Topographical distribution of absolute alpha-power in the EEG and psychopathology in schizophrenic outpatients

In 36 schizophrenic outpatients (Research Diagnostic Criteria) under neuroleptic maintenance treatment the EEG was recorded under resting conditions. The absolute alpha-power (7.5-13 Hz) was estimated by Fast Fourier Transform as the mean of 300 2-second epochs for the leads F3/A1, F4/A2, 01/A2 and 02/A2. Two lateralization quotients (anterior, posterior) and two anteriorization quotients (left, right) were calculated from the absolute alpha-power. Clinical status was assessed cross-sectionally with BRPS, GAS and CGI. The main findings are: 1) A linear relationship between the left/right ratio of absolute alpha-power over posterior regions and anxiety/depression--the more the alpha-power is left-lateralized, the higher the anxiety/depression score; 2) a curvilinear, inverted U-shaped relationship between the left/right ratio of absolute alpha-power over posterior regions and the score of schizophrenia-specific symptomatology; 3) the amount of daily neuroleptic dose (mgCPZ) has no impact on EEG-parameters. Results are discussed with respect to hemisphere asymmetry models of psychopathology.     

Comparative effectiveness of catheter ablation strategies for rhythm control in patients with atrial fibrillation: a meta-analysis

Background

Pulmonary vein isolation (PVI) forms the basis of catheter ablation strategies for atrial fibrillation (AF). Ablation of additional sites has been used to increase the efficacy of ablation procedures in restoring and maintaining normal sinus rhythm.

Objective

The aim of this paper was to compare the effectiveness of PVI versus PVI plus adjuvant atrial ablations (PVI+) in patients with AF.

Methods

A systematic search using bibliographic databases and gray literature was undertaken. Randomized and non-randomized controlled trials evaluating clinical efficacy, effectiveness, or safety of ablation procedures in adults with AF were included in this review.

Results

Of 3,204 potential citations identified by the original search, 21 randomized controlled trials and three non-randomized trials were included. Meta-analysis results reveal that in the first year after ablation, AF patients who underwent PVI+ strategies had a significantly higher rate of maintaining sinus rhythm than those who underwent PVI alone (RR 1.10, 95?% CI 1.02, 1.17). However, a subgroup meta-analysis was statistically significant for only PVI+ left atrial (LA) linear ablations (RR 1.16, 95?% CI 1.04, 1.29). The pooled success rates were higher in PVI+ group for both paroxysmal (RR 1.14, 95?% CI 1.06, 1.24) and non-paroxysmal AF (RR 1.53, 95?% CI 1.10, 2.14).

Conclusion

PVI+ strategies, particularly PVI+ LA ablations, appear to result in higher success rates than PVI alone in the first year after the procedure. Studies of longer duration are needed to evaluate the long-term benefits and safety of different adjunctive ablation approaches for rhythm control in AF patients.     

No influence of brain-derived neurotrophic factor (BDNF) polymorphisms on treatment response in a naturalistic sample of patients with major depression

The role of the brain-derived neurotrophic factor (BDNF) in the pathophysiology of major depressive disorder (MDD) remains to be elucidated. Recent post hoc analyses indicated a potential association of three polymorphisms in the BDNF gene with worse treatment outcome in patients with the subtype of melancholic depression. We aimed at replicating these findings in a German naturalistic multicenter follow-up. Three polymorphisms in the BDNF gene (rs7103411, rs6265 (Val66Met) and rs7124442) were genotyped in 324 patients with MDD and 470 healthy controls. We applied univariate tests and logistic regression models stratifying for depression subtype and gender. The three polymorphisms were not associated with MDD as diagnosis. Further, no associations were found in univariate tests. With logistic regression, we only found a tendency towards an association of the rs6265 (Val66Met) polymorphism with overall response to treatment (response rates: GG (val/val) < GA (val/met) < AA (met/met); p = 0.0129) and some gender differences for the rs6265 (Val66Met) and rs7103411 polymorphisms. Treatment outcome stratified for subtypes of depression did not differ significantly between the investigated polymorphisms or using haplotype analyses. However, results showed a tendency towards significance. At this stage, we cannot support an influence of these three polymorphisms. Further studies in larger patient samples to increase sample sizes of subgroups are warranted.     

Twelve‐month prevalence,comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1‐MH)

This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1‐MH]). A nationally representative sample (N = 5318) of the adult (18–79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS‐CIDI) to assess symptoms, syndromes and diagnoses according to DSM‐IV‐TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18–34: 37% versus 20% in age group 65–79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio‐economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected. Copyright © 2014 John Wiley & Sons, Ltd.     

Improvement of postischemic hepatic microcirculation after endothelina receptor blockade—Endothelin antagonism inflfuences platelet-endothelium interactions

Endothelin (ET) contributes to disturbances of hepatic microcirculation after ischemia/reperfusion (I/ R) by causing vasoconstriction and enhancing leukocyte- and platelet-endothelium interactions. The aim of this study was to investigate a possible protective role of a selective endothelinA receptor antagonist (ETA-RA) in this setting. In a rat model, warm ischemia of the left lateral liver lobe was induced for 90 minutes under intraperitoneal anesthesia with xylazine and ketamine. Groups of rats consisted of shamoperated (SO, n = 14), untreated ischemia (n = 14), and treatment with BSF208075 (5 mg/kg body weight IV, n = 14). The effect of the ET_A-RA on I/R was assessed by in vivo microscopy 20 to 90 minutes after reperfusion; by measurement of local tissue PO₂, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and glutathione S-transferase α levels, and by histologic investigation. In the untreated group, sinusoidal constriction to 69.4 ± 6.7% of diameters of SO rats was observed, leading to a significant decrease in perfusion rate (74.3 ± 2.1% of SO) and liver tissue PO₂ (43.5 ± 3.2% of SO) (P < 0.05). In addition, we found an increased percentage of stagnant leukocytes (142.9 ± 11.9%) and platelets (450.1 ± 62.3%) in sinusoids and in postsinusoidal venules (P < 0.05). Hepatocellular damage (ASTandALTincrease to1330 ± 157U/Land750 ± 125U/Lrespectively; previously, 27.1 ± 3.5 U/L and 28.5 ± 3.6 U/L) was detected 6 hours after reperfusion (P < 0.05). Administration of the ETA-RA before reperfusion significantly reduced I/R injury. Sinusoidal diameters were maintained (108.5 ± 6.6%), and perfusion rate (93.1 ± 1.8%) and tissue PO₂ (95.3 ± 5.7%) were significantly increased (P<0.05). According to reduced leukocyte-endothelium interactions after therapy, both platelet rolling and adhesion were significantly reduced (P < 0.05). The number of stagnant platelets in sinusoids was 199.5 ± 12.3% of 50 (P < 0.05). After treatment, hepatocellular damage was decreased (AST and ALT levels after 6 hours of reperfusion: 513 ± 106 U/L and 309 ± 84 U/L, respectively; P < 0.05), and histologic changes were reduced in the long term. Our results provide evidence that the new therapeutic approach with an ET_A-RA is effective in reducing hepatic I/R injury. In addition to reduced leukocyte-endothelium interactions, the number of stagnant and rolling platelets in sinusoids and venules was significantly reduced. The reduction in microcirculatory damages is responsible for better organ outcome.