Predictive validity and interrater reliability of the FACE-CARAS toolkit in a CAMHS setting.

BACKGROUND: The FACE-CARAS (Functional Analysis in Care Environments-Child and Adolescent Risk-Assessment Suite) toolkit has been developed to support practitioners in Child and Adolescent Mental Health Services (CAMHS) in performing a structured risk assessment. It covers a number of risk domains including violence, suicide, self-harm, experienced abuse, and exploitation. Interrater and internal reliability has already been established but not predictive validity. AIMS/HYPOTHESIS: Our aim was to establish the predictive validity of the FACE-CARAS in a CAMHS population. METHODS: Records from 123 young people with FACE-CARAS ratings completed by clinicians were examined in a retrospective file review to extract data on a relevant list of adverse outcomes at three and at 6 months following the assessment. Although this was not a prospective longitudinal study, researchers were blind to the clinicians' ratings, allowing valid testing of predictive power. Cases were drawn from across generic and specialist CAMHS teams in approximately equal proportions. Data were analysed using receiver operator characteristic statistics. RESULTS: Areas under the curve values in five of the seven risk areas approached or were greater than 0.8 indicated that the FACE-CARAS profile score was a good potential predictor of risks of self-harm, suicidal behaviours, serious self-neglect, abuse or exploitation by others, and violence to others at both 3 and 6 months. It was weakly "predictive" of accidental self-harm and no better than chance at signalling physical ill health. CONCLUSIONS: Findings support the use of the "profile summary" section of the tool as likely to generate clinically useful risk predictions. We were concerned that clinical use of the scale did not conform to research standards and often left subscales incompletely rated; however, the fact that the tool nonetheless proved a good predictor of most key adversities under scrutiny may add weight to its value in clinical practice. Further work with the FACE-CARAS subscales is recommended.

Hydrangea serrata extract attenuates PM-exacerbated airway inflammation in the CARAS model by modulating the IL-33/ST2/NF-κB signaling pathway.

Particulate matter (PM) significantly contributes to the global health crisis of respiratory diseases. It is known to induce and exacerbate conditions such as asthma and respiratory infections. Long exposure to PM can increase the risk of combined allergic rhinitis and asthma syndrome (CARAS). Although therapeutic drugs can be used to improve symptoms of respiratory diseases caused by PM, their usage is often accompanied by side effects. Therefore, many studies are being conducted to discover functional food materials that can more effectively treat respiratory diseases while minimizing the side effects of these therapeutic drugs. This study was conducted to investigate the efficacy of Hydrangea serrata extract (HSE) in airway inflammation in a mouse model of CARAS exacerbated by PM. In the CARAS mouse model worsened by PM, the airway inflammation improvement effect of HSE was evaluated by analyzing allergic nasal symptoms, changes in inflammatory cells, OVA-specific immunoglobulin (Ig) levels, cytokines, mast cell activation, and histopathological findings of both nasal mucosa and lung tissue. HSE effectively reduced OVA-specific IgE and IgG1 and inhibited the production of T helper type 2 (Th2)-related cytokines such as IL-4 and IL-5. Importantly, HSE reduced IL-33 and ST2 expression and inhibited the activation of the NF-κB signaling pathway. In addition, HSE inhibited airway hypersensitivity, mucus production, and inflammatory cell infiltration. These results suggest that HSE may inhibit airway inflammation in CARAS/PM mice by regulating the IL-33/ST2/NF-κB signaling pathway, opening avenues for considering HSE as a potential material for treating allergic airway inflammation diseases in the future.

Morita-Baylis-Hillman adduct 2-(3-hydroxy-1-methyl-2-oxoindolin-3-il) acrylonitrile (CISACN) ameliorates the pulmonary allergic inflammation in CARAS model by increasing IFN-γ/IL-4 ratio towards the Th1 immune response.

Combined allergic rhinitis and asthma syndrome (CARAS) is an airway-type 2 immune response with a profuse inflammatory process widely affecting the world population. Due to the compromise of quality of life and the lack of specific pharmacotherapy, the search for new molecules becomes relevant. This study aimed to evaluate the effectiveness of the Morita-Bailys-Hillman adduct (CISACN) treatment in the CARAS experimental model. Female BALB/c mice were ovalbumin (OVA) -sensitized and -challenged and treated with CISACN. The treatment decreased the eosinophil migration to the nasal and lung cavities and tissues and the goblet cell hyperplasia/hypertrophy, attenuated airway hyperactivity by reducing the hyperplasia/hypertrophy of the smooth muscle and the extracellular matrix's thickness. Also, the treatment reduced the clinical signs of rhinitis as nasal rubbing and sneezing in a histamine-induced nasal hyperreactivity assay. The immunomodulatory effect of CISACN was by reducing OVA-specific IgE serum level, and IL-33, IL-4, IL-13, and TGF-ß production, dependent on IFN-γ increase. Furthermore, the effect of CISACN on lung granulocytes was by decreasing the p-p38MAPK/p65NF-κB signaling pathway. Indeed, CISACN reduced the p38MAPK and p65NF-κB activation. These data demonstrated the anti-inflammatory and immunomodulatory effects of the CISACN with scientific support to become a pharmacological tool to treat airway inflammatory diseases.

PM2.5 exposure regulates Th1/Th2/Th17 cytokine production through NF-κB signaling in combined allergic rhinitis and asthma syndrome.

BACKGROUND: Particulate matter (PM) is a major component of air pollution from emissions from anthropogenic and natural sources and is a serious problem worldwide due to its adverse effects on human health. Increased particulate air pollution increases respiratory disease-related mortality and morbidity. However, the impact of PM with an aerodynamic diameter of ≤ 2.5 µm (PM2.5) on combined allergic rhinitis and asthma syndrome (CARAS) remains to be elucidated. Accordingly, in the present study, we investigated the effect of PM2.5 in an ovalbumin (OVA)-induced CARAS mouse model with a focus on NF-κB signaling. METHODOLOGY: We established an OVA-induced mouse model of CARAS to determine the effects of exposure to PM2.5. BALB/c mice were randomly divided into four groups: (1) naive, (2) PM2.5, (3) CARAS, and (4) CARAS/PM2.5. Mice were systemically sensitized with OVA and challenged with inhalation of ultrasonically nebulized 5% OVA three times by intranasal instillation of OVA in each nostril for 7 consecutive days. Mice in the PM2.5 and CARAS/PM2.5 groups were then exposed to PM2.5 by intranasal instillation of PM2.5 for several days. We then examined the impacts of PM2.5 exposure on histopathology and NF-κB signaling in our OVA-induced CARAS mouse model. RESULTS: PM2.5 increased infiltration of eosinophils in bronchoalveolar lavage fluid (BALF) samples and inflammatory cells in lung tissue. It also increased production of GATA3, RORγ, IL-4, IL-5, IL-13, and IL-17 in nasal lavage fluid (NALF) and BALF samples in the CARAS mouse model, but secretion of IL-12 and IFN-γ was suppressed. Exposure to PM2.5 increased OVA-specific IgE and IgG1 levels in serum, inflammatory cell infiltration in the airways, and fibrosis in lung tissue. It also activated the NF-κB signaling pathway, increasing Th2/Th17 cytokine levels while decreasing Th1 cytokine expression, thereby inducing an inflammatory response and promoting inflammatory cell infiltration in nasal and lung tissue. CONCLUSION: Our results demonstrate that PM2.5 can aggravate OVA-induced CARAS.

Bergapten ameliorates combined allergic rhinitis and asthma syndrome after PM2.5 exposure by balancing Treg/Th17 expression and suppressing STAT3 and MAPK activation in a mouse model.

Combined allergic rhinitis and asthma syndrome (CARAS) causes chronic respiratory inflammation in allergic individuals. Long-term exposure to particulate matter 2.5 (PM2.5; particles 2.5 µm or less in diameter) can aggravate respiratory damage. Bergapten (5-methoxysporalen) is a furocoumarin mostly found in bergamot essential oil and has significant antioxidant, anticancer, and anti-inflammatory activity. This study created a model in which CARAS was exacerbated by PM2.5 exposure, in BALB/c mice and explored the potential of bergapten as a therapeutic agent. The bergapten medication increased ovalbumin (OVA)-specific immunoglobulin (Ig) G2a level in serum and decreased OVA-specific IgE and IgG1 expression. Clinical nasal symptoms diminished significantly, with weakened inflammatory reaction in both the nasal mucosa and lungs. Furthermore, bergapten controlled the T helper (Th)1 to Th2 ratio by increasing cytokines associated with Th1-like interleukin (IL)-12 and interferon gamma and decreasing the Th2 cytokines IL-4, IL-5, and IL-13. Factors closely related to the balance between regulatory T cells and Th17 (such as IL-10, IL-17, Forkhead box protein P3, and retinoic-related orphan receptor gamma) were also regulated. Notably, pro-inflammatory cytokines IL-6, IL-1ß, and tumor necrosis factor-alpha were reduced by bergapten, which suppressed the activation of both the signal transducer and activator of transcription 3 signaling pathway and the mitogen-activated protein kinase signaling pathway. Therefore, bergapten might have potential as a therapeutic agent for CARAS.

CCR3 gene knockout in bone marrow cells ameliorates combined allergic rhinitis and asthma syndrome (CARAS) by reducing airway inflammatory cell infiltration and Th2 cytokines expression in mice model.

The present study aims to investigate the effects of CCR3 gene knockout in bone marrow cells (CCR3-KO) on the mouse model of combined allergic rhinitis and asthma syndrome (CARAS). It was found that CCR3-KO significantly reduced eosinophil (EOS) migration into the nasal (NALF) and bronchoalveolar (BALF) cavities of mice, and decreased Th2 cytokines (such as, IL-4, IL-5 and IL-13) levels in nasal mucosa and lung tissues. In addition, histological analysis showed that the damage degree of nasal mucosa structure in ovalbumin (OVA) modulated CCR3-KO mice was significantly less than that in OVA modulated Wild type (WT) mice, with reduced inflammatory cell infiltration and nasal mucus secretion. The infiltration of inflammatory cells in lung tissue was significantly reduced, and the proliferation of lung smooth muscle layer and extracellular matrix (ECM) production were decreased. Symptom analysis showed that CCR3-KO can reduced allergic rhinitis (AR) signals as nose scratching and sneezing. It was also found CCR3-KO reduce OVA-induced weight loss. The results showed that CCR3-KO could reduce the symptoms of allergic inflammation in CARAS mice by reducing airway inflammatory cell infiltration and down-regulating the expression of Th2 cytokines, and CCR3 gene could be used as a target gene for the treatment of CARAS.

Evaluating the Epithelial-Mesenchymal Program in Human Breast Epithelial Cells Cultured in Soft Agar Using a Novel Macromolecule Extraction Protocol.

The ability to grow in anchorage-independent conditions is an important feature of malignant cells, and it is well-established that cellular phenotypes in adherent cultures can differ widely from phenotypes observed in xenografts and anchorage-independent conditions. The anchorage-independent soft-agar colony formation assay has been widely used as a bridge between adherent cell cultures and animal tumor studies, providing a reliable in vitro tool to predict the tumorigenicity of cancer cells. However, this functional assay is limited in its utility for molecular mechanistic studies, as currently there is no reliable method that allows the extraction of biological macromolecules from cells embedded in soft-agar matrices, especially in experimental conditions where no visible colonies form. We developed a set of new methods that enable the extraction of DNA, RNA and proteins directly from cells embedded in soft agar, allowing for a wide range of molecular signaling analysis. Using the new methods and human mammary epithelial cells (HMECs), we studied the role of epithelial-mesenchymal transition (EMT) in the ability of HMECs to form colonies in soft agar. We found that, when cultured in soft agar instead of in adherent cultures, immortalized non-malignant HME-hTERT cells upregulated the epithelial program, which was noted to be necessary for their survival in this anchorage-independent condition. Overexpression of SV40 small T antigen (ST) or the EMT master-regulator SNAI1 negates this requirement and significantly enhances colony formation in soft agar driven by mutant-RAS. Interestingly, we found that, similar to SNAI1, ST also promotes EMT changes in HMECs, providing further support for EMT as a prerequisite for the efficient anchorage-independent colony formation driven by mutant-RAS in our HMEC model.

4-Carvomenthenol ameliorates the murine combined allergic rhinitis and asthma syndrome by inhibiting IL-13 and mucus production via p38MAPK/NF-κB signaling pathway axis.

The aim of this study was to analyze the 4-carvomenthenol (carvo) oral treatment on the experimental model of the combined allergic rhinitis and asthma syndrome (CARAS). BALB/c mice were OVA-sensitized on day zero and 7th (50 µg/mL OVA in 10 mg/mL Al (OH)3) and OVA-challenged (5 mg/mL, 20 µL/animal) for three weeks. In the last week, the animals were dally challenged with aerosol of OVA and the carvo treatment (12.5, 25 or 50 mg/kg) occurred one hour before each OVA-challenge. Data were analyzed and p < 0.05 was considered significant. Carvo (12.5-50 mg/kg) decreased significantly the eosinophil migration into the nasal (NALF) and bronchoalveolar (BALF) cavities as well as on the nasal and lung tissues of sick animals. The treatment also decreased mucus production on both tissue sections stained with PAS (periodic acid-Schiff satin). In addition, the histological analyzes demonstrated that sick mice presented hyperplasia and hypertrophy of the lung smooth muscle layer followed by increasing of extracellular matrix and carvo (50 mg/kg) inhibited these asthmatic parameters. We analyzed the allergic rhinitis signals as nasal frictions and sneezing and observed that carvo decreased these two signals as well as serum OVA-specific IgE titer, type 2 cytokine synthesis, mainly IL-13, with increasing of IL-10 production. Decreasing of IL-13 production corroborated with decreasing of mucus production and these effects were dependent on p38MAPK/NF-κB(p65) signaling pathway inhibition. Therefore, these data demonstrated that a monoterpene of essential oils presents anti-allergic property on an experimental model of CARAS suggesting a new drug prototype to treat this allergic syndrome.

Coexistence of allergic rhinitis and asthma in Indian patients: The CARAS survey.

CONTEXT: Asthma patients often suffer from concomitant allergic rhinitis (AR). However, there is paucity of such data from India. AIMS: This questionnaire-based survey evaluated the coexistence of AR in Indian asthmatics, and examined the inter-relationship between the two disease conditions. SUBJECTS AND METHODS: This survey conducted in ten cities across India, aimed to generate information on exposure to risk factors, history of atopy, the severity of asthma, and treatment regimen in patients with physician-diagnosed asthma. RESULTS: Data were obtained from 1161 asthma patients (mean age [±standard deviation]: 40.41 [±17.05] years). Prevalence of coexisting AR was found to be 65.24%, with the highest prevalence (80%) in the southern regions of India. Sneezing (71.78%) followed by watery, runny nose (63.59%) were the most common AR symptoms. Majority (72.32%) of the patients had seasonal AR. Coexistence of AR and asthma was significantly associated with the presence of personal and family history of atopy (odds ratio 2.53 and 1.51 respectively; both P < 0.005). Passive smoking, exposure to biomass fuel, and the presence of pets and animals at home were also significantly (P < 0.005) associated with AR-asthma coexistence. Prevalence of AR was found to increase with increasing asthma severity. The usage of oral steroids was significantly higher in patients with coexistent AR-asthma. Sixty-six percent of the patients with coexistent AR-asthma were prescribed intranasal corticosteroids. CONCLUSIONS: The results of the Coexistence of Allergic Rhinitis and ASthma (CARAS) survey highlight the high prevalence of concomitant AR in Indian patients with asthma, and reinforce the need for early diagnosis and guideline-based management of AR in patients with asthma.

TLR4 antagonist ameliorates combined allergic rhinitis and asthma syndrome (CARAS) by reducing inflammatory monocytes infiltration in mice model.

The present study aims to investigate the effects of toll-like receptor 4 (TLR4) antagonist in an ovalbumin (OVA)-induced mouse model of combined allergic rhinitis and asthma syndrome (CARAS). An OVA-induced mouse model of CARAS was established and TLR4 antagonist, TAK-242, was administrated intranasally or intraperitoneally. The number of sneezing and nasal rubbing was counted. The frequency of different cell types in the bronchoalveolar lavage fluid (BALF) and nasal lavage fluid (NLF) was analyzed using flow cytometry. Expressions of protein in nasal mucosa and lungs were determined using western blotting. Levels of interleukin (IL)-4, IL-5, and IL-13 were determined using Enzyme-linked Immunosorbent Assay (ELISA). Histological scores were applied for the assessment of lung injury. Treatment of TAK-242 downregulated CCL2 expression and reduced monocyte infiltration in nasal mucosa and lung tissues. Additionally, treatment of TAK-242 ameliorated upper airway symptoms including the sneezing and nasal rubbing by the regulation of cytokines including IL-4, IL-5, and IL-13. Furthermore, treatment of TAK-242 ameliorated lower airway symptoms including decreasing the frequency of CD45+SiglecF+CD11b+CD11c- eosinophils in BALF and IL13+ Th2 cells in the lungs. In conclusion, treatment of TAK-242 ameliorated CARAS-related lung injury by inhibiting lymphocyte infiltration, reducing monocytes infiltration, as well as regulating the frequency of eosinophils and Th2 cells.

Association of cystathionine beta-synthase polymorphisms and aneurysmal subarachnoid hemorrhage.

OBJECTIVE Cystathionine ß-synthase (CBS) is involved in homocysteine and hydrogen sulfide (H2S) metabolism. Both products have been implicated in the pathophysiology of cerebrovascular diseases. The impact of CBS polymorphisms on aneurysmal subarachnoid hemorrhage (aSAH) and its clinical sequelae is poorly understood. METHODS Blood samples from all patients enrolled in the CARAS (Cerebral Aneurysm Renin Angiotensin System) study were used for genetic evaluation. The CARAS study prospectively enrolled aSAH patients at 2 academic institutions in the United States from 2012 to 2015. Common CBS polymorphisms were detected using 5'exonuclease genotyping assays. Analysis of associations between CBS polymorphisms and aSAH was performed. RESULTS Samples from 149 aSAH patients and 50 controls were available for analysis. In multivariate logistic regression analysis, the insertion allele of the 844ins68 CBS insertion polymorphism showed a dominant effect on aSAH. The GG genotype of the CBS G/A single nucleotide polymorphism (rs234706) was independently associated with unfavorable functional outcome (modified Rankin Scale Score 3-6) at discharge and last follow-up, but not clinical vasospasm or delayed cerebral ischemia (DCI). CONCLUSIONS The insertion allele of the 844ins68 CBS insertion polymorphism was independently associated with aSAH while the GG genotype of rs234706 was associated with an unfavorable outcome both at discharge and last follow-up. Increased CBS activity may exert its neuroprotective effects through alteration of H2S levels, and independent of clinical vasospasm and DCI.

Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage.

OBJECTIVE Renin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin-Angiotensin System (CARAS) study prospectively evaluated common RAS polymorphisms and their relation to aneurysmal subarachnoid hemorrhage (aSAH). METHODS The CARAS study prospectively enrolled aSAH patients and controls at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin-converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5' exonuclease (TaqMan) genotyping assays and restriction fragment length polymorphism analysis. RESULTS Two hundred forty-eight patients were screened, and 149 aSAH patients and 50 controls were available for analysis. There was a recessive effect of the C allele of the angiotensinogen ( AGT) C/T single-nucleotide polymorphism (SNP) (OR 1.94, 95% CI 0.912-4.12, p = 0.0853) and a dominant effect of the G allele of the angiotensin II receptor Type 2 ( AT2) G/A SNP (OR 2.11, 95% CI 0.972-4.57, p = 0.0590) on aSAH that did not reach statistical significance after adjustment for potential confounders. The ACE level was significantly lower in aSAH patients with the II genotype (17.6 ± 8.0 U/L) as compared with the ID (22.5 ± 12.1 U/L) and DD genotypes (26.6 ± 14.2 U/L) (p = 0.0195). CONCLUSIONS The AGT C/T and AT2 G/A polymorphisms were not significantly associated with aSAH after controlling for potential confounders. However, a strong trend was identified for a dominant effect of the G allele of the AT2 G/A SNP. Downregulation of the local RAS may contribute to the formation of cerebral aneurysms and subsequent presentation with aSAH. Further studies are required to elucidate the relevant pathophysiology and its potential implication in treatment of patients with aSAH.

Associations between endothelin polymorphisms and aneurysmal subarachnoid hemorrhage, clinical vasospasm, delayed cerebral ischemia, and functional outcome.

OBJECTIVE Endothelin-1, a potent vasoconstrictor, and its receptors may be involved in the pathogenesis of aneurysmal subarachnoid hemorrhage (aSAH), clinical vasospasm, delayed cerebral ischemia (DCI), and functional outcome following aSAH. In the present study, common endothelin single nucleotide polymorphisms (SNPs) and their relation to aSAH were evaluated. METHODS Blood samples from all patients enrolled in the Cerebral Aneurysm Renin Angiotensin System (CARAS) study were used for genetic evaluation. The CARAS study prospectively enrolled patients with aSAH at 2 academic institutions in the US from 2012 to 2015. Common endothelin SNPs were detected using 5' exonnuclease (TaqMan) genotyping assays. Analysis of associations between endothelin SNPs and aSAH and its clinical sequelae was performed. RESULTS Samples from 149 patients with aSAH and 50 controls were available for analysis. In multivariate logistic regression analysis, the TG (odds ratio [OR] 2.102, 95% confidence interval [CI] 1.048-4.218, p = 0.036) and TT genotypes (OR 7.884, 95% CI 1.003-61.995, p = 0.05) of the endothelin-1 T/G SNP (rs1800541) were significantly associated with aSAH. There was a dominant effect of the G allele (CG/GG genotypes; OR 4.617, 95% CI 1.311-16.262, p = 0.017) of the endothelin receptor A G/C SNP (rs5335) on clinical vasospasm. Endothelin SNPs were not associated with DCI or functional outcome. CONCLUSIONS Common endothelin SNPs were found to be associated with presentation with aSAH and clinical vasospasm. Further studies are required to elucidate the relevant pathophysiology and its potential implications in the treatment of patients with aSAH.

External validation of the Practical Risk Chart for the prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage.

OBJECTIVE Delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) occurs in approximately 30% of patients. The Practical Risk Chart was developed to predict DCI based on admission characteristics; the authors seek to externally validate and critically appraise this prediction tool. METHODS A prospective cohort of aSAH patients was used to externally validate the previously published Practical Risk Chart. The model consists of 4 variables: clinical condition on admission, amount of cisternal and intraventricular blood on CT, and age. External validity was assessed using logistic regression. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS In a cohort of 125 patients with aSAH, the Practical Risk Chart adequately predicted DCI, with an AUC of 0.66 (95% CI 0.55-0.77). Clinical grade on admission and amount of intracranial blood on CT were the strongest predictors of DCI and clinical vasospasm. The best-fit model used a combination of the Hunt and Hess grade and the modified Fisher scale to yield an AUC of 0.76 (95% CI 0.675-0.85) and 0.70 (95% CI 0.602-0.8) for the prediction of DCI and clinical vasospasm, respectively. CONCLUSIONS The Practical Risk Chart adequately predicts the risk of DCI following aSAH. However, the best-fit model represents a simpler stratification scheme, using only the Hunt and Hess grade and the modified Fisher scale, and produces a comparable AUC.

Associations of renin-angiotensin system genetic polymorphisms and clinical course after aneurysmal subarachnoid hemorrhage.

OBJECTIVE Renin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin Angiotensin System (CARAS) study prospectively evaluated associations of common RAS polymorphisms and clinical course after aneurysmal subarachnoid hemorrhage (aSAH). METHODS The CARAS study prospectively enrolled aSAH patients at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5'exonuclease genotyping assays and pyrosequencing. Analysis of associations of RAS polymorphisms and clinical course after aSAH were performed. RESULTS A total of 166 patients were screened, and 149 aSAH patients were included for analysis. A recessive effect of allele I (insertion) of the ACE I/D (insertion/deletion) polymorphism was identified for Hunt and Hess grade in all patients (OR 2.76, 95% CI 1.17-6.50; p = 0.0206) with subsequent poor functional outcome. There was a similar effect on delayed cerebral ischemia (DCI) in patients 55 years or younger (OR 3.63, 95% CI 1.04-12.7; p = 0.0439). In patients older than 55 years, there was a recessive effect of allele A of the angiotensin II receptor Type 2 (AT2) A/C single nucleotide polymorphism (SNP) on DCI (OR 4.70, 95% CI 1.43-15.4; p = 0.0111). CONCLUSIONS Both the ACE I/D polymorphism and the AT2 A/C single nucleotide polymorphism were associated with an age-dependent risk of delayed cerebral ischemia, whereas only the ACE I/D polymorphism was associated with poor clinical grade at presentation. Further studies are required to elucidate the relevant pathophysiology and its potential implication in the treatment of patients with aSAH.

Association of nosocomial infections with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.

OBJECTIVE Delayed cerebral ischemia (DCI) is a recognized complication of aneurysmal subarachnoid hemorrhage (aSAH) that contributes to poor outcome. This study seeks to determine the effect of nosocomial infection on the incidence of DCI and patient outcome. METHODS An exploratory analysis was performed on 156 patients with aSAH enrolled in the Cerebral Aneurysm Renin Angiotensin System study. Clinical and radiographic data were analyzed with univariate analysis to detect risk factors for the development of DCI and poor outcome. Multivariate logistic regression was performed to identify independent predictors of DCI. RESULTS One hundred fifty-three patients with aSAH were included. DCI was identified in 32 patients (20.9%). Nosocomial infection (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.09-11.2, p = 0.04), ventriculitis (OR 25.3, 95% CI 1.39-458.7, p = 0.03), aneurysm re-rupture (OR 7.55, 95% CI 1.02-55.7, p = 0.05), and clinical vasospasm (OR 43.4, 95% CI 13.1-143.4, p < 0.01) were independently associated with the development of DCI. Diagnosis of nosocomial infection preceded the diagnosis of DCI in 15 (71.4%) of 21 patients. Patients diagnosed with nosocomial infection experienced significantly worse outcomes as measured by the modified Rankin Scale score at discharge and 1 year (p < 0.01 and p = 0.03, respectively). CONCLUSIONS Nosocomial infection is independently associated with DCI. This association is hypothesized to be partly causative through the exacerbation of systemic inflammation leading to thrombosis and subsequent ischemia.

La enfermedad en imágenes: representaciones de la gripe española en la prensa argentina (1918) / The disease in images: representations of the spanish flu in the argentine press (1918)

Resumen La gripe española, pese a ser una epidemia olvidada en Argentina, suscitó un fuerte impacto, tanto en la tasa de mortalidad del territorio nacional como en variados aspectos de la vida social, política, cultural y económica del país. En ese sentido, si bien se han realizado estudios desde perspectivas notoriamente enriquecedoras, no se ha planteado un abordaje que recupere las representaciones que realizaron, durante el brote, periódicos y revistas de circulación masiva. A partir de ese vacío historiográfico, el presente estudio pretende realizar un análisis de caricaturas e historietas colocadas en la reconocida revista argentina Caras y Caretas, intentando arrojar luz acerca de las diferentes formas en que la dolencia era presentada a su profuso público. El análisis, según lo venimos anticipando, nos lleva a proponer un abordaje anclado en una metodología de trabajo fundamentalmente cualitativa, definida a partir de la articulación del análisis histórico hermenéutico y del estudio de contenido, recuperando para este último algunas herramientas que nos otorga la sociosemiótica. Se trabajará sobre un conjunto de imágenes seleccionadas a partir de su contenido, en términos de los datos que arrojan sobre las condiciones de producción del discurso.

Abstract The spanish flu, despite being an epidemic forgotten in Argentina, caused a strong impact, both in the mortality rate of the national territory and in various aspects of the social, political, cultural and economic life of the country. In this sense, although there have been studies from notoriously enriching perspectives, an approach has not been proposed that recovers the representations made, during the outbreak, by newspapers and magazines of mass circulation. From this historiographical vacuum, this study aims to perform an analysis of cartoons and comics placed in the renowned argentine publishing house "Caras y Caretas", trying to shed light on the different ways in which the disease was presented by the magazine to its profuse public consumer. The analyse, as we have been anticipating, leads us to propose an approach anchored in a fundamentally qualitative work methodology, defined from the articulation of the hermeneutical historical analysis and the content study, recovering for the latter some tools that the socioemiotic gives us. Work will be done on a set of images selected from their content, in terms of the data they give about the conditions of speech production.

Dados normativos de um conjunto de faces do Karolinska Directed Emotional Faces em uma amostra brasileira / Normative data of a faces set from Karolinska Directed Emotional Faces in a Brazilian sample / Datos normativos de un conjunto de caras de Karolinska Directed Emotional Faces en una muestra brasileña

O objetivo desta pesquisa foi obter dados normativos de um conjunto de faces do Karolinska Directed Emotional Faces (KDEF) em uma amostra brasileira. Para isso foi utilizada uma amostra não probabilística (por conveniência) de 100 participantes da cidade de João Pessoa-PB. Esses tinham idades entre 18 e 62 anos (M=21,6; DP=6,2), a maioria do sexo feminino (76%). Os resultados mostraram que os participantes obtiveram um percentual de acerto médio de 76,2%, de modo que expressões de Alegria (94.7%) e Surpresa (90.3%) foram as emoções mais facilmente identificáveis e Medo (40.65%) a mais difícil. Em relação às medidas de intensidade e valência, Nojo seguida de Surpresa obtiveram classificações mais intensas, e Alegria foi a única emoção com valência positiva alta. Esses achados foram bastante similares com àqueles relatados em pesquisas anteriores, fornecendo normas subjetivas de classificação mais adequadas às características da população brasileira.

The goal of this research was to obtain normative data of set of faces from Karolinska Directed Emotional Faces (KDEF) in a Brazilian sample. It was used a non-probabilistic sample (convenience sample) of 100 participants from the city of João Pessoa-PB. Age ranged from 18 to 62 years (M=21.6, SD=6.2), in which the majority was female (76%). Results showed that participants achieved a mean hit rate of 76.2%, and expressions of joy (94.7%) and surprise (90.3%) were the easiest emotions to identify and fear (40.65%) the most difficult. Regarding the measures of intensity and valence, disgust and surprise obtained more intense classifications, and joy was the only emotion with high positive valence. These findings were quite similar to those reported in previous research, providing subjective norms of classification suitable to the characteristics of the Brazilian population.

El objetivo de esta investigación fue obtener datos normativos de un conjunto de expresiones faciales del Karolinska Directed Emotional Faces (KDEF) en una muestra brasileña. Para ello, se utilizó una muestra no probabilística (por conveniencia) de 100 participantes de la ciudad de João Pessoa-PB. Ellos tenían edades entre 18 y 62 años (M=21,6, DP=6,2), la mayoría del sexo femenino (76%). Los resultados mostraron que los participantes obtuvieron un porcentaje de acierto promedio del 76,2%, de modo que las expresiones de Alegría (94.7%) y Sorpresa (90.3%) fueron las emociones más fáciles de identificar y Miedo (40.65%) la más difícil. Con relación a las medidas de intensidad y valencia, Asco seguida de Sorpresa obtuvieron clasificaciones más intensas, y Alegría fue la única emoción con valencia positiva alta. Estos hallazgos fueron muy similares con aquellos reportados en investigaciones anteriores, proporcionando normas subjetivas de clasificación más adecuadas a las características de la población brasileña.

Test de percepción de diferencias: Estudio normativo del desempeño atencional en escolares argentinos / Perception of differences test (FACES): Normative study of attentional performance in argentine students

La atención juega un rol clave en el desempeño escolar de los niños. Numerosas investigaciones han informado que la capacidad atencional se correlaciona positivamente con las competencias de lectura, escritura y habilidades matemáticas en escolares primarios. En este marco surge la necesidad de evaluar las habilidades atencionales de los niños en el ámbito educativo con instrumentos válidos, confiables y adaptados a la población escolar. El propósito del trabajo realizado fue elaborar los datos normativos del Test de Percepción de Semejanzas y Diferencias (CARAS) y sus indicadores de desempeño atencional. Esta prueba es utilizada para evaluar la atención focalizada y sostenida y la aptitud para percibir, rápida y correctamente, semejanzas, diferencias y patrones estimulantes parcialmente ordenados. La investigaciónfue descriptiva y se empleó un diseño no experimental, seccional-transversal. El análisis se hizo con una muestra estandarizada por muestreo aleatorio estratificado de 4.462 alumnos, de establecimientos escolares públicos de nivel primario del Gran Mendoza (República Argentina) de 7 a 12 años de edad. Como resultado se obtuvieron puntuaciones correspondientes al desempeño atencional:eficacia atencional (EA), eficiencia atencional (FA) y rendimiento atencional (RA), en tiempos parciales de evaluación (t1 y t2) y tiempo total (T), según sexo y edad. Luego se determinaron las frecuencias acumuladas que posteriormente fueron transformadas a rangos percentilares. Con este tipo de estudio normativo se pretende brindar en los diferentes indicadores de desempeño atencional, una mayor precisión diagnóstica en la evaluación del mecanismo atencional en niños.

Attention plays a key role in school performance of children. Different studies have reported that the attentional capacity is positively correlated with the skills of reading, writing and math in primary school. In the teaching-learning process, a child uses different forms of attention. In one task, the child selects relevant information and inhibits the others. Perhaps, should divide his attention and switch his focus of attention between two or more sources of information, holding -intentionally- these activities for a specified time. In this context, it is important evaluate the attentional abilities of children in education with valid, reliable and adapted instruments to the school population. The main perceptual-attentional skills used in assessing attentional tasks are: perception of differences, visual discrimination, visual integration and perceptual speed. These tasks can be characterized as simple, yet include a lot of tests, which requires a relatively large time to be realized. In this way become continuous performance tasks in which the subject must locate significant stimulus to a wider set of stimuli acting distracting way. The purpose of this work was the development of normative data of performance indicators in Perception Test Similarities and Differences or FACES. This test is used to evaluate the focused and sustained attention and the ability to perceive, quickly and correctly, similarities, differences and partially ordered stimulating patterns. As a main feature, the CARAS, has 60 blocks stimuli each composed of three schematic drawings of faces (with elementary strokes representing the mouth, eyes, eyebrows and hair), one of which is different. The task is to determine the different side and cross it off. The research was descriptive and cross-sectional non-experimental design was used. The analysis was performed on a standardized sample stratified random sample of 4.462 students between 7 and 12 years of public primary schools of Mendoza (República Argentina). As a result are obtained performance attentional scores: attentional efficacy (AE), attentional efficiency (AE) and attentional yield (AY) in partial evaluation time (t1 and t2) and total time (T), for each sex and age. These attentional assessment indicators are proposed by the authors in previous work. Mathematical expressions derived from these indicators, emerged from the chronological review of the progress made in this assessment tool and the need to know more accurately the capabilities of the subjects tested. In this context, the term attentional performance is introduced as an inclusive concept of attentional efficiency, attentional efficiency and attentional yield of a subject in visual search tasks. Attentional efficiency allows to evaluate the accuracy with which a child discriminate stimuli within a series of similar stimuli; attentional efficiency (AF) is defined as the cognitive ability to regulate and optimize the attentional mechanism to select and maintain attention for an extended period of time, using minimal resources of time available. Moreover, attentional yield (AY) is the product resulting from the level of effectiveness and efficiency obtained in selection and sustained attentional task. Then, the cumulative frequencies, which were subsequently transformed to percentile ranks, were determined. With this kind of normative study is to provide, in different attentional performance indicators, greater diagnostic accuracy in assessing attentional mechanism in children. The attentional capacity is key to proper cognitive functioning, thus its evaluation is relevant for the purposes of precise diagnosis and adequate psycho-educational intervention programs that interrupt the cycle of failure and frustration helping to increase the feeling of self-efficacy in the school.

Alexithymia and Memory for Facial Emotions / Alexitimia y memoria para emociones faciales

Alexithymia is a multi-faceted personality construct that encompasses, among other features, difficulties in identifying and describing emotions. Prior research suggests that alexithymia is associated with poor recognition memory for emotional words. This study addressed the question of whether memory for emotional faces varies as a function of alexithymia. The 20-Item Toronto Alexithymia Scale (TAS-20), and measures of depression, trait anxiety and intelligence were administered to 40 healthy women. During the encoding experiment angry, fearful, happy, and neutral faces were presented. After 30 minutes a recognition test was conducted. Partial correlation analysis revealed that the TAS-20 scale Difficulties describing feelings was inversely correlated with correct recognition of fearful and angry faces. Alexithymia appears to adversely affect memory functioning for negative emotional faces.

La alexitimia es un constructo de personalidad multifacética que abarca, entre otras características, dificultades en la identificación y descripción de emociones. La investigación previa sugiere que la alexitimia se asocia con pobre memoria de reconocimiento para palabras emocionales. Este estudio abordó la pregunta de si la memoria para las caras emocionales varía en función de la alexitimia. El 20-Item Toronto Alexithymia Scale (TAS-20) y mediciones de depresión, ansiedad-rasgo e inteligencia se administraron a 40 mujeres sanas. Durante la codificación se presentaron rostros de enojo, temeroso, feliz, y se presentaron rostros neutrales. Después de 30 minutos se llevó a cabo una prueba de reconocimiento. El análisis de correlación parcial reveló que la escala TAS-20 y la descripción de sentimientos se correlacionó inversamente con adecuado reconocimiento de rostros temerosos y enojados. La alexitimia parece afectar negativamente a la memoria para los rostros emocionales negativos.