Subtypes of learning and memory on the California Verbal Learning Test-Second Edition (CVLT-II) in the standardization sample

The purpose of this study was to determine representative, core profile subtypes of learning and memory, based on four variables representing different latent constructs, in the standardization sample of the California Verbal Learning Test-Second Edition (CVLT-II; Delis, Kramer, Kaplan, & Ober, 2000). Two-stage cluster analysis identified six reliable subtypes. Variability in both level and pattern of performance contributed to the differentiation of these subtypes. Level of education was meaningfully related to variability in overall performance of the subtypes. Implications for the interpretation of CVLT-II findings obtained in clinical practice are discussed.     

Do postnatal glucocorticoids and retinopathy of prematurity relate?

To study a possible relation between the use of postnatal glucocorticoids and the incidence and severity of retinopathy of prematurity (ROP), we conducted a retrospective study over a 4-year period that compared data of 161 preterm infants treated with hydrocortisone for bronchopulmonary dysplasia (BPD) with the data of 253 controls. The incidence of overall ROP was 62.7% in the hydrocortisone group and 21.3% in the control group. The incidence of severe ROP (stages 3-5) was 5% in the treatment group and 0.4% in the control group. Using logistic regression, postnatal hydrocortisone therapy was not associated with an increased risk for ROP or severe ROP (OR 1.387, 95% confidence interval 0.773-2.489, p = 0.272 and OR 4.112, 95% C.I. 0.44-38.37, p = 0.16, respectively). Also, in a subgroup of extremely low-birth-weight infants (<1000 g), postnatal hydrocortisone had no influence on the incidence of (severe) ROP. In the infants with ROP (n = 155), only prolonged use of postnatal hydrocortisone was associated with an increased risk for severe ROP (OR 1.02, 95% C.I. 1.00-1.03, p = 0.03). In this study postnatal use of hydrocortisone was not associated with an increased risk for (severe) ROP. However, in infants already suffering from ROP, prolonged treatment with hydrocortisone concurred with an increased risk for severe ROP.     

Lower genital tract infections in diabetic women

The influence of glucose metabolism is seen in many infectious diseases, making diabetic patients more vulnerable to sepsis and other serious sequelae of bacterial invasion. Vaginal candidiasis is a common problem if the glycemia is poorly controlled. The level of glucose concentration in the blood after ingestion of sugar seems to explain an increased likelihood of recurrent infection. Specific immune aberrations, such as an elevated T-helper 2 response and a blunted T-helper 1 response, leading to tolerance, may result in chronic recurrent vulvovaginal candidiasis. In such patients, a low-grade infection with frequent exacerbations is seen, and treatment should be based on 24-hour glycemic control and long intermittent treatment with antifungals. Besides candidiasis, there is also evidence of an increased likelihood of cystitis. Upper urinary tract infections (UTIs) are also a frequent result of bladder colonization. Lethal emphysematous nephritis due to Candida albicans or gas-forming bacteria such as Escherichia coli, Klebsiella, Proteus, streptococci, or enterococci are known to occur in diabetic patients. Furthermore, UTIs in diabetic patients are difficult to eradicate and need longer and intense antibiotic therapy. Awareness of the increased likelihood of UTIs, frequent screening, and prolonged treatment in case of cystitis are warranted. For the prevention of UTI and bacterial vaginal infections (bacterial vaginosis, vaginal atrophy with bacterial colonization, aerobic vaginitis) estrogen therapy may be as important as antibiotic therapy. Catheterization should be limited since it promotes infection more in diabetic patients than in nondiabetic patients. In the case of recurrent vaginal candidiasis, tight control of glycemia is crucial, in addition to prolonged, intermittent therapy with antifungals.     

Blastomycosis in a young African man presenting with a pleural effusion

Blastomyces dermatitidis is a dimorphic fungus endemic to northwestern Ontario, Manitoba and some parts of the United States. The fungus is also endemic to parts of Africa. Pulmonary and extrapulmonary findings of a 24-year-old African man who presented with weight loss, dry cough and chronic pneumonia not resolving with antibiotic treatment are presented. The unusual occurrence of pulmonary blastomycosis associated with skin lesions and a moderate pleural effusion is reported.     

Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients

Objective

The heterogeneity of cognitive–behavioral patterns in patients with fibromyalgia (FM) has been proposed to underlie the variability in treatment outcomes. It has previously been shown that pain‐avoidance and pain‐persistence treatments tailored to the patient's pattern are effective in improving physical and psychological functioning and overall impact in high‐risk patients with heigthened psychological distress. In the present study, the cognitive–behavioral effects of these treatments were evaluated to provide insight into the main proposed mechanisms, specifically pain‐avoidance behaviors and activity pacing in the pain‐avoidance and pain‐persistence treatments, respectively.

Methods

High‐risk FM patients were classified into 2 groups, pain avoidance and pain persistence, and randomized in groups to the relevant treatment or waiting‐list control condition. The pain‐avoidance and pain‐persistence treatments both comprised 16 twice‐weekly sessions of cognitive–behavioral therapy and exercise training. Cognitive–behavioral factors assessed at pre‐ and posttreatment and 6 months of followup were evaluated using linear mixed models.

Results

A significant treatment effect was found for pain‐avoidance behavior in the pain‐avoidance treatment and for activity pacing in the pain‐persistence treatment, showing improvements in the treatment condition relative to the controls. Furthermore, the effect on functioning was mediated by changes in pain‐avoidance behavior in the pain‐avoidance treatment and by changes in activity pacing in the pain‐persistence treatment. Both treatments also showed significant improvements in other relevant cognitive–behavioral factors.

Conclusion

Both the pain‐avoidance and pain‐persistence treatments are effective in improving cognitive–behavioral factors in high‐risk FM patients. Pain‐avoidance behavior and activity pacing might be important mediating mechanisms for beneficial outcomes in pain‐avoidance and pain‐persistence treatments, respectively.     

A selective cyclooxygenase 2 inhibitor suppresses the growth of H-ras-transformed rat intestinal epithelial cells

BACKGROUND & AIMS: Constitutive expression of cyclooxygenase 2 (COX-2) has been found in 85% of colorectal cancers. Ras mutations are found in 50% of colorectal adenocarcinomas. The aim of this study was to determine the role of COX-2 in ras-induced transformation in rat intestinal epithelial (RIE) cells. METHODS: Cell growth was determined by cell counts. The expression of COX-2 was examined by Northern and Western analyses. For tumorigenicity assays, cells were inoculated into dorsal subcutaneous tissue of athymic nude mice. DNA-fragmentation assays were performed to detect apoptosis. RESULTS: The expression of COX-2 was increased in RIE-Ras cells at both messenger RNA (9-fold) and protein (12-fold) levels. Prostaglandin I2 levels were elevated 2.15-fold in RIE-Ras cells. Serum deprivation further increased COX-2 expression 3.8-fold in RIE-Ras cells. Treatment with a selective COX-2 antagonist (SC58125) inhibited the growth of RIE-Ras cells through inhibition of cell proliferation and by induction of apoptosis. SC-58125 treatment reduced the colony formation in Matrigel by 83.0%. Intraperitoneal administration of SC-58125 suppressed RIE-Ras tumor growth in nude mice by 60.3% in 4 weeks. SC-58125 treatment also induced apoptosis in RIE-Ras cells as indicated by increased DNA fragmentation. CONCLUSIONS: Overexpression of COX-2 may contribute to tumorigenicity of ras-transformed intestinal epithelial cells. Selective inhibition of COX-2 activity inhibits growth of ras-transformed intestinal epithelial cells and induces apoptosis. (Gastroenterology 1997 Dec;113(6):1883-91)     

Prostaglandin E2 potentiates platelet aggregation by priming protein kinase C

Prostaglandin E2 (PGE2) is produced by activated platelets and by several other cells, including capillary endothelial cells. PGE2 exerts a dual effect on platelet aggregation: inhibitory, at high, supraphysiologic concentrations, and potentiating, at low concentrations. No information exists on the biochemical mechanisms through which PGE2 exerts its proaggregatory effect on human platelets. We have evaluated the activity of PGE2 on human platelets and have analyzed the second messenger pathways involved. PGE2 (5 to 500 nmol/L) significantly enhanced aggregation induced by subthreshold concentrations of U46619, thrombin, adenosine diphosphate (ADP), and phorbol 12-myristate 13-acetate (PMA) without simultaneously increasing calcium transients. At a high concentration (50 mumol/L), PGE2 inhibited both aggregation and calcium movements. PGE2 (5 to 500 nmol/L) significantly enhanced secretion of beta-thromboglobulin (beta TG) and adenosine triphosphate from U46619- and ADP-stimulated platelets, but it did not affect platelet shape change. PGE2 also increased the binding of radiolabeled fibrinogen to the platelet surface and increased the phosphorylation of the 47-kD protein in 32P- labeled platelets stimulated with subthreshold doses of U46619. Finally, the amplification of U46619-induced aggregation by PGE2 (500 nmol/L) was abolished by four different protein kinase C (PKC) inhibitors (calphostin C, staurosporine, H7, and TMB8). Our results suggest that PGE2 exerts its facilitating activity on agonist-induced platelet activation by priming PKC to activation by other agonists. PGE2 potentiates platelet activation at concentrations produced by activated platelets and may thus be of pathophysiologic relevance.     

Fibrinolysis factors and lipid composition of the blood in treated and untreated hypertensive patients.

The correlations between the cardiovascular risk factors hypertension, overweight, hyperlipidemia and fibrinolysis parameters were studied in a group of 54 otherwise healthy patients (age 19 to 70 years) with essential hypertension of moderate severity. Of the 54 patients 43 were treated with antihypertensive drugs and eleven were not. The patients included in this study who were treated with antihypertensive drugs were, in spite of their treatment, still hypertensive. Lipoprotein levels and fibrinolysis parameters did not differ between the untreated and treated patients. In the patient group we found significant incidence of hypertriglyceridemia (46%) elevated LDL-cholesterol (28%) and elevated lipoprotein (a) levels (43%). In comparison with a healthy control group the hypertensive patient group showed a decreased median tissue plasminogen activator activity (interquartile range): 0.23 (0.79) IU.10(3)/l vs 1.5 (0.47) IU.10(3)/l in the controls (p less than 0.0001), an increased tissue plasminogen activator antigen concentration: 8.2 (4.5) micrograms/l vs 5.1 (3.9) micrograms/l in the controls (p less than 0.0001), an elevated plasminogen activator inhibitor-1 level: 2.8 (2.5) AU.10(3)/l vs 1.1 (2.0) AU.10(3)/l in the controls (p less than 0.01) and a slightly increased alpha 2-antiplasmin concentration: 110 (8)% vs 98 (16)% in the controls (p less than 0.0001). Median D-dimer concentration levels were substantially increased in the hypertensive patients: 315 (263) micrograms/l vs 199 (146) micrograms/l in the controls (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Discrepancies between the California Verbal Learning Test: Children's Version and the Children's Category Test after pediatric traumatic brain injury.

One hundred 9-16-year-old children with traumatic brain injury (TBI) completed the California Verbal Learning Test-Children's Version (CVLT-C) and the Children's Category Test (CCT) within 1 year after injury. Performance contrasts between these two instruments that were unusually large (> 16 T score points) were about as common in this clinical sample as in the standardization sample of both instruments. However, relatively poor performance on the CVLT-C as compared to the CCT was associated with prolonged coma and lower scores on the Processing Speed index of the Wechsler Intelligence Scale for Children-Third Edition. It is concluded that a relative weakness on the CVLT-C is more likely to reflect cerebral compromise after pediatric TBI than is a relative weakness on the CCT.