Increased P-wave dispersion in patients with newly diagnosed lichen planus

OBJECTIVE:

Lichen planus is a chronic inflammatory autoimmune mucocutaneous disease. Recent research has emphasized the strong association between inflammation and both P-wave dispersion and dyslipidemia. The difference between the maximum and minimum P-wave durations on an electrocardiogram is defined as P-wave dispersion. The prolongation of P-wave dispersion has been demonstrated to be an independent risk factor for developing atrial fibrillation. The aim of this study was to investigate P-wave dispersion in patients with lichen planus.

METHODS:

Fifty-eight patients with lichen planus and 37 age- and gender-matched healthy controls were included in this study. We obtained electrocardiographic recordings from all participants and used them to calculate the P-wave variables. We also assessed the levels of highly sensitive C-reactive protein, which is an inflammatory marker, and the lipid levels for each group. The results were reported as the means ± standard deviations and percentages.

RESULTS:

The P-wave dispersion was significantly higher in lichen planus patients than in the control group. Additionally, highly sensitive C-reactive protein, LDL cholesterol, and triglyceride levels were significantly higher in lichen planus patients compared to the controls. There was a significant positive correlation between highly sensitive C-reactive protein and P-wave dispersion (r = 0.549, p<0.001) in lichen planus patients.

CONCLUSIONS:

P-wave dispersion increased on the surface electrocardiographic measurements of lichen planus patients. This result may be important in the early detection of subclinical cardiac involvement. Increased P-wave dispersion, in terms of the tendency for atrial fibrillation, should be considered in these patients.     

Differential expression of mTOR signaling pathway proteins in lichen planopilaris and frontal fibrosing alopecia

Dysregulation of the mammalian target of rapamycin (mTOR) signaling pathway has a variety of effects on the immune system and stem cell proliferation. Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are inflammatory scalp conditions resulting in permanent alopecia, which are thought to be related to stem cell damage. Here we investigate the expression of mTOR signaling pathway proteins in human hair follicles of LPP and FFA patients. The expression of mTOR pathway proteins in biopsy specimens from lesional and non-lesional scalp areas of eight LPP and five FFA patients were compared to control scalp biopsies from patients undergoing surgical excisions of sebaceous cysts. We performed immunohistochemical evaluation using a panel of antibodies including mTOR, phospho-mTOR (Ser2448), phospho-p70S6K (Thr389), phospho-4EBP1 (Thr37146), and phospho-tuberin (T1462), as well as Western blot analysis for phospho-p70S6K (Thr389) expression. All evaluated mTOR pathway proteins were similarly expressed in the control and patient non-lesional scalps. While mTOR expression did not show significant alterations between the groups, p-mTOR, p-p70S6K, p-4EBP1, and p-tuberin expressions decreased in the interfollicular epidermis in the lesional scalps of patients. p-p70S6K and p-4EBP1 expression decreased in the outer root sheath (ORS) and inner root sheath (IRS) of the bulge of hair follicles in the lesional scalps of patients. p-mTOR and p-p70S6K expression increased in the lower follicle ORS and bulb of the hair follicles, and p-4EBP1 expression decreased in the bulb of the hair follicles in the lesional scalps of patients. Phospho-tuberin expression increased in the IRS of the bulge and lower follicle ORS of the hair follicles in the lesional scalps of patients, whereas its expression decreased in the bulb. Our results indicate that the mTOR signaling pathway proteins are localized throughout normal hair follicles and that expression of mTOR signaling pathway proteins is altered in the hair follicles of LPP and FFA patients. Further research is required to understand the mechanism by which mTOR operates in the pathogenesis of these diseases.     

视觉眼电生理在视网膜挫伤中的应用

86例86眼视网膜挫伤患者经过视觉眼电图检查。异常率81例(94％)。异常改变主要表现为光峰电位降低或者光峰电位和暗谷电位一致降低。患者Arden比有变化,部分降低,部分正常,部分增高。光峰电位降低幅度超过100Nu者63例(78％)。光峰电位降低幅度与视力变化受检时间和视网膜挫伤程度均无显著性差异。在诊断方面,EOG的价值与ERG和FFA作了对比。异常EOG和病理所见的视细胞损害相吻合。本文还对外伤性白内障、玻璃体积血和视神经挫伤的EOG检查进行了探索。     

Phenotypic characterization of lymphocyte subsets in mycosis fungoides. Comparison with large plaque parapsoriasis and benign chronic dermatoses

Altogether, 209 skin biopsies from 103 patients with mycosis fungoides (MF), large plaque parapsoriasis (LPP), and benign chronic dermatoses (BCD) have been examined immunohistologically with the use of a panel of 21 monoclonal antibodies against lymphoid cells and their subsets. All the infiltrates contained a mixture of T-lymphocytes, Langerhans cells, and other types of HLA-DR-positive dermal macrophages. The neoplastic T-cells in MF lesions expressed proliferation-(transferrin receptor) and activation-(the OKT10 antigen) associated markers more frequently than the T-cells in LPP and BCD. In other respects, the neoplastic T-cells in plaque lesions of MF resembled those seen in LPP and BCD; and most of these cases demonstrated a clear predominance of T-cells of helper/inducer type. The neoplastic T-cells in tumor lesions of MF were much more heterogeneous in phenotype. Only eight of these cases could be classified as T-helper neoplasms. In the remaining ten tumor cases, the neoplastic cells expressed either suppressor/cytotoxic or aberrant T-cell phenotypes. There were no phenotypic differences between the "classical" tumor stages and MF d'emblee cases. The data indicate that the early lesions of MF show an immunohistologic reaction pattern common to many immune responses of the skin and that the neoplastic cells in the advanced stages are more heterogeneous in phenotype than previously recognized.     

Directed attention reduces processing of emotional distracters irrespective of valence and arousal level

Emotional stimuli tend to capture attention, and this so-called motivated attention is commonly measured using the early posterior negativity (EPN) and the late positive potential (LPP). We hypothesized that voluntary, directed attention reduces motivated attention more strongly for highly than moderately arousing pleasant or unpleasant pictures. Participants were instructed to direct their attention to either a picture at fixation or the letters flanking the picture. Pictures varied substantially in arousal and valence. When the pictures were attended to, EPN and LPP increased linearly with arousal. When the letters were attended to, these linear effects decreased in the EPN for pleasant and unpleasant pictures and in the LPP for pleasant pictures. Thus, directed attention decreases processing of emotional distracters more strongly for highly than moderately arousing pleasant and unpleasant pictures. These results are consistent with the view that directed attention decreases emotion effects on sensory gain.     

An event-related potential study on exposure therapy for patients suffering from spider phobia

The present event-related potential (ERP) study investigated electrocortical changes related to cognitive behavior therapy (CBT) in spider phobic females. Forty-five patients and twenty non-phobic women were presented with phobia-relevant, generally fear-inducing, disgust-inducing and affectively neutral pictures in a first EEG session. Phobic patients were randomly assigned to either a therapy (TG) or a waiting-list (WG) group. EEG measurement was repeated after CBT or a waiting period. ERPs were extracted in the time windows 340-500 ms (P300), 550-770 ms (late positive potential (LPP), early LPP) and 800-1500 ms (late LPP). Relative to controls, untreated phobics showed enhanced amplitudes of P300 and early LPP in response to spider pictures. This most likely reflects the emotional significance of the phobic stimulus, which automatically draws attention. The therapy effect consisted of a significant enhancement of late LPP amplitudes in response to spider pictures. Results are discussed in terms of reduced attentional avoidance.     

A hemalog D analysis of chronic lymphocytic leukaemia and other lymphoproliferative disorders affecting the blood.

A correlative clinical and Hemalog D study of 80 cases of chronic lymphocytic leukaemia (CLL) was performed and the results compared with those in other lymphoproliferative disorders affecting the blood (eight cases of hairy-cell leukaemia, HCL; three cases of prolymphocytic leukaemia, PLL: two cases of lymphoplasmacytoid proliferation, LPP; and one case of Sézary's syndrome, SS). In CLL the mean percentage and absolute counts of large unstained cells (LUC) were 8.7% and 6.2 x 109/1 (6200/mm3), and the percentage of LUCs was not substantially affected by treatment; there was no correlation between LUCs and Rai clinical stage. SS and LPP were characterised by a similar percentage of LUCs, but both HCL and PLL were distinguished by a higher mean percentage of LUCs. Stage IV CLL was associated with monocytopenia, but other stages of CLL, PLL, LPP, and SS showed no consistent reduction of absolute numbers of non-lymphoid cell types. In contrast, HCL was characterised by a consistent absolute neutropenia and monocytopenia which distinguished its Hemalog D profile from that of PLL.     

The sound and the fury: Late positive potential is sensitive to sound affect

Emotion is an emergent construct of multiple distinct neural processes. EEG is uniquely sensitive to real‐time neural computations, and thus is a promising tool to study the construction of emotion. This series of studies aimed to probe the mechanistic contribution of the late positive potential (LPP) to multimodal emotion perception. Experiment 1 revealed that LPP amplitudes for visual images, sounds, and visual images paired with sounds were larger for negatively rated stimuli than for neutrally rated stimuli. Experiment 2 manipulated this audiovisual enhancement by altering the valence pairings with congruent (e.g., positive audio + positive visual) or conflicting emotional pairs (e.g., positive audio + negative visual). Negative visual stimuli evoked larger early LPP amplitudes than positive visual stimuli, regardless of sound pairing. However, time frequency analyses revealed significant midfrontal theta‐band power differences for conflicting over congruent stimuli pairs, suggesting very early (∼500 ms) realization of thematic fidelity violations. Interestingly, late LPP modulations were reflective of the opposite pattern of congruency, whereby congruent over conflicting pairs had larger LPP amplitudes. Together, these findings suggest that enhanced parietal activity for affective valence is modality independent and sensitive to complex affective processes. Furthermore, these findings suggest that altered neural activities for affective visual stimuli are enhanced by concurrent affective sounds, paving the way toward an understanding of the construction of multimodal affective experience.     

Emotional self–other voice processing in schizophrenia and its relationship with hallucinations: ERP evidence

Abnormalities in self–other voice processing have been observed in schizophrenia, and may underlie the experience of hallucinations. More recent studies demonstrated that these impairments are enhanced for speech stimuli with negative content. Nonetheless, few studies probed the temporal dynamics of self versus nonself speech processing in schizophrenia and, particularly, the impact of semantic valence on self–other voice discrimination. In the current study, we examined these questions, and additionally probed whether impairments in these processes are associated with the experience of hallucinations. Fifteen schizophrenia patients and 16 healthy controls listened to 420 prerecorded adjectives differing in voice identity (self‐generated [SGS] versus nonself speech [NSS]) and semantic valence (neutral, positive, and negative), while EEG data were recorded. The N1, P2, and late positive potential (LPP) ERP components were analyzed. ERP results revealed group differences in the interaction between voice identity and valence in the P2 and LPP components. Specifically, LPP amplitude was reduced in patients compared with healthy subjects for SGS and NSS with negative content. Further, auditory hallucinations severity was significantly predicted by LPP amplitude: the higher the SAPS “voices conversing” score, the larger the difference in LPP amplitude between negative and positive NSS. The absence of group differences in the N1 suggests that self–other voice processing abnormalities in schizophrenia are not primarily driven by disrupted sensory processing of voice acoustic information. The association between LPP amplitude and hallucination severity suggests that auditory hallucinations are associated with enhanced sustained attention to negative cues conveyed by a nonself voice.     

An event-related potential study on exposure therapy for patients suffering from spider phobia

The present event-related potential (ERP) study investigated electrocortical changes related to cognitive behavior therapy (CBT) in spider phobic females. Forty-five patients and twenty non-phobic women were presented with phobia-relevant, generally fear-inducing, disgust-inducing and affectively neutral pictures in a first EEG session. Phobic patients were randomly assigned to either a therapy (TG) or a waiting-list (WG) group. EEG measurement was repeated after CBT or a waiting period. ERPs were extracted in the time windows 340–500 ms (P300), 550–770 ms (late positive potential (LPP), early LPP) and 800–1500 ms (late LPP). Relative to controls, untreated phobics showed enhanced amplitudes of P300 and early LPP in response to spider pictures. This most likely reflects the emotional significance of the phobic stimulus, which automatically draws attention. The therapy effect consisted of a significant enhancement of late LPP amplitudes in response to spider pictures. Results are discussed in terms of reduced attentional avoidance.     

Clinical significance of unilateral sinusitis

In general, the etiologic factors of chronic paranasal sinusitis are systemic conditions such as nutrition, predisposition, allergy, and local factors such as nasal anatomic conditions. Among these factors, the development of unilateral sinusitis is a model case verifying the influence of local factors. In my study of 640 cases over a certain period of time, a comparison was made between 161 cases of unilateral sinusitis and 479 cases of bilateral sinusitis in order to verify the effects of local factors in the development of this disease. Patients with a history of previous sinus surgery or tumors were eliminated from the cases. 1. The male-female incidence rate, and the age distribution of the patients at the initial visit showed no prominent differences between unilateral and bilateral cases. 2. It was found that a larger number of cases of unilateral sinusitis had a duration of less than one year as compared to bilateral sinusitis which were longer than and year. Therefore it can be said that the duration of unilateral sinusitis is usually shorter than that of bilateral sinusitis. 3. In unilateral cases the patients with moderate to severe nasal septal deviation, one number of patients with septal deviation towards the diseased side was twice as high as that on the non-affected side. 4. The incidence rate of polyps occurring in the middle meatus was shown to be about twice as high in bilateral cases as in unilateral cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pityriasis lichenoides: a clonal T-cell lymphoproliferative disorder

Pityriasis lichenoides (PL) is a papulosquamous disorder often considered a form of reactive dermatosis and classified with small plaque parapsoriasis (digitate dermatosis). However, some patients with PL have developed large plaque parapsoriasis (LPP) and mycosis fungoides (MF), and lymphoid atypia and T-cell clonality have been reported in lesions of PL. We set out to explore the possibility that PL is a form of T-cell dyscrasia. Cases were selected by natural language search from an outpatient dermatopathology database; 35 cases were reviewed and clinicians and patients were contacted. Hematoxylin and eosin-stained sections were examined and immunophenotyping was carried out on paraffin-embedded, formalin-fixed tissue using antibodies to CD2, CD3, CD4, CD5, CD7, CD8, CD20, CD30, and CD56. In paraffin-embedded tissue, T-cell receptor (TCR)-gamma chain rearrangement was sought through polymerase chain reaction single stranded conformational polymorphism analysis. There were 14 males and 21 females with a mean age of 40 years held clinically to have PL chronica (PLC) (28 cases) and/or PL et varioliformis acuta (PLEVA) (7 cases). Five patients developed large atrophic poikilodermatous and/or annular plaques compatible with MF and/or LPP in a background of typical PLC. All biopsies showed tropism of lymphocytes to an epidermis manifesting psoriasiform hyperplasia, dyskeratosis, parakeratosis, and intraepithelial collections of Langerhans' cells and lymphocytes mimicking Pautrier's microabascesses. Epidermal atrophy, dermal fibroplasia, poikilodermatous alterations, and a dominance of intraepidermal cerebriform cells were seen only in patients with chronic persistent disease (i.e., PLC) and in some cases corresponded with clinical progression to MF. All cases had a T cell-dominant infiltrate, with a CD7 deletion in 21 of 32 biopsies examined; the CD7-negative cells were typically the largest and most atypical forms, often in a cohesive array within the upper layers of the epidermis. In 17 biopsies in which a CD4 stain was satisfactory for evaluation, 50% or more of the intraepidermal population was CD4 positive in 8 biopsies, whereas in 11 biopsies 50% or more of the dermal infiltrate was CD4 positive. The CD4-positive cells frequently had a cerebriform nuclear morphology and were CD7 negative. Most cases had an admixture of CD8-positive lymphocytes in excess of 40% or more of the intraepidermal and/or dermal infiltrate; it was the dominant intraepidermal infiltrate in 10 cases. The CD8-positive cells, typically small, round, and CD7 positive, showed a directed pattern of migration into acrosyringia and suprapapillary plates, with satellitosis around CD4-positive/CD8-negative/CD7-negative atypical lymphocytes. CD56 positivity was seen among the intraepidermal lymphoid cells and roughly paralleled the CD8 profile. In general, CD8-positive lymphocytes dominated in cases of PLEVA, whereas CD4-positive lymphocytes were very conspicuous and composed the dominant intraepidermal populace only in those biopsies of progressive PL/PLC. Clonality was shown in 25 of 27 biopsies in which amplifiable DNA was obtained. Intraepithelial atypical lymphocytes, phenotypic abnormalities, and TCR-gamma rearrangements suggest that PLC and PLEVA are a form of T-cell dyscrasia. Lesions may follow a recalcitrant course characteristic of MF and premycotic disorders such as LPP. The aberrant phenotype cell is similar to that defining MF: a CD4-positive T lymphocyte with a CD5 and CD7 deletion. Directed epidermal migration seen in biopsies procured from incipient lesions along with occasional temporal association to viral or drug exposure suggests that an abnormal immune response to an antigenic trigger may be the inciting event.     

Increased neural sensitivity to self‐relevant stimuli in major depressive disorder

The current research examined how individuals with depression process emotional, self‐relevant stimuli. Across two studies, individuals with depression and healthy controls read stimuli that varied in self‐relevance while EEG data were recorded. We examined the late positive potential (LPP), an ERP component that captures the dynamic allocation of attention to motivationally salient stimuli. In Study 1, participants read single words in a passive‐viewing task. Participants viewed negative, positive, or neutral words that were either normative or self‐generated. Exploratory analyses indicated that participants with depression exhibited affective modulation of the LPP for self‐generated stimuli only (both positive and negative) and not for normative stimuli; healthy controls exhibited similar affective modulation of the LPP for both self‐relevant and normative stimuli. In Study 2, using a separate sample and a different task, stimuli were provided within the context of sentence stems referring to the self or other people. Participants with depression were more likely to endorse negative self‐referent sentences and reject positive ones compared to healthy controls. Depressed participants also exhibited an increased LPP to negative stimuli compared to positive or neutral stimuli. Together, these two studies suggest that depression is characterized by relatively increased sensitivity to affective self‐relevant stimuli, perhaps in the context of a broader reduction in emotional reactivity to stimuli that are not self‐relevant. Thus, depression may be characterized by a more nuanced pattern based on the degree of stimulus self‐relevance than either a global decrease or increase in reactivity to affective stimuli.     

Genetic and cytogenetic studies in children with retinoblastoma

Genetic and cytogenetic studies were performed in 110 children with retinoblastoma (57 girls and 53 boys), with 70% of cases being unilateral and 30% bilateral. The mean age of the patients at diagnosis was 22.6 months in unilateral and 11.1 months in bilateral cases. Sporadic cases were 94.5%, and the remaining were familial. There was no difference when the paternal age of sporadic cases was compared with that of familial cases. Three patients from a family exhibiting unilateral retinoblastoma had an interstitial deletion at band 13q14. The presence of other neoplasms and the importance of the genetic and chromosomic studies, for the purpose of genetic counseling, are discussed.     

Nonlinear relations between post-traumatic stress symptoms and electrocortical reactivity during emotional face processing in combat-exposed veterans

Combat-related post-traumatic stress symptoms (PTSS) are prevalent among recently deployed veterans, making identification of biomarkers of PTSS in this population a public health priority. Given the link between threat processing neurobiology and PTSS, the threat-related late positive potential (LPP), an ERP reflective of attentional processing sensitive to emotion and its regulation, may have utility as a cost-effective biomarker. Existing PTSS/threat-related LPP findings are mixed, possibly due to variability in PTSS across samples, but this has never been explicitly tested. To address this gap, LPP amplitudes to angry, fearful, and happy emotional face stimuli were recorded among 81 combat-exposed veterans at a VA hospital. A quadratic relationship between self-reported PTSS and LPP amplitude modulation by angry faces emerged such that greater PTSS was related to a decreased LPP response to angry faces among veterans with subthreshold PTSD and an enhanced LPP response to angry faces among veterans with probable PTSD. These results suggest that prior mixed findings may be due to variability in PTSS severity. In addition, exploratory moderation analysis revealed that PTSS was positively associated with late LPP modulation for veterans reporting low cognitive reappraisal use and negatively associated with late LPP modulation for veterans reporting high cognitive reappraisal use. All results were specific to the 1,000–3,000 ms LPP time window. Thus, the functional nature of LPP modulation by direct threat cues may depend upon PTSS severity and/or related variables (e.g., cognitive reappraisal utilization).     

See no evil: directing visual attention within unpleasant images modulates the electrocortical response

The late positive potential (LPP) is larger for emotional than neutral stimuli, and reflects increased attention to motivationally salient stimuli. Recent studies have shown that the LPP can also be modulated by stimulus meaning and task relevance. The present studies sought to determine whether the magnitude of the LPP can be manipulated by directing attention to more or less arousing aspects within an emotional stimulus. To this end, trials included a passive viewing and directed attention portion. In both Studies 1 and 2, unpleasant compared to neutral images were associated with an increased LPP during passive viewing; additionally, directing attention to non-arousing compared to highly arousing areas of unpleasant images resulted in a decreased LPP. Results are discussed in terms of the utility of using the LPP to understand emotion–cognition interactions, especially with regard to directed visual attention as an emotion regulation strategy.     

A Family with Heritable Electrocardiographic QT-prolongation

A report is presented concerning a family with heritable electrocardiographic QT-prolongation attacks of syncope and possible sudden death. In 23 family members investigated, nine living cases were found to have the anomaly. Of these nine patients at least two had had syncopes in early childhood. Hearing loss was found in three of the nine patients, but in one of them this could have been due to noise trauma and in another hearing loss was unilateral. The inheritance follows an autosomal dominant pattern. As far as we know this is the first report of this disease from The Netherlands.