The risk of developing major depression among individuals with subthreshold depression: a systematic review and meta-analysis of longitudinal cohort studies.

BACKGROUND: Studies have consistently shown that subthreshold depression is associated with an increased risk of developing major depression. However, no study has yet calculated a pooled estimate that quantifies the magnitude of this risk across multiple studies. METHODS: We conducted a systematic review to identify longitudinal cohort studies containing data on the association between subthreshold depression and future major depression. A baseline meta-analysis was conducted using the inverse variance heterogeneity method to calculate the incidence rate ratio (IRR) of major depression among people with subthreshold depression relative to non-depressed controls. Subgroup analyses were conducted to investigate whether IRR estimates differed between studies categorised by age group or sample type. Sensitivity analyses were also conducted to test the robustness of baseline results to several sources of study heterogeneity, such as the case definition for subthreshold depression. RESULTS: Data from 16 studies (n = 67 318) revealed that people with subthreshold depression had an increased risk of developing major depression (IRR = 1.95, 95% confidence interval 1.28-2.97). Subgroup analyses estimated similar IRRs for different age groups (youth, adults and the elderly) and sample types (community-based and primary care). Sensitivity analyses demonstrated that baseline results were robust to different sources of study heterogeneity. CONCLUSION: The results of this study support the scaling up of effective indicated prevention interventions for people with subthreshold depression, regardless of age group or setting.

Sonographically guided lumbar puncture in pediatric patients.

Our aim with this study was to develop a user-friendly method for pediatric sonographically guided lumbar punctures so that we can visualize intrathecal anatomy, confirm intrathecal injection at the time of injection, and, most importantly, avoid ionizing radiation to a child's already radiosensitive pelvis. Sonographically guided lumbar puncture was prospectively performed in children aged 7 weeks to 16 years. All attempts (n = 9) were successful. We were able to identify relevant anatomy (including the conus in children 10 years and younger), confirm intrathecal injection, visualize intrathecal hematoma, and avoid radiation. Sonography is a promising modality for image-guided lumbar punctures without radiation in children.

Imaging of pregnant and lactating patients: part 1, evidence-based review and recommendations.

OBJECTIVE: The objectives of this article are to discuss the current evidence-based recommendations regarding radiation dose concerns, the use of iodinated and gadolinium-based contrast agents, and the comparative advantages of multimodality imaging (ultrasound, CT, and MRI) during pregnancy and lactation. We also discuss the use of imaging to evaluate pregnant trauma patients. CONCLUSION: Maternal and fetal radiation exposure and dose are affected by gestational age, anatomic site, modality, and technique. The use of iodinated and gadolinium-based contrast agents during pregnancy and lactation has not been well studied in human subjects. Imaging should be used to evaluate pregnant trauma patients only when the benefits outweigh the risks.

Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations.

OBJECTIVE: The objectives of this article are to discuss the current evidence-based recommendations regarding the use of diagnostic imaging in the evaluation of pulmonary embolism, appendicitis, urolithiasis, and cholelithiasis during pregnancy. CONCLUSION: Diagnostic imaging should be performed during pregnancy only with an understanding of the maternal and fetal risks and benefits, the comparative advantages of different modalities, and the unique anatomic and physiologic issues associated with pregnancy.

Estimating the difference in prevalence of common mental disorder diagnoses for Aboriginal and Torres Strait Islander peoples compared to the general Australian population.

AIMS: There is currently little nationally representative diagnostic data available to quantify how many Aboriginal and Torres Strait Islander people may need a mental health service in any given year. Without such information, health service planners must rely on less direct indicators of need such as service utilisation. The aim of this paper is to provide a starting point by estimating the prevalence ratio of 12-month common mental disorders (i.e. mood and anxiety disorders) for Indigenous peoples compared to the general Australian population. METHODS: Analysis of the four most recent Australian Indigenous and corresponding general population surveys was undertaken. Kessler-5 summary scores by 10-year age group were computed as weighted percentages with corresponding 95% confidence intervals. A series of meta-analyses were conducted to pool prevalence ratios of Indigenous to general population significant psychological distress by 10-year age groups. The proportion of respondents with self-reported clinician diagnoses of mental disorders was also extracted from the most recent survey iterations. RESULTS: Indigenous Australians are estimated to have between 1.6 and 3.3 times the national prevalence of anxiety and mood disorders. Sensitivity analyses found that the prevalence ratios did not vary across age group or survey wave. CONCLUSIONS: To combat the current landscape of inequitable mental health in Australia, priority should be given to populations in need, such as Indigenous Australians. Having a clear idea of the current level of need for mental health services will allow planners to make informed decisions to ensure adequate services are available.

Time-to-Maximum of the Tissue Residue Function Improves Diagnostic Performance for Detecting Distal Vessel Occlusions on CT Angiography.

BACKGROUND AND PURPOSE: Detecting intracranial distal arterial occlusions on CTA is challenging but increasingly relevant to clinical decision-making. Our purpose was to determine whether the use of CTP-derived time-to-maximum of the tissue residue function maps improves diagnostic performance for detecting these occlusions. MATERIALS AND METHODS: Seventy consecutive patients with a distal arterial occlusion and 70 randomly selected controls who underwent multimodal CT with CTA and CTP for a suspected acute ischemic stroke were included in this retrospective study. Four readers with different levels of experience independently read the CTAs in 2 separate sessions, with and without time-to-maximum of the tissue residue function maps, recording the presence or absence of an occlusion, diagnostic confidence, and interpretation time. Accuracy for detecting distal occlusions was assessed using receiver operating characteristic analysis, and areas under curves were compared to assess whether accuracy improved with use of time-to-maximum of the tissue residue function. Changes in diagnostic confidence and interpretation time were assessed using the Wilcoxon signed rank test. RESULTS: Mean sensitivity for detecting occlusions on CTA increased from 70.7% to 90.4% with use of time-to-maximum of the tissue residue function maps. Diagnostic accuracy improved significantly for the 4 readers (P < .001), with areas under the receiver operating characteristic curves increasing by 0.186, 0.136, 0.114, and 0.121, respectively. Diagnostic confidence and speed also significantly increased. CONCLUSIONS: All assessed metrics of diagnostic performance for detecting distal arterial occlusions improved with the use of time-to-maximum of the tissue residue function maps, encouraging their use to aid in interpretation of CTA by both experienced and inexperienced readers. These findings show the added diagnostic value of including CTP in the acute stroke imaging protocol.

6-hydroxylation: effect on the psychotropic potency of tryptamines.

6-Hydroxy-5-methoxy-N,N dimethyltryptamine and 5-methoxy-N, N-dimnethyltryptamine were synthesized and their psychotropic effects compared on trained rats in a Skinner box. The nonhydroxylated form was the more po tent. The metabolism of 5-methoxytryp tophol acetate ester was also studied to determine whether hydroxylation might occur in other than the six position with exogenous indoles. One metabolite was formed, with properties of a hydroxy-5-methoxyindole-3-acetic acid, which proved on chromatography not to be the 6-hydroxy structural isomer. Phar macologic and metabolic studies suggest that psychotropic activity of trypt amines may result from metabolites other than the 6-hydroxylated forms.

Stable complex of fibrinogen and fibrin.

Fibrin-stabilizing factor acts on monomeric fibrin combined with fibrinogen to form a stable complex that is soluble at physiologic pH and ionic strength. The complex has been isolated by chromatography on agarose gel and characterized by sedimentation rate near 24 S(w.20) at both pH 5.3 and 7.4, by coagulability when treated with thrombin, and by content of fibrinopeptides. Formation of the complex could provide a pathway for solubilization of monomeric fibrin produced in circulating blood.

Increased cardiovascular reactivity to agiotensin caused by renin.

After a short period of tachyphylaxis, there is a marked and sustained enhancement of pressor re sponses to renin and angiotensin during chronic administration of renin.

[Infants living with their mothers in the Rennes, France, prison for women between 1998 and 2013. Facts and perspectives]. / Les nourrissons vivant auprès de leur mère incarcérée au centre pénitentiaire des femmes de Rennes entre 1998 et 2013. Constats et perspectives.

Every year in France, nearly 50 infants live in a prison nursery with their mother. According to French law, infants can live with their mother in the prison nursery until they reach 18 months of age. The international community is concerned about the lack of validated social, medical and legal data on these infants living in prison. This was a retrospective and descriptive study. Medical and paramedical files of the General Council of Île-et-Vilaine, France, were studied. Every infant born between 1998 and 2013 while their mother was in prison were included. Fifty-four files were collected. The average length of stay was 6.2 months (n=54). The type of the mother's prison sentence was property damage in 40 % of cases, personal injury in 51.1 % of cases and both in 8.9 % of cases (n=45). The length of the mother's imprisonment was on average 45 months, ranging from 3 to 216 months (n=34). After prison, 42.9 % of the infants were placed in foster care and 57.1 % resided with their family (n=42). This child-mother incarceration could be an opportunity for positive intergenerational paramedical, medical and social services. The lack of data and problems collecting data restrict our knowledge of these families. This should motivate a national follow-up for these children.

Corticospinal tract atrophy and motor fMRI predict motor preservation after functional cerebral hemispherectomy.

OBJECTIVE The potential loss of motor function after cerebral hemispherectomy is a common cause of anguish for patients, their families, and their physicians. The deficits these patients face are individually unique, but as a whole they provide a framework to understand the mechanisms underlying cortical reorganization of motor function. This study investigated whether preoperative functional MRI (fMRI) and diffusion tensor imaging (DTI) could predict the postoperative preservation of hand motor function. METHODS Thirteen independent reviewers analyzed sensorimotor fMRI and colored fractional anisotropy (CoFA)-DTI maps in 25 patients undergoing functional hemispherectomy for treatment of intractable seizures. Pre- and postoperative gross hand motor function were categorized and correlated with fMRI and DTI findings, specifically, abnormally located motor activation on fMRI and corticospinal tract atrophy on DTI. RESULTS Normal sensorimotor cortical activation on preoperative fMRI was significantly associated with severe decline in postoperative motor function, demonstrating 92.9% sensitivity (95% CI 0.661-0.998) and 100% specificity (95% CI 0.715-1.00). Bilaterally robust, symmetric corticospinal tracts on CoFA-DTI maps were significantly associated with severe postoperative motor decline, demonstrating 85.7% sensitivity (95% CI 0.572-0.982) and 100% specificity (95% CI 0.715-1.00). Interpreting the fMR images, the reviewers achieved a Fleiss' kappa coefficient (κ) for interrater agreement of κ = 0.69, indicating good agreement (p < 0.01). When interpreting the CoFA-DTI maps, the reviewers achieved κ = 0.64, again indicating good agreement (p < 0.01). CONCLUSIONS Functional hemispherectomy offers a high potential for seizure freedom without debilitating functional deficits in certain instances. Patients likely to retain preoperative motor function can be identified prior to hemispherectomy, where fMRI or DTI suggests that cortical reorganization of motor function has occurred prior to the operation.

Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis.

RATIONALE AND OBJECTIVES: To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance (MR) perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy. MATERIALS AND METHODS: Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on posttreatment surveillance MRI were enrolled. DSC perfusion MRI and DTI were performed. Region of interest cursors were manually drawn in the contrast-enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis. RESULTS: Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and eight (33%) lesions were placed into the radiation necrosis group using biopsy results as the gold standard in all but three patients. Mean apparent diffusion coefficient values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast-enhancing lesion were significantly lower, and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group (P < 0.01, P = 0.03, P < 0.01, and P < 0.01, respectively). CONCLUSIONS: The combined assessment of DTI and DSC MR perfusion properties of new contrast-enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.

A physical simulator for endoscopic endonasal drilling techniques: technical note.

In this paper, the authors present a physical model developed to teach surgeons the requisite drilling techniques when using an endoscopic endonasal approach (EEA) to the skull base. EEA is increasingly used for treating pathologies of the ventral and ventrolateral cranial base. Endonasal drilling is a unique skill in terms of the instruments used, the long reach required, and the restricted angulation, and gaining competency requires much practice. Based on the successful experience in creating custom simulators, the authors used 3D printing to build an EEA training model from post-processed thin-cut head CT scans, formulating the materials to provide realistic haptic feedback and endoscope handling. They performed a preliminary assessment at 2 institutions to evaluate content validity of the simulator as the first step of the validation process. Overall results were positive, particularly in terms of bony landmarks and haptic response, though minor refinements were suggested prior to use as a training device.

Prediction of coronary heart disease based on clinical suspicion, age, total cholesterol, and triglyceride.

Our results, based on the definition of coronary heart disease by cinearteriography, show that definite relationships exist among incidence of coronary heart disease (CHD), age, total cholesterol (TC), and total triglycerides, with less definite ones between free cholesterol, and phospholipids for a specific group of 450 male patients referred to the Cleveland Clinic because of suspected coronary heart disease. Equations and graphs of the association of incidence of CHD with these conditions are presented. The relationships were strong enough to be of aid in discriminating CHD from normal; the most useful being age, TC, and TG. Incidence determinations were presented in terms of total incidence and incidence associated with the variable itself. Coronary angiography demonstrated 350 CHD and 100 normals or a ratio of 3.5 to 1. This ratio is a reflection of the high accuracy with which physicians suspect CHD. Age and TC were good discriminators in these patients suspected of CHD. An improved relationship and better discrimination was obtained by relating incidence simultaneously to age, TC, and TG. The probability of having CHD is the total incidence corresponding to the patient's age, TC, and TG. The probability level of 0.90 gave 95% assurance of a correct prediction for the physician-selected group of patients. Twenty-nine per cent of them had probabilities above 0.90.

Effects of clofibrate and a fat-modified diet on serum lipids.

The combined effect of clofibrate and a fat-modified diet was determined in 17 hyperlipidemic patients: 7 type IIA, 7 type IV, 2 type VI(IIB), and 1 type III. Control serum lipid levels and lipoprotein patterns and their alteration with a fat-modified diet had been determined previously 1/2 to 2 years for 3 patients, and 6 to 10 years for 14 patients. Two grams of clofibrate a day (0.5 gm four times daily) was taken along with the fat-modified diet for 2 to 6 months by 5 patients and for 2 years by 13 patients. The effect of clofibrate and a fat-controlled diet was also determined in 10 normolipidemic men who were subjects of an 18-day test in which the polyunsaturated fat diet was quantitatively prepared and eaten along with 2 gm clofibrate a day (0.5 gm four times daily). The effect of clofibrate on serum cholesterol levels was a further mean reduction in type IIA patients by 19 %, in type III by 23%, in type IV by 12%, in type VI by 7%, and in normolipidemic subjects by 8%. The extent of the additional serum cholesterol reduction with clofibrate in individual hyperlipidemic patients varied from +10% to minus 44% and was not related directly to the type of hyperlipidemia. The extent of reduction appeared related directly to the level of minus S 40-70 (similar to Sf 12-20) lipoprotein fraction in the control serum sample. Serum triglyceride levels were unaffected in type IIA and normolipidemic subjects. Serum triglyceride levels did not change consistently in the 2 type VI patients, rising by 11% in 1 and dropping by 31% in the other. Serum triglyceride levels were significantly (p = 0.001) and consistently reduced by 39% only in type IV patients.

Autoimmune hyperlipidemia in a patient. Atherosclerotic course and chaning immunoglobulin pattern during 21 years of study.

A 48 year old male patient presented with xanthomatosis, hyperbeta lipoproteinemia and hyper-IgA globulinemia; these two serum components occurred as a "complex." The patient has subsequently been studied for 22 years (1952 to 1974). His serum cholesterol and triglyceride levels have been consistently and excessively high despite efforts to regulate them by means of diet or diet and drugs. Serum immunoglobulin A (IgA) concentration ranged from 1,400 to 3,400 mg/dl compared with a normal value of 156 plus or minus 92 mg/dl. The metabolism of lipoproteins, judged by vitamin A turnover studies was slow. Peripheral atherosclerosis became evident 15 years after beginning the study whereas cinecoronary arteriography concurrently demonstrated only minimum changes. Xanthomas exhibited marked regression only during the last 6 years, after 16 years of diet and the addition of clofibrate for 7 years. Beta lipoprotein and IgA globulin determined by immunofluorescent and immunoelectrophoretic technics were demonstrated in the atherosclerotic material obtained from the patient's arterial wall. They were also found in the plasma cells of the bone marrow. The IgA globulin-beta lipoprotein complex in the serum was broken with difficulty. The patient's isolated IgA globulin, free of lipoprotein, formed a firm complex when mixed with beta lipoprotein prepared from normal human serum. Initially, IgA globulin studies showed presence of both kappa and lambda light chains in normal proportion. But after 18 years, the IgA globulin has become monoclonal, type lambda. The plasma cells of the bone marrow have become progressively more atypical and immature. No clinical indications of multiple myeloma have been found. It is concluded that association of lipoproteins with IgA globulin in the serum of this patient with hyperlipidemia, hyper-IgA globulinemia did not prevent the development of atherosclerotic lesions and the deposition of lipids and lipoproteins in the plaques. It is possible that the lipoprotein-immunoglobulin association may have retarded the process, since it became manifest only after many years of known hyperlipidemia.

Ehlers-Danlos syndrome type III in pregnancy.

A case of Ehlers-Danlos syndrome type III in pregnancy is described. During the pregnancy, the patient suffered from increasing joint laxity, requiring prolonged bed rest and traction. Early delivery by cesarean section was ultimately performed to relieve her symptoms. We have been unable to find other reports in the literature regarding Ehlers-Danlos syndrome type III in pregnancy.