Autobiographical integration of trauma memories and repressive coping predict post‐traumatic stress symptoms in undergraduate students

What differentiates those who are able to adapt well to adverse life events (i.e., persons who are resilient) from those who are not (e.g., persons who develop post‐traumatic stress symptoms)? Previous work suggests that enhanced autobiographical integration of trauma memories is associated with more severe post‐traumatic stress symptoms. Extending this line of work, the present study looked at whether the integration of trauma memories, repressive coping and cognitive reactivity are related to post‐traumatic stress symptomatology following negative life events among otherwise healthy young adults (N = 213). Results show that while enhanced integration of trauma memories and high levels of dissociation are related to elevated levels of post‐traumatic stress, people who generally engage in repressive coping report fewer post‐traumatic stress symptoms. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Enhanced integration of trauma memories is linked to increased post‐traumatic stress. ? High levels of trait dissociation are related to elevated levels of post‐traumatic stress symptomatology. ? A repressive coping style is associated with fewer post‐traumatic stress symptoms.     

Transthyretin protects Alzheimer's mice from the behavioral and biochemical effects of Abeta toxicity

Cells that have evolved to produce large quantities of secreted proteins to serve the integrated functions of complex multicellular organisms are equipped to compensate for protein misfolding. Hepatocytes and plasma cells have well developed chaperone and proteasome systems to ensure that secreted proteins transit the cell efficiently. The number of neurodegenerative disorders associated with protein misfolding suggests that neurons are particularly sensitive to the pathogenic effects of aggregates of misfolded molecules because those systems are less well developed in this lineage. Aggregates of the amyloidogenic (Abeta(1-42)) peptide play a major role in the pathogenesis of Alzheimer's disease (AD), although the precise mechanism is unclear. In genetic studies examining protein-protein interactions that could constitute native mechanisms of neuroprotection in vivo, overexpression of a WT human transthyretin (TTR) transgene was ameliorative in the APP23 transgenic murine model of human AD. Targeted silencing of the endogenous TTR gene accelerated the development of the neuropathologic phenotype. Intraneuronal TTR was seen in the brains of normal humans and mice and in AD patients and APP23 mice. The APP23 brains showed colocalization of extracellular TTR with Abeta in plaques. Using surface plasmon resonance we obtained in vitro evidence of direct protein-protein interaction between TTR and Abeta aggregates. These findings suggest that TTR is protective because of its capacity to bind toxic or pretoxic Abeta aggregates in both the intracellular and extracellular environment in a chaperone-like manner. The interaction may represent a unique normal host defense mechanism, enhancement of which could be therapeutically useful.     

An evaluation of self-management behaviors and medication adherence in patients with epilepsy

Comprehensive treatment of epilepsy involves many facets including self-management behaviors. The primary purpose of this study was to characterize the self-management behaviors of our patients. Additionally, we wanted to assess if the behaviors differed depending on the level of seizure control. Adult patients with epilepsy were recruited for this cross-sectional study. We used two previously validated scales to assess various self-management behaviors and collected clinical data. Our sample consisted of 50 patients (23 women). The mean overall Epilepsy Self-Management Scale (ESMS) question score was 3.72 ± 0.41. The mean question scores on the ESMS subscales Medication Management, Information Management, Safety Management, Seizure Management, and Lifestyle Management were 4.4, 2.7, 3.9, 4.0, and 2.6, respectively. Information Management and Safety Management subscale scores were higher in the patients continuing to have seizures. Based on the Morisky scale, patients fell into either the low (n = 2), medium (n = 27), or high (n = 21) medication-taking behavior category. Self-management skills, beyond medication-taking behaviors, should be emphasized during patient interactions.     

Telerehabilitation and its effect on story retelling by adults with neurogenic communication disorders

Background: Telerehabilitation (telerehab) is the method of using technology to provide rehabilitation services at a distance. The concept of delivering remote speech‐language pathology (SLP) services using telerehab tools and techniques has been acknowledged for more than 25 years. While research has demonstrated videoconference‐based telerehab to be a feasible, effective, and appropriate method for providing SLP services to a broad range of clients, studies have been primarily limited to technical feasibility or demonstration projects with relatively small sample sizes. There is an expressed need in the literature for controlled, randomised studies that track both quantitative outcomes of services delivered via telerehab as well as qualitative measures of satisfaction. Aims: The purpose of the study was to measure performance of adults with acquired brain injury on a standardised SLP assessment conducted in both face‐to‐face (FF) and videoconference‐based telerehab (T) settings. The objective was to determine if performance on the assessment, or subjective feedback from the participants, differed between settings. Methods & Procedures: A total of 40 participants with a recent onset of brain injury—12 with traumatic brain injury (TBI), 14 with a left cerebrovascular accident (LCVA), and 14 with a right cerebrovascular accident (RCVA)—were enrolled in the study. Participants were asked to retell stories from the Story Retell Procedure (Doyle, McNeil, Spencer, Goda, Cotrell, & Lustig, 1998) in both FF and T settings. Responses from the stories were scored by the clinician using the percent information unit scoring metric (McNeil, Doyle, Fossett, Park, & Goda, 2001). Additionally, a survey tool was used to probe each participant's level of satisfaction and willingness to use telerehab services in the future. Outcomes & Results: Across all participants, and within the TBI, LCVA, and RCVA groups, no significant difference in performance between the FF and T settings was found. Feedback from survey data demonstrated a high level of acceptance of the T setting. When compared to participants with LCVA or RCVA, however, participants with TBI were significantly more likely to show a lack of interest in future videoconferencing use. Conclusions: Story‐retelling performance by brain‐injured adults was not affected by setting. Additionally, participants expressed a high level of interest in using videoconferencing in the future. These findings offer additional support for telerehab as a viable alternative mode of SLP treatment for survivors of stroke and TBI. Further research is needed to investigate the utility of telerehab for delivering services to clients with attention impairments as well as those with severe cognitive‐communicative impairment, dysarthria, or aphasia.     

Loss of the mismatch repair protein MSH6 in human glioblastomas is associated with tumor progression during temozolomide treatment.

PURPOSE: Glioblastomas are treated by surgical resection followed by radiotherapy [X-ray therapy (XRT)] and the alkylating chemotherapeutic agent temozolomide. Recently, inactivating mutations in the mismatch repair gene MSH6 were identified in two glioblastomas recurrent post-temozolomide. Because mismatch repair pathway inactivation is a known mediator of alkylator resistance in vitro, these findings suggested that MSH6 inactivation was causally linked to these two recurrences. However, the extent of involvement of MSH6 in glioblastoma is unknown. We sought to determine the overall frequency and clinical relevance of MSH6 alterations in glioblastomas. EXPERIMENTAL DESIGN: The MSH6 gene was sequenced in 54 glioblastomas. MSH6 and O(6)-methylguanine methyltransferase (MGMT) immunohistochemistry was systematically scored in a panel of 46 clinically well-characterized glioblastomas, and the corresponding patient response to treatment evaluated. RESULTS: MSH6 mutation was not observed in any pretreatment glioblastoma (0 of 40), whereas 3 of 14 recurrent cases had somatic mutations (P = 0.015). MSH6 protein expression was detected in all pretreatment (17 of 17) cases examined but, notably, expression was lost in 7 of 17 (41%) recurrences from matched post-XRT + temozolomide cases (P = 0.016). Loss of MSH6 was not associated with O(6)-methylguanine methyltransferase status. Measurements of in vivo tumor growth using three-dimensional reconstructed magnetic resonance imaging showed that MSH6-negative glioblastomas had a markedly increased rate of growth while under temozolomide treatment (3.17 versus 0.04 cc/mo for MSH6-positive tumors; P = 0.020). CONCLUSIONS: Loss of MSH6 occurs in a subset of post-XRT + temozolomide glioblastoma recurrences and is associated with tumor progression during temozolomide treatment, mirroring the alkylator resistance conferred by MSH6 inactivation in vitro. MSH6 deficiency may therefore contribute to the emergence of recurrent glioblastomas during temozolomide treatment.     

The value of microbial cultures in diagnostic lymph-node biopsy

Microbial cultures were performed on 163 lymph-node biopsies from a variety of sites and in all age groups. Growth occurred in 76 (47%), 41 of which were considered contaminants. The final diagnoses were as follows: mycobacterial infection (27 biopsies), coccidioidomycosis (two cultures), nonspecific inflammatory changes (82 cultures), malignancy (51 cultures), and Whipple's disease (one culture). Microbial culture was the sole means of diagnosing nine cases of mycobacterial infection. The fluorescent stain demonstrated acid-fast bacilli in only 16 biopsies, twice the frequency with the standard Ziehl-Neelson stain. Other bacterial isolates were of uncertain significance in most instances. Routine culture for mycobacteria and fungi is recommended for all lymph nodes that show granulomatous changes.