) than that of middle-aged and young rats with normal surges. CONCLUSION: Decreased luteinizing hormone beta-messenger ribonucleic acid expression, but not pituitary luteinizing hormone content at 12 noon on proestrus is correlated with attenuated luteinizing hormone surges in middle-aged rats.

Favorable hemodynamic effects of magnesium sulfate in preeclampsia.

OBJECTIVE: Our purpose was to evaluate the hemodynamic effects of magnesium sulfate in preeclamptic and preterm labor patients. STUDY DESIGN: Fifteen preeclamptic patients at 32.4 +/- 3.3 (mean +/- SD) weeks' gestation and 11 preterm labor patients (31.3 +/- 2.8 weeks) were hemodynamically monitored in the lateral recumbent position by thoracic electrical bioimpedance (BoMed, Irvine, Calif.) before and during high-dose magnesium sulfate bolus and infusion. Cardiac index, systemic vascular resistance index, mean arterial pressure, heart rate, and stroke index were all recorded at baseline and during magnesium sulfate infusion. All patients received a standard crystalloid infusion. Data analysis continued until the patient received epidural placement or other antihypertensive therapy or was delivered. RESULTS: At baseline the systemic vascular resistance index was 2465 +/- 718 F.ohm/m2 and the cardiac index was 3.6 +/- 1.0 L/min/m2 for the preeclamptic patients. These were significantly different compared with the preterm labor patients, who had a systemic vascular resistance index of 1377 +/- 563 F.ohm/m2 and 4.6 +/- 1.2 L/min/m2. Magnesium sulfate infusion resulted in a rapid, sustained fall in systemic vascular resistance and a rise in cardiac index in the preeclamptic patient. This effect was evident at least 4 hours after initiation of the bolus and infusion. In the preterm labor patients the hemodynamic effects of magnesium sulfate were minimal and were noted only during the magnesium sulfate bolus. CONCLUSION: Magnesium sulfate infusion appears to have a prolonged hemodynamic effect in the preeclamptic patient. Sustained reduction in systemic vascular resistance and an increase in cardiac index is found in patients with preeclampsia but not in preterm labor.

In vitro interaction of zeolite fibers with individual cells (macrophages NR8383): measurement of intracellular oxidative burst.

Inhalation of fibrous minerals such as asbestos and erionite can cause various lung diseases, including cancer. The mechanism by which these fibers induce disease is an area of active research. Interaction of fibers with lung macrophages leads to release of many substances. Among these, reactive oxygen metabolites (which include hydrogen peroxide, superoxide, and possibly hydroxyl radicals) are proposed to cause cellular damage. In this paper, we report a method for observing intracellular hydrogen peroxide release as rat lung-derived macrophages (NR-8383) phagocytize erionite fibers. This is possible by observing the fluorescence of 2',7'-dichlorofluorescein-the intracellular, oxidized form of 5 (and 6)-carboxy-2', 7'-dichlorodihydrofluorescin formed in the presence of newly released hydrogen peroxide. We are able to image the fluorescence within a single cell, thereby allowing us to get information on the spatial distribution of the metabolites.