Etiology of obsessions and compulsions: a meta-analysis and narrative review of twin studies

The relative importance of genetic and environmental factors in the etiology of obsessive-compulsive (OC) symptoms is unclear. Cognitive-behavioral models propose that shared environment (e.g., parenting style) is important. Family segregation studies suggest that nonadditive genetic factors may be involved. To investigate the etiology of OC symptoms, a meta-analysis was conducted of 37 twin samples from 14 studies, supplemented by a narrative review. Results indicated that in terms of mean effect sizes, (a) additive genetic effects and nonshared environment accounted for most of the variance in OC symptoms, (b) shared environment and nonadditive genetic effects made little or no contribution; (c) these findings did not vary with sex or symptom severity; (d) variance due to nonshared environment increased with age; (e) gene-environment interactions play an etiologic role; (f) OC symptoms are shaped by etiologic factors common to all types of OC symptoms but also have symptom-specific etiologies; and (g) OC symptoms are also shaped by very general etiologic factors (e.g., those influencing negative emotionality). Overall, the findings indicate that OC symptoms have a complex etiologic architecture that is not adequately explained by contemporary etiological models.     

胸腹联体婴儿分离术二例

目的通过2例胸腹联体婴儿分离手术探讨联体婴儿的外科治疗方法。方法于2004年7月和2005年4月收治2例胸腹联体婴儿,第1例因脐疝皮肤破裂、肠管外露伴破裂急诊行分离手术,胸腹创面用局部皮瓣修复,继发创面用人工皮覆盖。第2例于出生后2个月先行胸腹壁皮肤扩张术,扩张完成1个月后行分离手术,用异体心包重建心包腔,多孔聚乙烯支架重建胸骨缺损,聚丙烯单丝网片重建腹壁,用胸腹扩张旋转皮瓣关闭胸腹创面。结果第1对婴儿分别于分离后2h和39h死于呼吸衰竭和呼吸、循环衰竭。第2对婴儿均成活治愈出院。结论胸腹联体分离术应先行皮肤扩张以利于创面愈合,胸壁重建以多孔聚乙烯支架为好,腹壁重建可用聚丙烯网。分离手术最好在婴儿出生3个月后进行。     

Borderline personality disorder and mood spectrum

Several lines of evidence have raised the question of whether Borderline Personality Disorder (BPD) is an independent disease entity or it might be better conceptualized as belonging to the spectrum of mood disorders. This study explores a wide array of lifetime mood features (mood, cognitions, energy, and rhythmicity and vegetative functions) in patients with BP and mood disorders. The sample consisted of 25 BPD patients who did not meet the criteria for bipolar disorders, 16 bipolar disorders patients who did not meet the criteria for BPD, 19 unipolar patients who did not meet the criteria for BPD, and 30 non-clinical subjects. Clinical diagnoses were determined by administering the structured clinical interviews for DSM-IV disorders. The Mood Spectrum Self-Report (MOODS-SR) was used for measuring lifetime mood phenomenology. Clinical subjects displayed higher mean scores than normal subjects in all domains of the MOODS-SR, and BPD patients displayed higher scores than unipolar patients in the Mood and Cognition depressive subdomains. Differences between patients with BP and bipolar disorders on MOODS psychopathology did not attain statistical significance for any (sub)domain considered. The results of this study are consistent with previous findings suggesting the importance of mood dysregulations in patients with BPD.     

Radiology assessment of omphalopagus conjoined twins: A case report

Conjoined twins are rare and present a challenge for surgeons and radiologists and classified according to the main site of connection: thorax (thoracopagus), abdomen (omphalopagus), etc. Here, we report a Seventeen-month-old, female omphalopagus conjoined twins, born from a mother with a family history of twins, who performed CT-scan and ultrasound echocardiography for elective surgery preparation and X-ray evaluation after the separation surgery. From the CT-Scan examination, revealed each baby had its own, separate heart (one with dextrocardia), each baby had its own liver but they were partially fused and several small branches crossed each other (superior mesenteric artery, intercostal artery, and hepatic vasculature). Findings at surgery are consistent with radiological findings, but we missed to evaluate the pericardium despite being informed by the CT-scan that each baby had its own heart. Radiological investigation plays an important role in the evaluation, all possibilities must be taken into account: operation feasibility, shared organs, soft tissue, and bone structure.