Trimethoprim-sulfamethoxazole-related hallucinations

Although adverse drug reactions are a well-recognized cause of mental status changes in the elderly, antimicrobials are not often implicated. Trimethoprim-sulfamethoxazole-induced hallucinations in immune-competent patient with switching to nitrofurantoin and risperidone, without associated polypharmacy, have not been reported in the literature. In this case report, we present an 86-year-old Caucasian immune-competent female with major depressive disorder and insomnia who developed hallucinations when treated with two trimethoprim-sulfamethoxazole tablets (80 mg/400 mg) in every 12 hours (4 tablets daily) because of lower urinary infection. After trimethoprim-sulfamethoxazole discontinuation and switching to nitrofurantoin and risperidone, symptoms significantly improved.     

Modelling sample selection using Archimedean copulas

Summary. By a theorem due to Sklar, a multivariate distribution can be represented in terms of its underlying margins by binding them together using a copula function. By exploiting this representation, the ‘copula approach’ to modelling proceeds by specifying distributions for each margin and a copula function. In this paper, a number of families of copula functions are given, with attention focusing on those that fall within the Archimedean class. Members of this class of copulas are shown to be rich in various distributional attributes that are desired when modelling. The paper then proceeds by applying the copula approach to construct models for data that may suffer from selectivity bias. The models examined are the self‐selection model, the switching regime model and the double‐selection model. It is shown that when models are constructed using copulas from the Archimedean class, the resulting expressions for the log‐likelihood and score facilitate maximum likelihood estimation. The literature on selectivity modelling is almost exclusively based on multivariate normal specifications. The copula approach permits selection modelling based on multivariate non‐normality. Examples of self‐selection models for labour supply and for duration of hospitalization illustrate the application of the copula approach to modelling.     

Failure of anti-TNF treatment in patients with rheumatoid arthritis: The pros and cons of the early use of alternative biological agents

The five TNF inhibitors currently approved for the treatment of RA are characterised by differences in their molecular structures, half-lives, administration routes, dosing intervals, immunogenicity, and use in women who wish to become pregnant. TNF inhibitors still represent the first biologic after conventional synthetic DMARD (csDMARD) in the majority of patients according to registry data. This was possibly because they were historically the first biological agents available (biological DMARDS with a different mechanism of action or targeted synthetic DMARDs did not become available until 2006s), and so switching from one to another was frequent in the case of an inadequate response and/or side effects. TNF inhibitors are also efficacious for other inflammatory joint and spine diseases, and have been approved for inflammatory bowel disease, uveitis and psoriasis. In addition, national registries have provided long-term safety data and demonstrated their beneficial effect on cardiovascular morbidity and mortality. However, approximately 30–40% of patients discontinue anti-TNF treatment because of primary failure, secondary loss of response, or intolerance. The options for managing anti-TNF treatment failures include switching to an alternative anti-TNF (cycling) or to another class of targeted drug with a different mechanism of action (swapping).The aim of this review is to evaluate the pros and cons of whether it is more appropriate to choose a second anti-TNF biological agents after the failure of the first or swap treatment early.     

文拉法辛与选择性五羟色胺再摄取抑制剂对抑郁症转换策略疗效的Meta分析

目的 系统评价文拉法辛(venlafaxine)与选择性5-羟色胺再摄取抑制剂(selective serotonin reuptake inhibitor,SSRI)对抑郁症转换策略疗效的差异.方法 检索1990 ～ 2010年的MEDLINE和中文文献,纳入文拉法辛与SSRI对抑郁症转换策略治疗效果的随机对照试验并进行Meta分析.结果 8个随机对照试验符合纳入标准,共5350例抑郁症患者.Meta分析结果显示,文拉法辛的临床治愈率是52.5%,SSRI的临床治愈率是43.3%,二者的差异有统计学意义(OR ＝ 1.38,95%CI:1.20 ～ 1.58,P ＜ 0.01);文拉法辛的有效率是67.8%,SSRI的有效率是59.6%,二者的差异有统计学意义(OR ＝ 1.33,95%CI:1.15 ～ 1.53,P ＜ 0.01).结论 文拉法辛较SSRI对抑郁症转换策略有更高的临床治愈率与有效率.     

The development of anticipatory cognitive control processes in task-switching: an ERP study in children, adolescents, and young adults

To investigate the development of advance task-set updating and reconfiguration, behavioral and event-related potential (ERP) data were recorded in children (9-10 years), adolescents (13-14 years), and young adults (20-27 years) in a cued task-switching paradigm. In pure blocks, the same task was repeated. In mixed blocks, comprised of stay and switch trials, two tasks were intermixed. Age differences were found for stay-pure performance (mixing costs) in the 600-ms but not in the 1200-ms cue-target interval (CTI). Children showed larger reaction time mixing costs than adults. The ERPs suggested that the larger costs were due to delayed anticipatory task-set updating in children. Switch-stay performance decrements (switch costs) were age-invariant in both CTIs. However, ERP data suggested that children reconfigured the task-set on some stay trials, rather than only on switch trials, suggesting the continued maturation of task-set reconfiguration processes.     

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

AIM: To evaluate the efficacy of technical modifications of total hepatic vascular exclusion(THVE) for hepatectomy involving inferior vena cava(IVC).METHODS: Of 301 patients who underwent hepatectomy during the immediate previous 5-year period, 8(2.7%) required THVE or modified methods of IVC cross-clamping for resection of liver tumors with massive involvement of the IVC. Seven of the patients had diagnosis of colorectal liver metastases and 1 had diagnosis of hepatocellular carcinoma. All tumors involved the IVC, and THVE was unavoidable for combined resection of the IVC in all 8 of the patients. Technical modifications of THVE were applied to minimize the extent and duration of vascular occlusion, thereby reducing the risk of damage.RESULTS: Broad dissection of the space behind the IVC coupled with lifting up of the liver from the retrocaval space was effective for controlling bleeding around the IVC before and during THVE. The procedures facilitate modification of the positioning of the cranial IVC cross-clamp. Switching the cranial IVC cross-clamp from supra- to retrohepatic IVC or to the confluence of hepatic vein decreased duration of the THVE while restoring hepatic blood flow or systemic circulation via the IVC. Oblique cranial IVC cross-clamping avoided ischemia of the remnant hemi-liver. With these technicalmodifications, the mean duration of THVE was 13.4 ± 8.4 min, which was extremely shorter than that previously reported in the literature. Recovery of liver function was smooth and uneventful for all 8 patients. There was no case of mortality, re-operation, or severe complication(i.e., Clavien-Dindo grade of Ⅲ or more).CONCLUSION: The retrocaval liver lifting maneuver and modifications of cranial cross-clamping were useful for minimizing duration of THVE.     

Serial correlation in lateralized choices of hand and target

We investigated how lateralized choices of hand and target are influenced by previous behavior. Three monkeys retrieved food pellets following cues indicating the location of available food pellet targets, and the hand that could be used to acquire a target. In pseudo-randomized trials, the monkeys could retrieve food pellet targets only on their right side, only on their left side, or their choice of either right or left side, using only their right hand, only their left hand, or their choice of either hand. We examined separately the patterns of serial correlation in target choices and hand choices. Although individual monkeys showed overall laterality preferences, instead of repeatedly using the preferred hand, we found that the monkeys tended to switch hands in successive trials. This serial correlation in hand choice was stronger and more robust than serial correlation in target choice. Furthermore, the pattern of serial correlation for target choice closely resembled that of serial correlation for hand choice when the animal was allowed to choose both target and hand, but only when the target cue was presented before the hand cue. These results suggest that when cued to choose a hand first, the monkeys tended to make a separate decision as to whether to switch their target choices or not, whereas their decisions to switch hands and targets were linked more tightly if the animal was cued to choose a target first.     

Attentional set mixing: Effects on target selection and selective response activation

Performance is impaired under set mixing conditions that require frequent readjustments of attentional focus over an extended time period. We compared set repetitions within pure blocks (constant focus of attention) to physically identical repetitions within mixed blocks (changing focus of attention). The aim was to investigate how set mixing affects target selection, indexed by the N2pc component, and selective response activation, indexed by the lateralized readiness potential (LRP). We found that set mixing prolonged the evolution of the N2pc while leaving its onset unaffected. Impaired target selection indicated by the N2pc mixing effect also delayed the start of response planning indexed by an onset delay of the stimulus-locked LRP, explaining one part of the behavioral mixing cost. A larger part of mixing cost could be attributed to a prolonged response planning phase, indexed by an earlier onset of the response-locked LRP.     

Retrospective study of advanced melanoma patients treated with ipilimumab after nivolumab: Analysis of 60 Japanese patients

Background

Due to resistance and immune-related adverse events (irAE) some melanoma patients require ipilimumab after nivolumab therapy. However, little is known about the result of this switching.