Admission inflammatory markers and isolation of a causative organism in patients with spontaneous spinal infection

Introduction

The purpose of this study was to investigate the significance of the inflammatory markers on admission in the isolation of a causative pathogen in patients with spinal infection. Spinal infection is treated frequently at spinal units and can encompass a broad range of clinical entities. Its diagnosis is often delayed because of the difficulty of identifying the responsible pathogen.

Methods

Patients with spinal infection treated in our institution over a period of eight years were identified and their notes studied retrospectively. Admission C-reactive protein (CRP), white cell count (WCC) as well as co-morbidities and mode of pathogen identification were recorded. Overall, 96 patients were included in the study.

Results

The CRP levels on admission were correlated significantly with the overall potential for isolation of a pathogen (p<0.0001) and positive biopsy cultures (p=0.0016). Admission WCC levels were associated significantly with the overall potential for isolation of a pathogen (p=0.0003) and positive biopsy cultures (p=0.0023). Both CRP and WCC levels were significantly negatively correlated with the duration of the preceding symptoms (p=0.0003 and p<0.0001 respectively). Delay in presentation was significantly negatively correlated with organism isolation (p=0.0001). Multivariate analyses identified the delay in presentation as the strongest independent variable for organism isolation (p=0.014) in cases of spontaneous spinal infection when compared with the admission CRP level (p=0.031) and WCC (p=0.056).

Conclusions

In spontaneous spinal infection, delay in presentation is the strongest independent variable for organism isolation. High inflammatory marker levels on admission are a useful prognostic marker for the overall potential of isolating a causative organism either by blood cultures or by biopsy in patients with negative blood cultures. Furthermore, the admission inflammatory marker levels allow for treating surgeons to counsel their patients of the likelihood of achieving a positive microbiological yield from biopsy.     

Effects of training in short-term psychodynamic psychotherapy: changes in graduate clinician technique

Abstract

This study investigates the effects of graduate clinician training in short-term psychodynamic psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) on the acquisition of techniques within and across two training cases. Sessions 3 and 9 from the first and second treatment cases of 15 graduate clinicians receiving structured training in STPP were examined for the frequency of psychodynamic–interpersonal (PI) therapeutic techniques. Results demonstrated that structured training in STPP led to a significantly increased use of PI therapeutic techniques both within and across cases. The authors also examined the frequency of cognitive–behavioral (CB) therapeutic techniques used by the graduate clinicians. No changes in the number of CB interventions were observed over the same set of sessions. Practical implications for the use of structured clinical training and issues pertinent to supervision in graduate education are reviewed. Finally, the impact of structured training on graduate clinicians’ ability to form positive collaborative relationships with their patients is also discussed.

Zusammenfassung

Die Effekte von Training in psychodynamischer Kurzzeittherapie: Veränderungen in der Technik bei graduierten klinischen Studenten

Diese Studie untersucht die Effekte von Training auf das Aneignen von Techniken in psychodynamischer Kurzzeittherapie innerhalb und über 2 Trainingsfälle hinweg bei graduierten klinischen Studenten. Die dritte und 9. Sitzung des ersten und 2. Trainingsfalls von 15 graduierten Klinikern, die ein strukturiertes Training für psychodynamische Kurzzeittherapie durchliefen, wurden auf die Häufigkeit psychodynamischer individueller therapeutisccher Techniken hin untersucht. Die Ergebnisse zeigten, dass eine strukturiertes Training in psychodynamischer Kurzzeittherapie zu einem signifikant häufigeren Einsatz von psychodynamisch interpersonellen therapeutischen Techniken, sowohl innerhalb eines Trainingsfalles als auch über beide Fälle hinweg, führt. Die Autoren haben auch die Häufigkeit von kognitiv-verhaltensmässigen Techniken der Auszubildenden untersucht. Hierbei gab es für die untersuchten Sitzungen keine Veränderung in den Häufigkeiten. Praktische Implikationen zur Verwendung des strukturierten klinischen Trainings und Themen, die für die Supervision der Ausbildung in der zweiten Phase relevant sind, werden durchgenommen. Schließlich wird auch der Einfluß des strukturierten Trainings auf die Fähigkeit der Auszubildenden, positive Beziehungen in der Zusammenarbeit mit ihren Patienten zu bilden, diskutiert.

Résumé

Les effets de la formation dans la psychothérapie psychodynamique brève?: changements dans la technique chez le clinicien postgradué

Cette étude investigue les effets de la formation des cliniciens postgradués en psychothérapie psychodynamique brève?(STPP?; Book, 1998?; Luborsky, 1984?; Strupp & Binder, 1984?; Wachtel, 1993) sur l'acquisition de techniques dans et entre deux cas de formation. Les séances 3 et 9 du premier et deuxième cas de formation de 15 cliniciens postgradués recevant de la formation structurée en STPP étaient examinés en fonction de la fréquence des techniques thérapeutiques psychodynamiques – interpersonnelles (PI). Les résultats ont démontré que la formation structurée en STPP a entraîné un emploi augmenté de façon significative de techniques thérapeutiques PI aussi bien dans qu'entre les cas. Les auteurs ont examiné également la fréquence de techniques thérapeutiques cognitives-comportementales (CB) utilisées par les cliniciens postgradués. Aucun changement du nombre d'interventions CB n'a été observé dans le même ensemble de séances. Des implications pratiques pour l'application d'une formation clinique structurée et des sujets en lien avec la supervision dans l’éducation postgraduée sont revues. Finalement, l'impact d'une formation structurée sur la capacité du clinicien postgradué à former des relations de collaboration positive avec leurs patients est également discuté.

Resumen

Efectos de la supervisión en psicoterapia psicodinámica breve: cambios en la técnica clínica del graduado

Este estudio investiga los efectos de la supervisión clínica del graduado en psicoterapia psicodinámica breve (STPP; Libro, 1998, Luborsky, 1984, Strupp /& Binder, 1984, Wachtel, 1993) sobre la adquisición de técnicas dentro y a través de dos casos de supervisión. Se estudiaron las 3ra. y 9na. sesiones del primero y segundo casos de supervisión de quince clínicos graduados que recibieron supervisión en STPP, para ver la frecuencia de las técnicas terapéuticas psicodinámicas-interpersonales (PI). Los resultados demostraron que la supervisión estructurada en STPP condujo a un aumento significativo del uso de técnicas terapéuticas PI tanto dentro como a través de los casos. Los autores también estudiaron la frecuencia de técnicas terapéuticas cognitivo-comportamentales (CB) usadas por los clínicos graduados. No se observaron cambios en el número de intervenciones CB en el mismo conjunto de sesiones. Se pasó revista a las implicaciones prácticas del uso de la supervisión clínica estructurada y a cuestiones pertinentes a la supervisión en la educación de los graduados. Finalmente, también se debate sobre el impacto que puede tener la supervisión estructurada sobre la capacidad de los clínicos graduados para formar relaciones colaboradoras positivas con sus pacientes.

Resumo

Efeitos do treino em psicotetrapia psicodinâmica breve: Mudanças nas técnicas de estudantes

Este estudo examina os efeitos do treino clínico de estudantes graduados em psicoterapia psicodinâmica breve (PPB; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) em termos de aquisições das técnicas durante e entre dois casos de treino. Foi analisada a frequência de técnicas terapêuticas de psicoterapia interpessoal (PI), nas sessões 3 e 9 do primeiro e do segundo caso de treino de 15 estudantes graduados que estavam recebendo formação estruturada em PPB. Os resultados demonstraram que o treino estruturado em PPB conduzia a um aumento significativo no uso de técnicas terapêuticas de PI durante e entre os casos. Os autores analisaram também a frequência das técnicas terapêuticas cognitivo-comportamentais (CC) utilizadas pelos estudantes. Não se verificaram mudanças no número de intervenções CC durante o mesmo conjunto de sessões. São revistas as implicações práticas para a utilização de treino clínico estruturado e aspectos pertinentes para a supervisão de estudantes graduados. Finalmente, será também discutido o impacto do treino estruturado sobre as capacidades dos estudantes para estabelecerem relações terapêuticas positivas com os seus pacientes.

     

Genomic insights into abdominal aortic aneurysms

Introduction

An individual’s genetic background plays a significant role in his or her chances of developing an abdominal aortic aneurysm (AAA). This risk is likely to be due to a combination of multiple small effect genetic factors acting together, resulting in considerable difficulty in the identification of these factors.

Methods

Methods for the identification of genetic factors associated with disease are usually based on the analysis of genetic variants in case-control studies. Over the last decade, owing to advances in bioinformatics and laboratory technology, these studies have progressed from focusing on the examination of a single genetic variant in each study to the examination of many millions of variants in a single experiment. We have conducted a series of such experiments using these methods.

Results

Our original methods using candidate gene approaches led to the initial identification of a genetic variant in the interleukin-10 gene associated with AAA. However, further studies failed to confirm this association and highlighted the necessity for adequately powered studies to be conducted, as well as the need for confirmatory studies to be performed, prior to the acceptance of a variant as a risk for disease. The subsequent application of genomic techniques to our sample set, in a global collaboration, has led to the identification of three robustly verified risk loci for AAA in the LRP1, LDLR and SORT1 genes.

Conclusions

Genomic studies of AAA have led to the identification of new pathways involved in the pathogenesis of AAA. The exploration of these pathways has the potential to unlock new avenues for therapeutic intervention to prevent the development and progression of AAA.     

Neuropeptide Y Attenuates Stress‐Induced Bone Loss Through Suppression of Noradrenaline Circuits

Chronic stress and depression have adverse consequences on many organ systems, including the skeleton, but the mechanisms underlying stress‐induced bone loss remain unclear. Here we demonstrate that neuropeptide Y (NPY), centrally and peripherally, plays a critical role in protecting against stress‐induced bone loss. Mice lacking the anxiolytic factor NPY exhibit more anxious behavior and elevated corticosterone levels. Additionally, following a 6‐week restraint, or cold‐stress protocol, Npy‐null mice exhibit three‐fold greater bone loss compared to wild‐type mice, owing to suppression of osteoblast activity. This stress‐protective NPY pathway acts specifically through Y2 receptors. Centrally, Y2 receptors suppress corticotropin‐releasing factor expression and inhibit activation of noradrenergic neurons in the paraventricular nucleus. In the periphery, they act to control noradrenaline release from sympathetic neurons. Specific deletion of arcuate Y2 receptors recapitulates the Npy‐null stress response, coincident with elevated serum noradrenaline. Importantly, specific reintroduction of NPY solely in noradrenergic neurons of otherwise Npy‐null mice blocks the increase in circulating noradrenaline and the stress‐induced bone loss. Thus, NPY protects against excessive stress‐induced bone loss, through Y2 receptor‐mediated modulation of central and peripheral noradrenergic neurons. © 2014 American Society for Bone and Mineral Research.     

A taxonomy of rorschach autisms with implications for differential diagnosis among thinking-disordered patients

A tripartite taxonomy of perceptual-cognitive errors on the Rorschach, abbreviated TRAUT, was reviewed. TRAUT classifies “autisms” as stemming from either an arrant disregard for the blot shapes (HYPO), an inordinate attention to unusual blot areas (HYPER), or an endorsement of counter-factual relationships among blot areas (RELER) included among Exner's Unusual Verbalizations. The scoring of HYPOs and HYPERs and the frequency of their occurrence among thought-disordered groups were determined by examining Rorschachs of inpatient schizophrenics, outpatient schizophrenics, borderline personality disorders, and Cluster A personality disorders. Because HYPOs and HYPERs yielded better differential diagnoses than RELERs among these four groups, it was suggested that such percepts should be scored routinely as a screen for thought disorder.     

Fludarabine: a new agent with major activity against chronic lymphocytic leukemia

Fludarabine was used to treat 68 patients with previously treated chronic lymphocytic leukemia (CLL). Nine (13%) patients achieved a complete remission and 30 (44%) a partial remission. The response rates for Rai stages 0 to 2, 3, and 4 were 64%, 58%, and 50% respectively. Seventeen (43%) of the 40 Rai stage 1 to 3 patients and four (19%) of the Rai stage 4 patients returned to Rai stage 0. Survival was strongly correlated with the final Rai stage achieved. The survival of the 11 partial responders with residual disease consisting only of residual bone-marrow nodules was similar to the complete responders (36+ months) and superior to the other partial response patients (16 months). The response to fludarabine was rapid, with 36 (92%) of the 39 responders having achieved at least a partial response following the first three courses. Complete responses occurred in the blood, liver, spleen, and lymph nodes in 48% to 69% of the patients. Eradication of all disease in the bone marrow occurred in only 13% of the cases. Neutropenia and thrombocytopenia occurred in 56% and 25% of evaluable courses. Major infections occurred in 9% of evaluable courses and fevers of unknown origin or minor infections in 12% of courses respectively. Myelosuppression and infection were more common in patients with initial Rai stages 3 and 4 and in nonresponding patients. Other toxicity was mild. No CNS toxicity was noted.