Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study

Background: Accumulating evidence suggests that experiences of trauma and victimization during childhood are associated with an increased risk to develop clinical and subclinical psychosis in adulthood. A recent cross‐sectional study showed a significant association between trauma and psychotic experiences in adolescents. The current study aimed to extend these findings by investigating the longitudinal effects of negative life experiences on the risk for subclinical psychotic symptoms 2 years later in an adolescent general community sample. Methods: Data were derived from the standard health screenings of the Youth Health Care Divisions of the Public Health Services, in the South of the Netherlands. A total of 1129 adolescents filled out a self‐report questionnaire at age 13/14 years and 2 years later (15/16 years), assessing psychotic experiences, as well as experiences of being bullied, sexual trauma, and negative life events. Results: Logistic regression analyses revealed that sexual trauma increased the risk for psychotic symptoms 2 years later. Life events contributed to the risk for psychosis over time and psychosis in turn gave rise to new life events. No significant association with bullying was found after controlling for confounders. Conclusion: The results provide further evidence for an association between childhood environment and psychosis in the crucial developmental period of early adolescence. Early and later psychological stress, if severe, may impact on the risk for psychosis in adolescence through mechanisms of person–environment interaction and correlation.     

High‐resolution maps of magnetization transfer with inherent correction for RF inhomogeneity and T1 relaxation obtained from 3D FLASH MRI

An empirical equation for the magnetization transfer (MT) FLASH signal is derived by analogy to dual‐excitation FLASH, introducing a novel semiquantitative parameter for MT, the percentage saturation imposed by one MT pulse during TR. This parameter is obtained by a linear transformation of the inverse signal, using two reference experiments of proton density and T₁ weighting. The influence of sequence parameters on the MT saturation was studied. An 8.5‐min protocol for brain imaging at 3 T was based on nonselective sagittal 3D‐FLASH at 1.25 mm isotropic resolution using partial acquisition techniques (TR/TE/α = 25ms/4.9ms/5° or 11ms/4.9ms/15° for the T₁ reference). A 12.8 ms Gaussian MT pulse was applied 2.2 kHz off‐resonance with 540° flip angle. The MT saturation maps showed an excellent contrast in the brain due to clearly separated distributions for white and gray matter and cerebrospinal fluid. Within the limits of the approximation (excitation <15°, TR/T₁ ? 1) the MT term depends mainly on TR, the energy and offset of the MT pulse, but hardly on excitation and T₁ relaxation. It is inherently compensated for inhomogeneities of receive and transmit RF fields. The MT saturation appeared to be a sensitive parameter to depict MS lesions and alterations of normal‐appearing white matter. Magn Reson Med 60:1396–1407, 2008. © 2008 Wiley‐Liss, Inc.     

Mikrometastatische Zellen im Knochenmark von Patientinnen mit Mammakarzinom

Hintergrund. Der immunzytologische Nachweis disseminierter epithelialer Zellen im Knochenmark bei Patientinnen mit Mammakarzinom wird seit den frühen 80er Jahren in vielen Kliniken und Institutionen durchgeführt. Trotz zahlreicher Publikationen zum Thema ist es bis heute weder national noch international gelungen, die Methode zu standardisieren und den “idealen” Antik?rper zu etablieren.     

Sepsis—Current Aspects of Pathophysiology and Implications for Diagnosis and Management

Abstract Sepsis is characterized by disrupted inflammatory homeostasis due to infection. While a localized and controlled inflammatory reaction helps to eliminate and control infection, a dysregulated host response triggers multiple organ failure determining course and prognosis. Consequent surgical source control paralleled by adequate and early antibiotic therapy remains the cornerstone of care. Nevertheless, mortality remains as high as 50–60% for severe sepsis and septic shock. As the molecular mechanisms are becoming increasingly better defined, interventions aiming to interfere with the host response to infection have been undertaken, largely with disappointing results. Thus, many evidence-based recommendations suggest waiving of resource-consuming interventions, such as supplementation of antithrombin or immunoglobulins. Nevertheless, several seminal studies have indicated that meticulous supportive care according to pathophysiological principles, most notably early goal-directed therapy, low-dose hydrocortisone and activated protein C, can disrupt dysfunctional cascades favorably influencing the course of the disease. In parallel, there is increasing evidence from national and international surveys that therapy of severe sepsis on ICUs worldwide is generally in poor compliance with current guidelines, while personal perception of the physicians in charge would suggest high rates of adherence to evidence-based recommendations. Thus, strategies of change management, such as implementation of ‘sepsis bundles’, are warranted to achieve better standards of care toward the aim of the “surviving sepsis campaign”, i.e. a reduction of mortality rates by 25% within the next years.     

Effect of oxidized regenerated cellulose/collagen matrix on dermal and epidermal healing and growth factors in an acute wound

Rapid healing of acute wounds, e.g., in burned patients, can be essential for survival. Oxidized regenerated cellulose/collagen (ORC/collagen) has been shown to improve wound healing of chronic wounds. The aim of the present study was to determine the effect of ORC/collagen on dermal and epidermal healing as well as growth factor concentration in acute wounds. Rats received a full-thickness excision wound and were treated with either ORC/collagen plus a hydrocolloid dressing or a hydrocolloid dressing alone. Planimetry, immunological assays, histological and immunohistochemical techniques were used to determine dermal and epidermal regeneration, protein concentration, and growth factor concentration. In addition, dermal vascularization and structure were determined. Wounds treated with ORC/collagen showed a significantly faster reepithelization than those treated with hydrocolloid alone, p < 0.05. This accelerated wound healing rate may be explained by significantly higher levels of platelet-derived growth factor, keratinocyte growth factor, insulin-like growth factor-I, and insulin-like growth factor binding protein-3 in the ORC/collagen group leading to antiapoptotic effects of skin cells, p < 0.05. There were no significant differences in collagen morphology or deposition, neo-angiogenesis, or vascular endothelial growth factor concentration between both treatment groups. We conclude that ORC/collagen matrix accelerates epidermal regeneration and locally increases growth factor concentrations. Increased reepithelization was associated with decreased skin cell apoptosis. Based on our data we hypothesize that the ORC/collagen matrix may also have beneficial effects on acute wounds in a clinical setting.     

Modular Uncemented Tricompartmental Total Knee Arthroplasty A Comparison between Posttraumatic and Nonposttraumatic Osteoarthrosis

Background:   

The incidence of posttraumatic osteoarthrosis, especially in younger patients, increases. In different studies total knee arthroplasty (TKA) is only indicated in 0–12% of cases of posttraumatic osteoarthrosis, because most authors feel that the indication for TKA in younger patients should be narrowly restricted. The most common indications for TKA include primary idiopathic osteoarthrosis and rheumatoid arthritis predominantly in patients > 60 years.     

In Vivo Uptake and Elimination of Isoflurane by Different Membrane Oxygenators during Cardiopulmonary Bypass

Background: Volatile anesthetics are frequently used during cardiopulmonary bypass (CPB) to maintain anesthesia. Uptake and elimination of the volatile agent are dependent on the composition of the oxygenator. This study was designed to evaluate whether the in vivo uptake and elimination of isoflurane differs between microporous membrane oxygenators containing a conventional polypropylene (PPL) membrane and oxygenators with a new poly-(4-methyl-1-pentene) (PMP) membrane measuring isoflurane concentrations in blood.

Methods: Twenty-four patients undergoing elective coronary bypass surgery with the aid of CPB were randomly allocated to one of four groups, using either one of two different PPL-membrane oxygenators for CPB or one of two different PMP-membrane oxygenators. During hypothermic CPB, 1% isoflurane in an oxygen-air mixture was added to the oxygenator gas inflow line (gas flow, 3 l/min) for 15 min. Isoflurane concentration was measured in blood and in exhaust gas at the outflow port of the oxygenator. Between-group comparisons were performed for the area under the curve (AUC) during uptake and elimination of the isoflurane blood concentrations, the maximum isoflurane blood concentration (Cmax), and the exhausted isoflurane concentration (FE).

Results: The uptake of isoflurane, expressed as AUC of isoflurane blood concentration and a function of FE, was significantly reduced in PMP oxygenators compared to PPL oxygenators (P < 0.01). Cmax was between 8.5 and 13 times lower in the PMP-membrane oxygenator groups compared to the conventional PPL-membrane oxygenator groups (P < 0.01).