Biomarkers of altered coagulation and fibrinolysis as measures of disease activity in active inflammatory bowel disease: a gender-stratified, cohort analysis

Background

Growing evidence recognizes inflammatory bowel disease (IBD) as a chronic inflammatory condition characterized by a hypercoagulable state and prothrombotic conditions. The aims of our study were to evaluate the abnormalities in coagulation and fibrinolysis status in patients with IBD, and to analyze parameters of altered coagulation and fibrinolysis status which can correlated with and predict inflammatory parameters of disease activity.

Methods

A cohort of 271 consecutive IBD patients was compared with healthy controls for coagulation and fibrinolysis status. Associations between altered coagulation and fibrinolysis status stratified by gender and inflammatory parameters were analyzed.

Results

The mean levels of platelet, platelet distribution width, prothrombin time, fibrinogen, activated partial thromboplastin time were significantly higher in IBD patients than in healthy controls (all P < 0.05). Mean platelet volume was lower in male patients with IBD than in healthy controls (P < 0.01). Furthermore, multiple linear regression indicated that fibrinogen was an independent predictor of ESR (β = 1.316, P = < 0.001) and CRP (β = 1.233, P = 0.015) in male patients with active ulcerative colitis. Platelet (β = 0.436, P = 0.037) and prothrombin time (β = 0.810, P = < 0.001) were predictors of Crohn's Disease Activity Index in female patients with Crohn's disease.

Conclusions

To our knowledge, this study provides characteristics on altered coagulation and fibrinolysis status in active IBD patients using the largest number of cases assembled in one study to date. Our data suggest that in IBD patients, abnormalities in coagulation and fibrinolysis status were associated with disease activity. Fibrinogen, platelet and prothrombin time were predictors of inflammation.     

High plasma nesfatin-1 level in patients with major depressive disorder

Aim

In the present study, our aim was to determine the changes in the plasma concentrations of a recently discovered peptide hormone nesfatin-1 in patients with major depressive disorder and then to make a comparison with the control group.

Method

Subjects in the patient group were randomly selected from Mustafa Kemal University, Medical School, Research and Training Hospital, Psychiatry Department, Outpatient Clinic and subjects in the control group were selected from healthy volunteers. Healthy control subjects were matched in terms of weight and body mass index. Hamilton Depression Rating Scale (HAM-D) was applied to both groups. ELISA method was used for measurement of plasma nesfatin-1 levels.

Results

The average nesfatin-1 level was statistically higher in patients with major depressive disorder than in the control group (p < 0.001). A positive correlation was observed between plasma nesfatin-1 levels and HAM-D scores both in the patient group (r = 0.59, p < 0.001) and in the control group (r = 0.58, p < 0.001).

Conclusion

Our findings suggest a possible relationship between major depressive disorder and high plasma nesfatin-1 level.     

Dose-dependent frontal hypometabolism on FDG-PET in methamphetamine abusers

Objective

Although a lot of evidence from neuropsychological and neuroimaging studies supports the view that patients with substance dependence have abnormalities in the prefrontal cortex, functional deficits in the prefrontal cortex have not been fully investigated in methamphetamine (MA) dependent patients. This study was prepared to examine whether MA abusers have cerebral metabolic abnormalities and executive dysfunction.

Method

Twenty-four abstinent MA dependent patients and 21 age-matched control subjects underwent resting brain FDG-PET and completed computerized versions of the Wisconsin card sorting test (WCST). Resting brain PET images were obtained 30 min after an intravenous injection of 370 MBq of ¹⁸F-FDG. Significant differences in glucose metabolism were estimated for every voxel using t-statistics on SPM2 implemented in Matlab.

Results

Resting brain FDG-PET revealed significant hypometabolism in the left inferior frontal white matter (Talairach coordinates (x, y, z): −34, 7, 31) in MA dependent patients compared to the control subjects (corrected p = 0.001, peak Z = 5.37, voxel number 201). The nearest gray matter region was the left inferior frontal cortex (Brodmann area 9). There were negative correlations between the relative regional cerebral metabolism for glucose (rCMRglc) in the left inferior frontal white matter and the total cumulative dose of MA (r = −0.57, p < 0.01). MA dependent patients completed significantly fewer categories (3.8 ± 2.2) and made more perseveration errors (21.3 ± 11.8) and total errors (43.5 ± 19.5) on the WCST when compared to the control subjects (p < 0.01).

Conclusions

These data suggest that MA dependent patients have dose-dependent frontal hypometabolism and frontal executive dysfunction.     

Bivalirudin is inferior to heparin in preservation of intraoperative autologous blood

Introduction

Bivalirudin is used as an alternative to heparin in cardiac surgery, and may be superior to heparin with regard to platelet function. Bivalirudin however, is prone to cleavage by thrombin resulting in coagulation in areas of stasis.

Material and Methods

We compared the preservation of platelet function and the quality of anticoagulation in autologous blood of 26 cardiac surgical patients collected intraoperatively and anticoagulated ex vivo with either bivalirudin or heparin, with supplementation of bivalirudin over time and prevention of stasis.

Results

We found in both preservatives a reduction in ADP-induced platelet aggregation response over a period of 105 minutes (median, IQR: 73-141) as measured by Multiplate®. Supplementation of additional bivalirudin (23 ± 1.1 μg/ml/hr) and prevention of stasis was not able to prevent thrombin generation. We found a 5-fold increase in levels of prothrombin fragment 1 + 2 in bivalirudin preserved autologous blood as compared to heparin preserved blood (F₁₊₂ levels median 8.9 nM [quartile percentiles 4.2-12.4] vs 1.3 nM [0.6-2.1], P = 0.001 Mann-Whitney, n = 10).

Conclusions

Our study suggests that preservation of platelet function in autologous blood anticoagulated with bivalirudin is not a suitable alternative to heparin.     

Acute ischemic stroke in the very elderly Chinese: risk factors, hospital management and one-year outcome

Background

Little information is available on Asian patients over 80 years with stroke. We aimed to investigate characteristics of the very elderly ischemic stroke hospitalized patients in China.

Methods

We prospectively enrolled consecutive patients with acute ischemic stroke from March, 2002 to October, 2008 into the analysis. Patients were divided into two groups: <80 years versus ≥80 years and risk factors, hospital management and one-year outcome were compared.

Results

Of the 2619 cases included, 302 (11.5%) patients were 80 years or older. Compared with patients <80 years, patients over 80 years old had higher rates of hypertension (66.2% versus 56.1%, p = 0.001), atrial fibrillation (23.5% versus 14.5%, p = 0.000), and coronary heart disease (13.6% versus 5.7%, p = 0.000). In addition, they were less likely to have received transthoracic echocardiography (45.4% versus 55.4%, p = 0.001), color Doppler of extracranial vessels (54.0% versus 61.2%, p = 0.015), antiplatelet agents (80.8% versus 86.8%, p = 0.004), or anticoagulants (4.0% versus 9.0%, p = 0.003). After adjusting for sex and stroke severity on admission, the very elderly patients had higher case-fatality and disability rates at one year (33.8% versus 13.2%, p = 0.000; 37.8% versus 20.9%, p = 0.000; respectively).

Conclusions

In China, the proportion of the very elderly in hospitalized stroke population is lower than that in western countries whereas the most common risk factors seem similar. The hospital management for these patients is relatively insufficient and the long-term outcome is generally unfavorable compared with patients under 80 years old.     

Hospitalizations due to spontaneous intracerebral hemorrhage in the region of Nis (Serbia): 11-year time-series analysis

Background

The study of seasonal variability of intracerebral hemorrhage (ICH) occurrence may contribute to a better understanding of the nature of this disease and open up new perspectives in its prevention. The aim of this study was to test seasonal patterns in the number of admissions of ICH patients and determine which months have maximal and minimal number of admissions.

Methods

The main data source for this study was a hospital-based registry at the Clinic of Neurology in Nis, Serbia. During the studied period (1997-2007) a total of 1569 ICH patients were registered. Time series, consisting of the monthly number of hospitalized patients, for the 128 months of the study duration, has been successfully modeled using the multiplicative Auto Regressive Integrated Moving Average (ARIMA) model.

Results

Using the maximum likelihood method, utilizing Melrad's algorithm, the parameters of this ARIMA model have been calculated: constant (estimate 12.068, p < 0.001), auto regressive-AR(1) (estimate 0.866, p < 0.001), moving average-MA(1) (estimate 0.775, p < 0.001), seasonal moving average-SMA(12) (estimate −0.198, p = 0.036). ARIMA modeling has been successful and showed that there is a clear seasonal pattern in the data analyzed.

Conclusion

Based on the seasonal multiplicative ARIMA model and the seasonal time series decomposition, we showed that, in the period covered by the study, the peak of admissions occurred in March, and the trough of admissions was found in August.     

Effect of pramipexole on cutaneous-silent-period parameters in patients with restless legs syndrome

Objective

The aim of this study was to investigate cutaneous-silent-period (CSP) parameters in patients with restless legs syndrome (RLS) and examine the effects of treatment on CSP which, to our knowledge, have not been investigated till date.

Methods

A total of 25 patients with RLS and 25 healthy volunteers were studied. CSP latency and duration in the upper and lower extremities were examined in the two groups. In RLS patients, the variables were examined before and after pramipexole treatment.

Results

Lower-extremity CSP latency was longer (106.22 ± 11.69 ms vs. 91.67 ± 8.53 ms; p < 0.001) and CSP duration was shorter (35.50 ± 10.91 ms vs. 49.47 ± 6.43 ms; p < 0.001) in patients, compared with controls. In the patient group, CSP durations in the upper (40.88 ± 7.95 ms vs. 46.84 ± 10.22 ms; p = 0.006) and lower extremities (35.50 ± 10.91 ms vs. 44.91 ± 6.43 ms; p = 0.005) were prolonged after treatment, compared with pre-treatment values.

Conclusions

Small-fibre neuropathy may exist in RLS. In addition, we suggest that pramipexole may regulate cortical and spinal inhibitory mechanisms.

Significance

The use of CSP may aid in the diagnosis of RLS and may be used as a measure of treatment effectiveness.     

Reference intervals for platelet aggregation assessed by multiple electrode platelet aggregometry

Introduction

Analyses of platelet aggregation in hirudin whole blood using Multiplate® was validated. Reference intervals for the most commonly used agonists were established, and the association between platelet aggregation, age, gender and haematological values was analysed.

Material and methods

We included 121 healthy individuals to establish reference intervals and six healthy individuals for evaluation of the day-to-day variation. Platelet aggregation was evaluated on hirudin whole blood employing Multiplate® induced by arachidonic acid, ADP, collagen and ristocetin (RISTOlow and RISTOhigh). Measurements of haematological values were performed employing Sysmex K-4500.

Results

We found no association between platelet aggregation and age (p > 0.57 for all agonists, except RISTOlow: p = 0.05). Platelet aggregation was significantly higher in women compared to men for all agonists (p < 0.0003), except RISTOlow (p = 0.05). A reference interval is presented as 95% confidence interval suitable for any age and both sex. Day-to-day variation was < 11% for all agonists except for RISTOlow. No association was found between platelet aggregation and haematocrit or red blood cell count after adjusting for age and gender except for RISTOhigh. A positive significant association was found between platelet count and platelet aggregation (p < 0.04). Finally, a significant positive association was found between platelet aggregation and white blood cell count for all agonists (p < 0.05) except RISTOlow and RISTOhigh (p > 0.05).

Conclusion

Reference intervals for platelet aggregation in healthy individuals (age: 17 to 66 years) were established in hirudin whole blood measured by Multiplate® employing the most commonly used agonists.     

Neurological involvement in patients with falciparum malaria; frequency and prognostic value

Objective

The objective of this study was to evaluate the prognostic significance of neurological manifestations in falciparum malaria.

Methods

We analyzed adult patients with malaria admitted from 2001 to 2003, diagnosed by asexual forms of Plasmodium falciparum in peripheral blood films and identified cases of malaria with neurological involvement. A patient was classified as having neurological involvement if they reported or had one or more of the following symptoms; headache, altered mental status, seizures, neck rigidity, brisk reflexes, cranial neuropathy and hyper or hypotonia.

Results

A total of 454 patients were included in the study. Out of these, 123 (27%) were diagnosed as complicated (severe) malaria and 331 (73%) as uncomplicated malaria at admission. Overall 70 (15.4%) patients had evidence of neurological involvement at initial evaluation. Twenty-seven patients out of 123 (22%) with complicated malaria and 43 patients out of 331 (13%) with uncomplicated malaria had neurological involvement. Over all, 16 (4%) patients died, 13 (11%) had complicated malaria (n = 123) and 3 (1%) had uncomplicated malaria (n = 381). Mortality in patients having neurological involvement (n = 70) was 9 (13%) as compared to 7 (2%) in patients with malaria having no neurological involvement (n = 384). This difference was statistically significant (p = 0.012). Seizure was identified as predictor of mortality on Univariate analysis [OR 5.091 (1.835-14.121)].

Conclusion

Fifteen percent of patients with falciparum malaria admitted to our hospital had neurological symptoms and neurological involvement was associated with increased mortality.     

Validation par analyse factorielle du Big Five Inventory français (BFI-Fr). Analyse convergente avec le NEO-PI-R

Background

After five decades of research, an initial consensus on a general taxonomy of personality traits, the “Big Five” personality dimensions, is nowadays largely accepted. These dimensions do not represent a particular theoretical perspective but were derived from factor analyses of the natural-language terms people use to describe themselves and others. The Big Five Inventory (BFI) does not use single adjectives as items because such items are answered less consistently than when they are accompanied by definitions or elaboration. It uses 44 short phrases based on the trait adjectives known to be prototypical markers of the Big Five. The Big Five have been most typically labeled E (Extraversion, Energy, Enthusiasm), A (Agreeableness, Altruism, Affection), C (Conscientiousness, Constraint, Control of impulse), N (Neuroticism, Negative affectivity, Nervousness), and O (Openness, Originality, Open-mindedness). The BFI has been translated and validated in different languages. The development was done in such a way that they resembled as closely as possible the original English version, both in psychological meanings and psychometric properties.

Objectives

The goal of this paper is to present the validation process of the French BFI (BFI-Fr) on a large student sample to verify psychometric properties, including factor structure and internal reliability and to show that the scales possess the necessary convergent and discriminant validity with the NEO personality inventory, revised (NEO-PI-R).Study 1: Internal consistency and intercultural comparison.

Materials and method

Two thousand four hundred and ninety-nine students were included (women 69%; mean age 20.2 years old, S.D. = 2.21, between 15 and 46 years). The 45 items of the BFI-Fr were filled out anonymously by the students at the university.

Results and discussion

A factorial analysis using principal components was performed on the student answers (raw data) and resulted in a five-factor varimax-rotated solution that was easily verified as the expected five dimensions E, A, C, N, and O, which explained 42% of the total variance. Cronbach's alpha coefficients which measure the internal coherence were respectively: 0.82, 0.75, 0.80, 0.82, and 0.74. This factorial analysis represents a very good replication of the American BFI. The mean internal consistency (0.79) is excellent, providing clear evidence of the psychometric qualities of the tool (internal validity). Normality of the distribution factors was verified before comparing the scores of French students with those of American and Spanish students. Mean scores and standard deviations were very similar in the three countries. As in previous research, gender differences in personality were found: females had higher scores (p < 0.001) for N, A, and C.Study 2: convergent and discriminant validation with the NEO-PI-R.The goal of study 2 was to compare the BFI-Fr with the NEO-PI-R.

Materials and method

Three hundred and sixty students (women 55%, mean age 21.1 years, S.D. = 2.30, between 18.3 and 45.5) were included. In the same session, they completed both the BFI-Fr and the French NEO-PI-R.

Results and discussion

Internal consistencies of the five personality dimensions were comparable for the BFI and the NEO-PI-R. Correlations between the corresponding pairs were all high (mean = 0.74) and significant (p < 0.001). These results provide evidence of the convergent validity of the BFI-Fr. Discriminant validity was excellent, with correlations between the other scales much lower than the convergent correlations, averaging only 0.14.

General discussion and conclusion

All three studies demonstrate that the BFI-Fr is a valid, powerful yet very efficient tool, as are the original English version and the other translations. The much longer NEO-PI-R remains the instrument of choice. Psychiatrists, psychologists, and researchers can now make use of another inventory in French to measure the Big Five which has the advantages of being simple, robust, reliable, and economical (5 to 10 min to complete).     

Interictal alterations of cytokines and leukocytes in patients with active epilepsy

Background

Involvement of the innate immune system in the pathogenesis of epilepsies has been suggested but possible interactions between the immune system and human epilepsy remain unclear. We analyzed the interictal immuno-phenotype of leukocyte subsets and proinflammatory cytokine profiles in epileptic patients and correlated them with the epilepsy syndrome.

Methods

101 patients with active focal or generalized epilepsy were prospectively included and compared to 36 healthy controls. Immuno-phenotype of leukocyte subsets and cytokines IL-1β, IL-6 and tnfα were measured in peripheral blood. Multivariate analyses were performed to test group differences.

Results

As compared to controls, the patients showed an elevated percentage of monocytes (18.06 ± 7.08% vs. 12.68 ± 4.55%, p < 0.001), NK cells (14.88 ± 7.08% vs. 11.43 ± 5.41%, p = 0.019) and IL-6 concentration (3.33 ± 3.11 pg/ml vs. 1.5 ± 1.36 pg/ml, p = 0.002). This remained true when focal epilepsies or generalized epilepsies were compared separately to controls but only focal epilepsies showed additionally a decrease in B lymphocyts (8.16 ± 3.76% vs. 11.54 ± 4.2%, p < 0.001). Treatment with lamotrigine was associated with a higher percentage of B lymphocytes and valproate with an increased percentage of CD4⁺ T lymphocytes. Therapy with levetiracetam showed a trend towards decreased CD8⁺ T cell counts. No significant differences were seen between focal and generalized epilepsies and between temporal and extratemporal lobe epilepsies.

Conclusion

Patients with active epilepsy revealed interictal alterations of the immune system which varied among specific syndromes and were influenced by antiepileptic drug treatment.     

Evaluation of plasma urokinase-type plasminogen activator and urokinase-type plasminogen-activator receptor in patients with acute and chronic hepatitis B

Introduction

Urokinase-type plasminogen activator (uPA) and urokinase-type plasminogen activator receptor (uPAR) are known to be important factors in the pathogenesis of tumors and certain non-viral inflammatory diseases. However, their role in infectious virus diseases such as hepatitis B has been less well studied. This study aimed to test the hypothesis that the abnormalities of fibrinolysis and degradation of extracellular matrix mediated by uPA and uPAR are directly related to the inflammatory damage to liver cells caused by the hepatitis B virus. We therefore analyzed their role and clinicopathological significance in patients with acute or chronic hepatitis B.

Materials and methods

Eighty patients with acute or chronic hepatitis B, together with 30 healthy controls, were enrolled. uPA and uPAR in plasma were detected by commercial enzyme-linked immunosorbent assay (ELISA) kits.

Results

The levels of uPA and uPAR in patients with acute or chronic hepatitis B significantly exceeded those in healthy controls (p < 0.05). Patients with severe chronic hepatitis B had significantly higher levels of uPA and uPAR than those with moderate and mild chronic disease (p < 0.05) and those with acute hepatitis B (p < 0.05). Moreover, the plasma uPA and uPAR markedly increased in the acute stage (p < 0.05) and dramatically decreased in the remission stage (p < 0.05), but in all stages levels exceeded those in healthy subjects (p < 0.05). In addition, the concentration of plasma uPAR was positively correlated with prothrombin (PT) (r = 0.605, p < 0.01) and total bilirubin (TBIL) (r = 0.649, p < 0.01).

Conclusions

It is suggested that the plasma levels of uPA and uPAR are closely related to the degree and period of inflammation in patients with acute or chronic hepatitis B, and that uPA and uPAR might be important indicators for disease progression.     

Subjective awareness of tardive dyskinesia and insight in schizophrenia

Background

Lack of awareness of tardive dyskinesia (TD) and poor insight into mental illness are common in schizophrenia, raising the possibility that these phenomena are manifestations of a common underlying dysfunction.

Methods

We investigated relationships between low awareness of TD and poor insight into mental illness in 130 patients with schizophrenia and TD. We also examined selected demographic and clinical correlates of these two phenomena.

Results

Sixty-six (51%) patients had no or low awareness of TD and 94 (72%) had at least mild impairment of insight into their mental illness. Low awareness of TD was not significantly correlated with greater impairment of insight into mental illness. Regression analyses indicated that the Positive and Negative Syndrome Scale (PANSS) disorganised factor (β = 0.72, t = 11.88, p < 0.01) accounted for 52% of the variance in insight into mental illness (adjusted R² = 0.55) (F[2, 127] = 81.00, p < 0.01) and the Extrapyramidal Symptom Rating Scale (ESRS) dyskinesia subscale score (β = 0.47, t = 6.80, p < 0.01), PANSS disorganised factor (β = −0.26, t = −3.73, p < 0.01), and ESRS parkinsonism subscale score (β = 0.31, t = 4.55, p < 0.01) together accounted for 37% of the variance in awareness of TD (adjusted R² = 0.37) (F[3, 126] = 26.87, p < 0.01).

Conclusion

The two phenomena appear to be dissociated, and may be domain-specific.     

Efficacy and safety of pramipexole in chinese patients with restless legs syndrome: results from a multi-center, randomized, double-blind, placebo-controlled trial

Background

We performed a six-week study of pramipexole vs. a placebo in Chinese restless legs syndrome patients.

Methods

Overall, 305 enrolled patients were assigned randomly in a 2:1 ratio to the pramipexole group (N = 202) and the placebo group (N = 103).

Results

Of 287 patients in the full analysis set, the pramipexole group showed significant improvement compared with the placebo group in the change of their International Restless Legs Syndrome Study Group Rating Scale of Severity (IRLS) total score from baseline to week 6 after adjustment of centers and baseline characters (−15.87 ± 0.66 vs. −11.35 ± 0.92, p < 0.0001) and in the proportion of patients who were “much improved” and “very much improved” when measured by Clinical Global Impressions-Improvement (81.9% vs. 54.3%, p < 0.0001). At week 6, the IRLS responder rate was 73.8% (pramipexole) and 48.9% (placebo) (p < 0.0001) and the patient global impression responder rate was 68.6% (pramipexole) and 43.5% (placebo) (p < 0.0001). The proportion of adverse events was 62.9% in the pramipexole group and 43.7% in the placebo group, respectively. No deaths occurred.

Conclusion

Pramipexole was effective and well-tolerated in Chinese patients with restless legs syndrome.     

Evaluation of cerebral vasomotor reactivity in Parkinson's disease: is there any association with orthostatic hypotension?

Objective

Our aim was to look for a probable relationship between cerebral vasomotor reactivity (VMR) and orthostatic hypotension (OH) in Parkinson's disease (PD).

Materials and methods

This study was conducted on 44 patients with PD. Assessment of cerebral VMR was performed by means of transcranial Doppler (TCD) of middle cerebral artery (MCA) before and after a vasodilatory stimulus, carbon dioxide test. Moreover, orthostatic hypotension was evaluated.

Results

OH was presented in 12 (27.3%) Parkinson's patients. The average resting blood flow velocity (BFV) in the MCA was 30.20 (SD = 9.58) cm s⁻¹ which significantly increased to 46.25 (SD = 16.23) cm s⁻¹ after carbon dioxide test (P < 0.001). Impaired VMR was observed in 15 (34.1%) of the subjects, while it was not associated with the presence of OH (P = 0.770).

Conclusion

Evaluation of VMR in patients affected by PD, could assist in early diagnosis of cerebral autonomic dysfunction and prevent its serious consequences prior and more valid to OH.     

Fibrinogen and D-dimer analysis of chronic subdural hematomas and computed tomography findings: a prospective study

Objective

We investigated the relationship between fibrinolytic factors and computed tomography (CT) findings in patients with chronic subdural hematomas (CSDHs).

Methods

Thirty-one patients with CSDHs were divided on the basis of CT findings into heterogeneous and homogeneous groups. A sample from the subdural hematoma was obtained at surgery to measure the concentrations of fibrinogen and D-dimer.

Results

The mean level of fibrinogen in the heterogeneous group, including the layering (n = 4) and mixed (n = 10) type, was 88.2 ± 121.2 mg/dL, whereas in the homogeneous group, including high density (n = 2), isodensity (n = 9), and low density (n = 6) types, it was <25 mg/dL. The concentration of fibrinogen was significantly higher in the heterogeneous group than in the homogeneous group (p = 0.006). The mean level of D-dimer in the heterogeneous group was 35,407.9 ± 16,325.5 μg/L, whereas for the homogeneous group it was 1476.4 ± 2091.4 μg/L. The concentration of D-dimer was significantly higher in the heterogeneous group than in the homogeneous group (p < 0.001).

Conclusions

The layering and mixed types of CSDH exhibited higher concentrations of fibrinogen and D-dimer in subdural hematoma than the homogeneous types. These fibrinolytic factors appear to be associated with evolution in CSDHs with heterogeneous density.     

Long-term outcome following Intensive Residential Treatment of Obsessive-Compulsive Disorder

Background

IRT has been demonstrated as an effective treatment for severe, refractory OCD.

Methods

Consecutive IRT subjects were ascertained over a 12 month period (female N = 26, male N = 35). Psychometric measures were completed at admission and discharge from the McLean/MGH OCD Institute IRT, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) and the Work and Social Adjustment Scale (WSA)(N = 61). These measures were repeated at one (N = 57), three (N = 42) and six months (N = 36) following discharge. This study was IRB approved.

Results

OCD mean severity did not significantly worsen from discharge to the one (17.4, SD 6.5), three (16.5, SD 7.4) or six month (16.2, SD 7.3) follow-up (p > 0.25). Furthermore, the significant improvement from admission was maintained at each of the one (17.4, SD 6.5), three (16.5, SD 7.4) and six month (16.2, SD SD 7.3) follow-up time points (p < 0.001). Relapsers were significantly more likely to be living alone following discharge (p = 0.01), and were less likely to have comorbid illnesses (p = 0.02). There were no significant differences found between study dropouts and completers with regards to YBOCS scores (P > 0.47).

Conclusion

In the first OCD IRT long-term follow-up study to date, findings have indicated that mean treatment gains were maintained at one, three, and six months post-discharge. This finding is important as it suggests that improvements of OCD severity were subsequently retained in home and work environments. Improvement of depression severity from admission was also maintained.     

V-RISK-10: Validation of a screen for risk of violence after discharge from acute psychiatry

Background

Current violence risk assessment instruments are time-consuming and mainly developed for forensic psychiatry. A paucity of violence screens for acute psychiatry instigated the development and validation of the V-RISK-10. The aim of this prospective naturalistic study was to test the predictive validity of the V-RISK-10 as a screen of violence risk after discharge from two acute psychiatric wards.

Methods

Patients were screened with V-RISK-10 before discharge, and incidents of violence were recorded 3, 6, 9 and 12 months after discharge. A total of 381 of the 1017 patients that were screened completed the follow up.

Results

The ROC-AUC values for any violent behaviour were 0.80 and 0.75 (p < 0.001) for the 3 and 12 months follow-up periods, respectively, and significant for both genders. The most accurate risk estimates were obtained for severe violence. For persons without a known history of violence prior to the screening, AUCs were 0.74 (p = 0.004) and 0.68 (p = 0.002).

Conclusions

Results indicate that the V-RISK-10 is a valid and clinically useful screen for violence risk after discharge from acute psychiatry, and even significant for patients without a known previous history of violence.     

Evaluation of a Post-operative Thrombin Inhibitor Replacement Protocol to reduce Haemorrhagic and Thrombotic Complications after Paediatric Liver Transplantation

Introduction

Bleeding and thrombotic complications contribute to morbidity and mortality following paediatric orthotopic liver transplantation (OLT). However, the pathophysiology of haemostasis during paediatric OLT is not well understood. This report consists of two complimentary studies examining the frequency of haemostatic complications before and after the introduction of a post-operative thrombin inhibitor replacement therapy protocol at a single institution.

Materials and Methods

A retrospective study of 40 patients who underwent 43 liver transplants between July 1992 and July 2002, identified bleeding to be the most frequent complication associated with OLT (30%), however thrombotic complications were also common (12.5%). In 2003, following a detailed analysis of haemostatic profiles of children undergoing OLT, a thrombin inhibitor replacement protocol was introduced. A prospective clinical outcome audit was undertaken from April 2003 to September 2008 to determine the effect of the new protocol on haemostasis.

Results

Commencement of the thrombin inhibitor replacement protocol significantly reduced the incidence of thrombosis (from 5 to 1, p < 0.05), graft loss (from 4 to none, p < 0.05), mortality due to thrombosis or bleeding (from 3 to none, p < 0.05) and was associated with a 50% reduction in frequency of major bleeding.

Conclusion

In conclusion, the introduction of a post-operative thrombin inhibitor replacement therapy protocol following paediatric OLT significantly improved haemostasis-related morbidity and mortality outcomes in children.