The predicted and observed course of psychotherapy for anxiety and mood disorders

By applying hierarchical linear modeling (HLM) techniques, patient clinical characteristics at the beginning of treatment were used to predict individual patient responses (N = 160) to psychotherapy. Four diagnostic groups (mood, anxiety, other, and no diagnosis) were formed among the patients based on intake-administered Structured Diagnostic Interview for the Diagnosis of DSM-III-R axis I Disorders. Patients with mood and anxiety disorders had predicted courses of response to psychotherapy that were similar but different from patients with other disorders and no diagnosis. Predicted and observed courses of response to psychotherapy in a subsample (N = 75) who had provided enough data to model the actual course of treatment showed high levels of congruence, thus supporting the validity of predicting course of response. HLM predictive profiling offers a new approach for assessing treatment effectiveness of psychotherapy with patients having axis I diagnostic conditions by considering an individual patient's clinical characteristics.     

Pediatric intramedullary spinal cord tumors Critical review of the literature

The objective of this review was to analyze the literature on the management of intramedullary spinal cord tumors to determine whether enough information was available for treatment guidelines to be established. Using standard computerized search techniques, databases containing medical literature were queried for keywords related to intramedullary spinal cord tumors, beginning in 1966. Of the 445 articles published in English and with potential relevance, only 75 articles were included in the final analyses. Based on the strength of their recommendations for the treatment of this controversial condition, articles were divided into class I, class II and class III data. There were no class I studies related to any aspect of the treatment of intramedullary spinal cord tumors. Based on this critical review of literature, gross total removal of an ependymoma confirmed by immediate postoperative magnetic resonance imaging and adjunctive treatment for high-grade tumors using radiotherapy, with or without chemotherapy, can be recommended as standards of therapy. With the strength of a guideline, radiotherapy should be withheld after gross total removal of intramedullary ependymomas and radical resection of low-grade intramedullary astrocytomas. The use of intraoperative ultrasonography and evoked potentials, important surgical adjuncts, can also be considered guidelines. The radical resection of intramedullary low-grade astrocytomas is an option. Received: 15 October 1998     

Metaphorical Stories for Education About Mental Health Challenges and Stigma

In 1989, my psychiatrist convinced me to present to a small group of parents of people with mental health challenges. I had terrible stage fright, but I coped well. It was such a success that I was invited to present to other groups. Thus, I started presenting to groups and other audiences. In this article, I want to share my experience using metaphorical stories when presenting. The more I presented to different audiences, the more I found I was trying to explain complicated matters. It is not enough to want to communicate with someone, and it is not enough that he or she wants to communicate with oneself. Suitable conditions are required for communication. Because I was captivated in my childhood by the fables of Aesop, La-Fontaine, and Krilov, I used in my presentations various fables and other types of metaphorical stories to bridge the gap of knowledge and to enable communication. When I could not find metaphorical stories to suit my presentations, I made them up.     

Calibre spectra of the lingual and hypoglossal nerves of the rhesus monkey

The presence of muscle spindles in the tongue of the rhesus monkey and their absence in the cat's tongue, raises the question of whether this difference alters the structural and functional composition of, in particular, the rhesus monkey's hypoglossal nerve as compared to the same nerve in the cat. Using both random and complete sampling techniques, calibre spectra analyses were carried out on the following regions of the rhesus monkey's hypoglossal nerve: The medial and lateral end branches, and regions of the main trunk proximal and distal to the point where the ramus descendens is given off. In addition, the calibre spectrum of the lingual nerve was determined. The results suggested that neither the lingual nerve nor the proximal region of the hypoglossal nerve contained enough fibers of Group I diameter to justify the statement that they cintained spindle afferents. Distal to the point where the cervical contribution joins the hypoglossal nerve, however, the calibre spectrum exhibited a marked shift towards a closer resemblance to the spectra of limb muscle nerves in terms of the proportion of Group I diameter fibers. These findings suggested that although lingual spindle afferent fibers are present in the distal portion of the monkey's twelfth nerve, they may not reach the central nervous system in this nerve.     

Differential expression of multiple calmodulin genes in cells of the white matter of the rat spinal cord

Calmodulin (CaM) displays complex cytoplasmic and synaptic functions in the nervous system. However, the very little information that is available on the gene expression of the multiple CaM genes in different glial cell types are from brain tissues of rodents, and no data have been published on their CaM gene expression in the spinal cord. Therefore, we have modified and tested a color in situ hybridization method sensitive enough to detect mRNA populations in cells with low CaM mRNA abundances in the white matter of the rat lumbar spinal cord. Morphologically, two distinct cell types expressing CaM mRNAs were detected. Differential CaM gene expression was demonstrated in medium-sized astrocyte-like cells that reside predominantly in the dorsal column of the spinal cord, where CaM I mRNA was most abundant, followed by the CaM III and CaM II mRNA populations. The oligodendrocytes displayed a less differential CaM gene expression in both the dorsal and the lateral columns, but the CaM I gene had a slightly higher expression level than those of the other CaM genes. The results indicate that the CaM gene expression profile of the spinal cord is richer and more complex than previously thought on the basis of conventional radioactive in situ hybridization techniques. Thus, when a method that is sufficiently sensitive was used, more cell types could be demonstrated to express CaM mRNAs; hence, in spite of their lower CaM expression, glial cells could also be visualized.     

The role of the striatum in addiction

Addiction is a notorious treatment-resistant psychiatric disorder characterized by the impairment of self-monitoring, loss of interest in other targets of pleasure, and uncorrectable impulsive/compulsive drug-seeking behaviors. The striatum, particularly the ventral striatum (= the nucleus accumbens) is deeply involved in the acquisition and expression of addiction. Although only few pharmacotherapeutic approaches against addiction are available, the currently used animal models of addiction are sophisticated enough to mimic most of the representative phenotypes observed in human addicts. In addition, recent advances in neuroimaging techniques, such as positron emission tomography or functional magnetic resonance imaging, as well as computational neuroscience approaches have promoted our understanding of addiction, particularly at the circuitry level. In this review, I introduce some pivotal topics regarding addiction for discussion. First, I outline the updated concept regarding how dopamine is involved in addiction by focusing on 2 seemingly uncompromising hypotheses, prediction-error theory and incentive salience theory. Second, after providing a brief introduction to unmanageable maladaptive behaviors in addiction that may be attributable to the impairments of the medial prefrontal cortex, anterior cingulate cortex, and orbitofrontal cortex, I emphasize the roles of glutamatergic inputs projecting from these frontal areas to the nucleus accumbens in cue-primed reinstatement of drug-seeking and impaired neuronal plasticity. Third, on the basis of the complementary or counterbalancing relationship between goal-directed behaviors and habits, I discuss the foresights and pitfalls of the current concept of "addiction as a pathological habit." Lastly, I conclude my discussion with an integrated (but a rough) circuitry model of addiction.     

Non-invasive intracranial pressure assessment

Assessing intracranial pressure (ICP) remains a cornerstone in neurosurgical care. Invasive techniques for monitoring ICP remain the gold standard. The need for a reliable, safe and reproducible technique to non-invasively assess ICP in the context of early screening and in the neurocritical care environment is obvious. Numerous techniques have been described with several novel advances. While none of the currently available techniques appear independently accurate enough to quantify raised ICP, there is some promising work being undertaken.     

Identification and cell lineage of individual neural precursors in the Drosophila CNS

The Drosophila CNS is complex enough to serve as a model for many of the molecular, cellular and developmental functions of the vertebrate CNS, yet simple enough for single-cell analysis. Recent advances have provided molecular markers that allow most Drosophila CNS precursors to be uniquely identified, as well as methods for determining the complete cell lineage of each precursor. A detailed understanding of wild-type neurogenesis, combined with existing molecular genetic techniques, should provide insight into the fundamental mechanisms that generate neuronal and glial diversity.     

Sensitivity of functional tympanic membrane thermometry (fTMT) as an index of hemispheric activation in cognition

The measure of hemispheric activation in cognitive and clinical studies remains out of reach of many scientists due to cost, analysis complexity, and practical consideration of the techniques available such as fMRI, EEG, or EMG. The present study was conducted to determine whether infrared functional tympanic membrane thermometry (fTMT) is a measure of lateralised activation sensitive enough to be used in typical cognitive and clinical experiments. A total of 24 participants had their tympanic membrane temperature measured while performing a letter-matching task. Activation in the two hemispheres was manipulated by changing the proportion of matches occurring in the left and right visual fields and by varying the task complexity. Changes in fTMT due to the greater proportion of matches presented in one visual field and due to the modulation in task complexity were detected. These findings suggest that fTMT is a measure of broad lateralised cerebral activation sensitive enough for use in typical psychological studies.     

Sensitivity of functional tympanic membrane thermometry (fTMT) as an index of hemispheric activation in cognition

The measure of hemispheric activation in cognitive and clinical studies remains out of reach of many scientists due to cost, analysis complexity, and practical consideration of the techniques available such as fMRI, EEG, or EMG. The present study was conducted to determine whether infrared functional tympanic membrane thermometry (fTMT) is a measure of lateralised activation sensitive enough to be used in typical cognitive and clinical experiments. A total of 24 participants had their tympanic membrane temperature measured while performing a letter-matching task. Activation in the two hemispheres was manipulated by changing the proportion of matches occurring in the left and right visual fields and by varying the task complexity. Changes in fTMT due to the greater proportion of matches presented in one visual field and due to the modulation in task complexity were detected. These findings suggest that fTMT is a measure of broad lateralised cerebral activation sensitive enough for use in typical psychological studies.     

Effect of personality disorders on outcome of treatment

Although many clinicians have long believed that personality pathology may interfere with the effectiveness of treatment of axis I disorders, until recently there were no empirical studies on the subject. This report reviews the recent literature with regard to the following questions: a) Does personality pathology predict negative outcome of treatment for axis I disorders? b) If so, are there specific personality traits or disorders that account for such a negative outcome? The literature review reveals a robust finding that patients with personality pathology have a poorer response to treatment of axis I disorders than those without such pathology. Specific axis I disorders reported on include DSM-III major depression, panic disorder, and obsessive-compulsive disorder. Both inpatients and outpatients have been studied. There is too little literature to determine whether certain pathological personality traits are especially important, but there is enough to provide methodological guidance for future studies. Such studies should use standardized measures of personality and outcome, should match personality and nonpersonality groups on severity of the axis I disorder, and should be certain that axis I diagnoses are not confounded by axis II symptoms.     

The platelet reactivity of the alpha 2(I)-chain of type I collagen: platelet aggregation induced by polymers of the molecule [alpha 2(I)]3

Polymers of the collagenous species alpha 2(I) trimer, a molecule of which contains three alpha 2(I) chains derived from type I collagen, have been shown to induce the aggregation of platelets when tested at a temperature low enough to avoid loss of the tertiary structure of the molecule. Under these conditions, the alpha 2(I) chain appears to possess greater platelet reactivity than the corresponding type I collagen-derived alpha 1(I) chain. In contrast to previous reports of its lack of reactivity, our results indicate that the alpha 2(I) chain must contribute importantly to the overall platelet reactivity of collagen type I in vivo. Our findings furthermore support the concept that any collagen-like structure may be expected to interact with platelets provided due regard is given to tertiary and quaternary structural requirements.     

Pyridoxine neuropathy in rats: specific degeneration of sensory axons

When rats received pyridoxine in doses large enough to cause neuropathy in humans, the animals developed gait ataxia that subsided after the toxin was withdrawn. By using quantitative histologic techniques, we found axonal degeneration of sensory system fibers and that the fibers derived from the ventral root were spared. Although the degeneration approached the dorsal root ganglion, neurons in the ganglion did not degenerate. We found no early decrease in oxygen consumption of nerve, suggesting that impaired oxidative metabolism was not the primary event.     

Chiari I畸形合并脑积水的手术治疗(附33例报告)

目的　研究Chiari I畸形合并脑积水的手术方式和手术方法,并评价手术效果。方法　回顾性分析33例Chiari I畸形合并脑积水患者,全部病例均采用后颅凹减压术并在显微镜、脑室镜等辅助下切除下疝的小脑扁桃体并松解去除脑室系统内外粘连,使用神经补片减张缝合硬膜。术前术后分别作MR和脑室系统径线的测量比较并随访复查。结果　全部病例MR显示颈延髓压迫解除,枕大池形态恢复,2 3例症状明显改善,2 5例脑室明显缩小,6例脑室系统变化不显著,2例脑积水仍有发展。结论　Chiari I畸形合并脑积水以梗阻因素为主,术中除作好骨性结构的充分减压外,还应松解粘连、解除梗阻并重建枕大池,争取在手术中一次性解决颈延髓压迫和脑积水两个问题。     

The psychological impact of ambulatory peritoneal dialysis on adults and children

The most common medical complication causing patient and spouse reaction remains peritonitis. Psychological difficulties include different levels of problems with body image distortion and major role reversal issues with resulting significant marital discord, especially in our diabetic patients. Contrary to patients on maintenance hemodialysis and IPD, no patients were noted to become pathologically depressed although adjustment problems manifested as depression were seen. The increasing role of technology in treatment means that greater attention should be paid to how patients relate psychologically to the application of what can seem to be overpowering or even fearsome technical means. Appropriate evaluation and selection of candidates for CAPD can enable these chronically ill persons to better control and adapt to the critically necessary procedure of dialysis. In the words of a 55-year-old gentleman on CAPD for three years: "It is unbelievable how much freer and fitter I feel since being on CAPD. I have had several holidays and can drive 200 miles on my own without difficulty. The main advantage to me is that CAPD has restored my independence. I feel well enough to enjoy life--the best criterion for judging any treatment."     

Interaction between metabotropic and ionotropic glutamate receptors regulates neuronal network activity.

Experimental and computational techniques have been used to investigate the group I metabotropic glutamate receptor (mGluR)-mediated increase in the frequency of spinal cord network activity underlying locomotion in the lamprey. Group I mGluR activation potentiated the amplitude of NMDA-induced currents in identified motoneurons and crossed caudally projecting network interneurons. Group I mGluRs also potentiated NMDA-induced calcium responses. This effect was blocked by a group I mGluR-specific antagonist, but not by blockers of protein kinase A, C, or G. The effect of group I mGluRs activation was also tested on NMDA-induced oscillations known to occur during fictive locomotion. Activation of these receptors increased the duration of the plateau phase and decreased the duration of the hyperpolarizing phase. These effects were blocked by a group I mGluR antagonist. To determine its role in the modulation of NMDA-induced oscillations and the locomotor burst frequency, the potentiation of NMDA receptors by mGluRs was simulated using computational techniques. Simulating the interaction between these receptors reproduced the modulation of the plateau and hyperpolarized phases of NMDA-induced oscillations, and the increase in the frequency of the locomotor rhythm. Our results thus show a postsynaptic interaction between group I mGluRs and NMDA receptors in lamprey spinal cord neurons, which can account for the regulation of the locomotor network output by mGluRs.     

How genetically heterogeneous are the major psychiatric disorders?

Linking specific chromosomal regions with the abnormal genes responsible for major psychiatric disorders is rendered particularly difficult because of three factors: diagnostic uncertainty; the possibility that some psychiatric disorders are caused by the concerted action of more than one gene; and the possibility that similar disorders may result from alternative genetic abnormalities. The approach proposed here is to concentrate initially on the highly focused problem of resolving the question of genetic heterogeneity of a given disorder. To this end, it is recommended (a) that studies concentrate on pedigrees large enough to contain at least two nuclear families with several affected individuals, and (b) that, within them, work be confined to an intensive examination of such small nuclear families containing an affected parent and at least two affected offspring with a fairly unmistakable phenotype—bipolar disorder, type I. By using molecular and genetic techniques designed to extract maximal information from this relatively small number of affected individuals, it should be possible to determine whether or not bipolar disorder is genetically heterogeneous. This is a limited but very important question, and the technology is presently available to answer it. The answer should, in turn, guide subsequent approaches to identification of the relevant gene or genes.     

In vivo preparation and identification of mitral cells in the main olfactory bulb of the mouse

The mouse main olfactory bulb (MOB) is commonly used as a mammalian model to study olfactory processing. The genetic techniques available with the mouse make its MOB a powerful model for analysis of neuronal circuitry. The mouse has been used as a mammalian model for all types of MOB neurons, but especially to study the activity of mitral cells. However, mouse mitral cell activity is most commonly studied in vitro. Therefore, we aimed to develop a protocol to record the activity of antidromically identified mitral cells in mouse in vivo. Currently, such a protocol does not exist. Using extracellular techniques, we report a protocol that is able to record neurons from all mouse MOB layers. Specifically, mitral cell single-units were identified by antidromic activation from the posterior piriform cortex, and their spontaneous activity was recorded for more than 30 min. This protocol is stable enough to record from single-units while buprenorphine was applied both topically to the surface of the MOB and injected systemically.     

微血管减压术中对岩上静脉的处理

随着显微外科技术的进步,微血管减压术的安全性正在逐步提高。近来,在术中保留岩上静脉（SPV）系统的意义越来越受到关注。由于SPV的属支变异较大,不同患者对切断SPV的反应存在个体差异。在微血管减压术中,应慎重处理SPV以提高手术效果,减少并发症和降低病死率。本文围绕SPV的解剖特点和微血管减压术中对SPV处理的最新观点作一综述。     

颈内动脉床突上段血泡样动脉瘤手术治疗

目的 探讨颈内动脉床突上段血泡样动脉瘤(BBA)的手术技巧.方法 对7例开颅手术夹闭的BBA进行分析,采取额极软脑膜下分离,预先或术中临时阻断载瘤动脉,直接游离瘤颈两侧或载瘤动脉相连续部,分离出能够通过动脉瘤夹闭小空间即可,不必完全显露瘤体;强调选用小弯形动脉瘤夹一次夹闭,如果瘤颈撕裂在载瘤动脉临时孤立无充盈状态下,将瘤颈根部包括载瘤动脉壁连续部部分动脉壁一并夹闭.结果 本组6例术后完全康复;1例术后2周出现大脑半球大面积梗死,肢体偏瘫,痴呆.结论 采用特殊的手术技巧,能够减少BBA的手术风险,提高治愈率.

Abstract：

Objective To explore the surgical techniques for rare blood blister - like aneurysm (BBA) in the superior segment of clinoid process of internal carotid artery. Method The clinical data of seven cases of BBAs were studied. The separation of pia mater of the frontal pole was performed. The parent artery was blocked temporarily during the surgery. Sculpture type was adopted to directly dissociate the continuation part between the aneurysm neck and parent artery to get a small space enough for incarceration of aneurysm without exposure of the entire aneurysm. One incarceration of the lesser curvature - like aneurysm clip was specially performed to temporarily isolate the parent artery in the case of avulsion of aneurysm neck,to incarcerate the aneurysm root including the continuous part of parent artery wall in a nonfilling state. Results There were 6 cases of complete recovery after operation, 1 case of large area infarction of hemicerebrum after 2 weeks of operation resulting in hemiplegia and dementia Conclusions Special surgical techniques could reduce the surgical risk for BBA and improve curative rate.