Quality of Relationships With Caregivers,Depression, and Life Satisfaction After Dysvascular Lower Extremity Amputation

Objective

To describe the relationship between caregiver-specific support and conflict, and psychosocial outcomes among individuals experiencing their first dysvascular lower extremity amputation (LEA).

The role of cognitive biases and personality variables in subclinical delusional ideation

Introduction. A number of cognitive biases, most notably a data gathering bias characterised by “jumping to conclusions” (JTC), and the “bias against disconfirmatory evidence” (BADE), have been shown to be associated with delusions and subclinical delusional ideation. Certain personality variables, particularly “openness to experience”, are thought to be associated with schizotypy.

Methods. Using structural equation modelling, we examined the association between two higher order subfactors (“aspects”) of “openness to experience” (labelled “openness” and “intellect”), these cognitive biases, and their relationship to subclinical delusional ideation in 121 healthy, nonpsychiatric controls.

Results. Our results suggest that cognitive biases (specifically the data gathering bias and BADE) and the “openness” aspect are independently associated with subclinical delusional ideation, and the data gathering bias is weakly associated with “positive schizotypy”. “Intellect” is negatively associated with delusional ideation and might play a potential protective role.

Conclusions. Cognitive biases and personality are likely to be independent risk factors for the development of delusions.     

Dermatitis during Spaceflight Associated with HSV-1 Reactivation

Human alpha herpesviruses herpes simplex virus (HSV-1) and varicella zoster virus (VZV) establish latency in various cranial nerve ganglia and often reactivate in response to stress-associated immune system dysregulation. Reactivation of Epstein Barr virus (EBV), VZV, HSV-1, and cytomegalovirus (CMV) is typically asymptomatic during spaceflight, though live/infectious virus has been recovered and the shedding rate increases with mission duration. The risk of clinical disease, therefore, may increase for astronauts assigned to extended missions (>180 days). Here, we report, for the first time, a case of HSV-1 skin rash (dermatitis) occurring during long-duration spaceflight. The astronaut reported persistent dermatitis during flight, which was treated onboard with oral antihistamines and topical/oral steroids. No HSV-1 DNA was detected in 6-month pre-mission saliva samples, but on flight day 82, a saliva and rash swab both yielded 4.8 copies/ng DNA and 5.3 × 10⁴ copies/ng DNA, respectively. Post-mission saliva samples continued to have a high infectious HSV-1 load (1.67 × 10⁷ copies/ng DNA). HSV-1 from both rash and saliva samples had 99.9% genotype homology. Additional physiological monitoring, including stress biomarkers (cortisol, dehydroepiandrosterone (DHEA), and salivary amylase), immune markers (adaptive regulatory and inflammatory plasma cytokines), and biochemical profile markers, including vitamin/mineral status and bone metabolism, are also presented for this case. These data highlight an atypical presentation of HSV-1 during spaceflight and underscore the importance of viral screening during clinical evaluations of in-flight dermatitis to determine viral etiology and guide treatment.     

Programmable multiple pacing configurations help to overcome high left ventricular pacing thresholds and avoid phrenic nerve stimulation

BACKGROUND: High left ventricular pacing (LVP) thresholds and phrenic nerve stimulation (PNS) are common problems with cardiac resynchronization (CRT). Newer systems capable of multiple LVP configurations may help overcome these problems without the need for reoperation. METHODS: CRT systems capable of multiple LVP configurations (Guidant models H155 and H145) were implanted in 43 patients (study group). An additional 49 patients (control group) received CRT systems (Guidant, Medtronic, Biotronik, St. Jude Medical, various models) lacking this feature. RESULTS: Overall, acute high (> or =2.5 V/0.5 ms) LVP thresholds were encountered in 13 (30%) of the study group, and 25 (50%) of control group patients (P = 0.03). PNS was encountered in 5 (12%) of the study group and 12 (24%) of control group patients (P = 0.13). All cases of high LVP thresholds and PNS in the study group were managed by switching to a different LVP configuration, while high thresholds remained in control group patients, and PNS was managed by replacing the lead. The CS lead was successfully placed in a lateral branch in 95% of study group, compared to only 77% of control group patients (P = 0.004). CONCLUSIONS: Multiple LVP configurations were clinically useful in a significant number of patients undergoing CRT system implantation by helping to overcome high LVP thresholds and PNS, and by providing more flexibility in placing the LV lead.