The Integration of the Glutamatergic and the White Matter Hypotheses of Schizophrenia's Etiology

Background: schizophrenia's endophenotipic profile is not only generally complex, but often varies from case to case. The perspective of trying to define specific anatomic correlates of the syndrome has led to disappointing results. In that context, neurophysiologic hypotheses (e. g. glutamatergic hypothesis) and connectivity hypotheses became prominent. Nevertheless, despite their commitment to the principle of denying 'localist' views and approaching the syndrome's endophenotype from a whole brain perspective, efforts to integrate both have not flourished at this moment in time. Objectives: This paper aims to introduce a new etiological model that integrates the glutamatergic and the WM (WM) hypotheses of schizophrenia's etiology. This model proposes to serve as a framework in order to relate to patterns of brain abnormalities from the onset of the syndrome to stages of advanced chronification. Highlights: Neurotransmitter abnormalities forego noticeable WM abnormalities. The former, chiefly represented by NMDAR hypo-function and associated molecular cascades, is related to the first signs of cell loss. This process is both directly and indirectly integrated to the underpinning of WM structural abnormalities; not only is the excess of glutamate toxic to the WM, but its disruption is associated to the expression of known genetic risk factors (e. g., NRG-1). A second level of the model develops the idea that abnormal neurotransmission within specific neural populations ('motifs') impair particular cognitive abilities, while subsequent WM structural abnormalities impair the integration of brain functions and multimodality. As a result of this two-stage dynamic, the affected individual progresses from experiencing specific cognitive and psychological deficits, to a condition of cognitive and existential fragmentation, linked to hardly reversible decreases in psychosocial functioning.

SELF-REPORTED URINARY INCONTINENCE IN THE POSTPARTUM PERIOD: CLINICAL CHARACTERISTICS

The objective of this cross-sectional study was to characterize the manifestations of self-reported urinary incontinence in the postpartum period. We interviewed 288 women who were clients of a teaching health center in Sao Paulo, between the months of January and August of 2009. The data showed that among the 71 incontinent women (24.6%), 44 (62%) reported stress urinary incontinence, 65 (91.5%) were aware of urine leakage, 33 women (46.5%) experienced urine loss more than once a week, and 24 (33.8%) reported persistent urinary incontinence at the time of interview. The severity classified as moderate urinary incontinence was identified in 53 women (74.7%). The findings highlight the importance of studies on urinary incontinence in the postpartum period, as well as approaching this issue in education and health care interventions with women in the reproductive stage.

The profile of women who have experienced cesarean section and obstetric care at a public maternity hospital in Ribeirao Preto

The present paper presents the social and obstetric profile of women undergoing cesarean childbirth at a public maternity hospital in the interior of Sao Paulo state. This is a quantitative, retrospective, descriptive study performed using documental research. The collected data refer to the period between July and December 2005, and between January and June 2006. A total of 670 records were reviewed. A 23% rate of cesarean births was identified at the institution studied during the aforementioned period. The studied population was characterized as having a low level of education, living in a common-law relationship, and not having a paid occupation. The main indications for cesarean sections were iterativity and acute fetal distress. The findings revealed an emphasis on obstetric nursing in the low-risk normal childbirth scenario, considering the non-interventionist character inherent to their education and training.

Role of biopsies in patients with residual rectal cancer following neoadjuvant chemoradiation after downsizing: can they rule out persisting cancer?

Aim The study aimed to determine the value of postchemoradiation biopsies, performed after significant tumour downsizing following neoadjuvant therapy, in predicting complete tumour regression in patients with distal rectal cancer. Method A retrospective comparative study was performed in patients with rectal cancer who achieved an incomplete clinical response after neoadjuvant chemoradiotherapy. Patients with significant tumour downsizing (> 30% of the initial tumour size) were compared with controls (< 30% reduction of the initial tumour size). During flexible proctoscopy carried out postchemoradiation, biopsies were performed using 3-mm biopsy forceps. The biopsy results were compared with the histopathological findings of the resected specimen. UICC (Union for International Cancer Control) ypTNM classification, tumour differentiation and regression grade were evaluated. The main outcome measures were sensitivity and specificity, negative and positive predictive values, and accuracy of a simple forceps biopsy for predicting pathological response after neoadjuvant chemoradiotherapy. Results Of the 172 patients, 112 were considered to have had an incomplete clinical response and were included in the study. Thirty-nine patients achieved significant tumour downsizing and underwent postchemoradiation biopsies. Overall, 53 biopsies were carried out. Of the 39 patients who achieved significant tumour downsizing, the biopsy result was positive in 25 and negative in 14. Only three of the patients with a negative biopsy result were found to have had a complete pathological response (giving a negative predictive value of 21%). Considering all biopsies performed, only three of 28 negative biopsies were true negatives, giving a negative predictive value of 11%. Conclusion In patients with distal rectal cancer undergoing neoadjuvant chemoradiation, post-treatment biopsies are of limited clinical value in ruling out persisting cancer. A negative biopsy result after a near-complete clinical response should not be considered sufficient for avoiding a radical resection.

Burden of maternal bipolar disorder on at-risk offspring: A controlled study on family planning and maternal care

Introduction: Bipolar disorder (BD) is a highly incapacitating disease typically associated with high rates of familial dysfunction. Despite recent literature suggesting that maternal care is an important environmental factor in the development of behavioral disorders, it is unclear how much maternal care is dysfunctional in BD subjects. Objective: The objective of this study was to characterize maternal care in DSM-IV/SCID diagnosed BD type I subjects compared to healthy controls with (PD) and without (NPD) other psychiatric diagnoses. Materials and methods: Thirty-four BD mothers and 106 controls underwent an interview about family planning and maternal care, obstetrical complications, and mother-child interactions. K-SADS-PL questions about violence exposure were used to ascertain domestic violence and physical/sexual abuse. Results: BD mothers were less likely to have stable unions (45.5%; p < 0.01) or to live with the biological father of their children (33.3%; p < 0.01), but had higher educational level and higher rates of social security use/retirement. They also had fewer children and used less contraceptive methods than controls. Children of BD women had higher rates of neonatal anoxia, and reported more physical abuse (16.1%; p = 0.02) than offspring of NPD mothers. Due to BD mothers' symptoms, 33.3% of offspring suffered physical and/or psychological abuse. Limitations: Post hoc analysis, and the use of questions as a surrogate of symptoms as opposed to validated instruments. Conclusion: This is one of few reports confirming that maternal care given by BD women is dysfunctional. BD psychopathology can lead to poor maternal care and both should be considered important environmental risk factors in BD, suggesting that BD psychoeducation should include maternal care orientation. (C) 2012 Elsevier B.V. All rights reserved.

Capsulorhexis rescue after peripheral radial tear-out: Quick-pull technique

We describe a technique to rescue the continuous curvilinear capsulorhexis (CCC) in cases in which complete radial tears make it impossible to use normal traction forceps. A circumferential path and rapid movement are applied in the plane of the anterior capsule in the direction of the center pupil. This technique was used in 50 cases. In 47, the CCC could be completed; in 3, it could not and surgery was continued with low-parameter phacoemulsification. No other intraoperative complications occurred.

Coping Style and Depressive Symptomatology during Pregnancy in a Private Setting Sample

Aim: to evaluate the association of antenatal depressive symptomatology (AD) with life events and coping styles, the hypothesis was that certain coping strategies are associated to depressive symptomatology. Methods: we performed a cross sectional study of 312 women attending a private clinic in the city of Osasco, Sao Paulo from 27/05/1998 to 13/05/2002. The following instruments were used: Beck Depression Inventory (BDI), Holmes and Rahe Schedule of Recent Events (SSRS), Folkman and Lazarus Ways of Coping Questionnaire and questionnaire with social-demographic and obstetric data. Inclusion criteria: women with 110 past history of depression, psychiatric treatment, alcohol or drug abuse and no clinical-obstetrical complications. Odds ratios and 95% CI were used to examine the association between AD (according to BDI) and exposures variables. Hypothesis testing was done with chi(2) tests and a p value < .05. Results: AD occurred in 21.1% of pregnant women. By the univariate analyses, education, number of pregnancies, previous abortion, husband income, situation of marriage and score of SSRS were associated with AD. All coping styles were associated with AD, except seeking support and positive reappraisal. By the multivariate analyses, four coping styles were kept in the final model: confront (p = .039), accepting responsibility (p < .001), escape-avoidance (p = .002), problem-solving (p = .005). Conclusions: AD was highly prevalent and was associated with maladaptive coping styles.

Incontinência urinária autorreferida no pós-parto: características clínicas

Este estudo transversal teve como objetivo caracterizar as manifestações de incontinência urinária autorreferida no pós-parto. Foram entrevistadas 288 mulheres atendidas em um Centro de Saúde Escola do município de São Paulo, entre janeiro e agosto de 2009. Os dados indicaram que, dentre as 71 mulheres incontinentes (24,6%), 44 destas (62%) referiram incontinência urinária aos esforços, 65 (91,5%) sentiam a urina escoar, 33 mulheres (46,5%) apresentavam perdas por mais de uma vez na semana e 24 (33,8%) acusaram perda urinária persistente no momento da entrevista. A gravidade, classificada como incontinência urinária moderada, foi constatada em 53 mulheres (74,7%). Os achados realçam a importância de investigações sobre incontinência urinária no período pós-parto, assim como sua abordagem no ensino e na assistência à mulher no período reprodutivo.

Prevalência de incontinência urinária autorreferida no pós-parto e fatores relacionados

OBJETIVOS: Verificar a prevalência de incontinência urinária (IU) autorreferida por mulheres no pós-parto e identificar os fatores relacionados. MÉTODOS: Estudo epidemiológico transversal, realizado no período de janeiro a agosto de 2009. Foram entrevistadas 288 mulheres com 30 dias a 6 meses de pós-parto. Os dados foram analisados estatisticamente. RESULTADOS: Observou-se prevalência de 24,6% de IU autorreferida no pós-parto. A idade média das mulheres foi de 26 anos, apenas a cor da pele apresentou diferença estatística significante, com maior representatividade em mulheres brancas. Dentre as 71 entrevistadas que referiram IU no pós-parto, a maioria era primípara e submeteu-se ao parto normal. CONCLUSÃO: A ocorrência de IU autorreferida no pós-parto associa-se à cor da pele com predominância em primíparas em comparação às não primíparas. Identificar os fatores relacionados à IU em mulheres no pós-parto e sua prevalência contribui no planejamento de atenção de enfermagem obstétrica à mulher que vivencia o período reprodutivo.

Perfil das mulheres submetidas à cesareana e assistência obstétrica na maternidade pública em Ribeirão Preto

O artigo apresenta o perfil social e obstétrico das mulheres submetidas ao parto cesárea em uma maternidade pública do interior do Estado de São Paulo. Trata-se de estudo quantitativo, retrospectivo, do tipo descritivo, com pesquisa documental. Os dados coletados referem-se ao período entre os meses de junho e dezembro de 2005, e janeiro a junho de 2006. Foram consultados 670 prontuários. A taxa de parto cesárea na instituição-campo foi calculada em 23% para o período supracitado. Foram características da população estudada a baixa escolaridade formal, a união consensual e o trabalho não remunerado. As principais indicações para as cesarianas foram a iteratividade e o sofrimento fetal agudo. Como desdobramento dos achados está a ênfase pela valorização da enfermagem obstétrica no cenário de atendimento ao parto normal de baixo risco, considerando seu caráter não-intervencionista inerente à sua formação.

Isufficienza Placentare nella Specie Equina

Lo sviluppo e la funzionalità della placenta influenzano direttamente la crescita ed il benessere del feto all'interno dell'utero, quindi qualsiasi problema strutturale o funzionale della placenta influenzerà lo sviluppo del feto. Lo scopo di questa tesi è stato quello di approfondire diversi aspetti clinici e clinico-patologici dell’insufficienza placentare nella specie equina, con l’intento di individuare dei parametri che possano essere di ausilio per l’identificazione precoce del puledro a rischio e della necessità di interventi terapeutici. La valutazione della concentrazione di lattato nel sangue e nel liquido amniotico potrebbe essere un utile strumento diagnostico per la diagnosi di acidosi metabolica associata ad ipossia/ischemia nel puledro e per identificare la necessità di un intervento precoce alla nascita. La risposta all’ipossia sembra essere mediata dall’HIF-1 e dall’HSF-1 anche nel puledro neonato, e se questi dati venissero confermati su un numero maggiore di animali, i due marcatori proteici e la MDA potrebbero essere utilizzati per la diagnosi di PAS nel puledro. L’esame di tutta l’unità placentare riveste un ruolo di fondamentale importanza per l’acquisizione di informazioni riguardo all’ambiente di vita intrauterino del puledro, ed è quindi auspicabile nella pratica ostetrica routinaria una maggiore attenzione all’esame della placenta, soprattutto in caso di patologie materno-fetali. Tra i parametri biochimici valutati al momento della nascita, la creatininemia e la glicemia possono fornire informazioni sull’efficienza dello scambio placentare ed essere quindi utilizzati per individuare puledri a rischio. Infine, lo sviluppo di una macro per il software ImageJ porta alla luce uno strumento nuovo, semplice da usare ed economico, per la valutazione morfometrica dell’arborizzazione dei villi placentari; tuttavia la ricerca necessità ulteriori indagini su un numero maggiore di animali per valutare le differenze morfometriche tra placente normali e patologiche.

Integrating optical fiber force sensors into microforceps for ORL microsurgery

The delicate anatomy of the ear require surgeons to use great care when operating on its internal structures. One example for such an intervention is the stapedectomy, where a small crook shaped piston is placed in the oval window of the cochlea and connected to the incus through crimping thus bypassing the diseased stapes. Performing the crimp process with the correct force is necessary since loose crimps poorly transmit sound whereas tight crimps will eventually result in necrosis of the incus. Clinically, demand is high to reproducibly conduct the crimp process through a precise force measurement. For this reason, we have developed a fiber Bragg grating (FBG) integrated microforceps for use in such interventions. This device was calibrated, and tested in cadaver preparations. With this instrument we were able to measure for the first time forces involved in crimping a stapes prosthesis to the incus. We also discuss a method of attaching and actuating such forceps in conjunction with a robot currently under development in our group. Each component of this system can be used separately or combined to improve surgical accuracy, confidence and outcome.

Off-label use of misoprostol for labor induction: a nation-wide survey in Switzerland

Off-label use of drugs is frequent in obstetrical practice. No data however are available about nation-wide off-label use in obstetrics regarding frequency and patient information. The objective of our study was to assess the clinical practice of off-label use of misoprostol for labor induction.

Quality, size, and composition of pediatric endobronchial biopsies in cystic fibrosis

BACKGROUND: Studies on airway remodeling in children with cystic fibrosis (CF) may be hampered by difficulty in obtaining evaluable endobronchial biopsy specimens because of large amounts of mucus and inflammation in the CF airway. We prospectively assessed how the quality of biopsy specimens obtained from children with CF compare with those from children with other airway diseases. METHODS: Fiberoptic bronchoscopy with endobronchial biopsy was performed in 67 CF children (age range, 0.2 to 16.8 years), 34 children with wheeze/asthma (W/A), and 64 control children with chronic respiratory symptoms. Up to three biopsy specimens were taken and stained with hematoxylin and eosin. Biopsy specimen size and structural composition were quantified using stereology. RESULTS: At least one evaluable biopsy specimen was obtained in 72% of CF children, in 79% of children with W/A, and in 72% of control subjects (difference was not significant). The use of large biopsy forceps (2.0 mm) rather than small biopsy forceps (1.0 mm) [odds ratio (OR), 5.8; 95% confidence interval (CI), 1.1 to 29.8; p = 0.037] and the number of biopsy specimens taken (odds ratio, 2.6; 95% confidence interval, 1.3 to 5.2; p = 0.006) significantly contributed to the success rate. Biopsy size and composition were similar between groups, except that CF children and those patients with W/A had a higher percentage of the biopsy specimen composed of muscle than did control subjects (median 6.2% and 9.7% vs 0.9%, respectively; p = 0.002). CONCLUSIONS: Biopsy size and quality are adequate for the study of airway remodeling in CF children as young as 2 months of age. Researchers should use large forceps when possible and take at least two biopsy specimens per patient. An increased airway smooth muscle content of the airway mucosa may contribute to the pathophysiology of CF lung disease.

Time required to obtain endobronchial biopsies in children during fiberoptic bronchoscopy

BACKGROUND: Endobronchial biopsies are an important tool for the study of airway remodeling in children. We aimed to evaluate the impact of performing endobronchial biopsies as a part of fiberoptic bronchoscopy on the length of the procedure. METHODS: Clinically indicated fiberoptic bronchoscopy at which endobronchial biopsy was attempted as a part of a research protocol was performed in 40 children (median age 6 years, range 2 months-16 years). Time needed for airway inspection, bronchoalveolar lavage (BAL) with three aliquots of 1 ml/kg of 0.9% saline, sampling of three macroscopically adequate biopsies, teaching, and other interventions (e.g., removal of plugs) was recorded. The bronchoscopist was not aware that the procedure was being timed. RESULTS: Median (range) duration (min) was 2.5 (1.0-8.2) for airway inspection, 2.8 (1.7-9.4) for BAL, 5.3 (2.5-16.6) for biopsy sampling, 2.4 (1.5-6.6) for teaching and 4.1 (0.8-18.5) for other interventions. Three adequate biopsies were obtained in 33 (83%) children. Use of 2.0 mm biopsy forceps (via 4.0 and 4.9 mm bronchoscopes) rather than 1.0 mm (via 2.8 and 3.6 mm bronchoscopes) significantly reduced biopsy time (4.6 min vs. 8.4 min, P < 0.001). CONCLUSIONS: It takes a median of just over 5 min to obtain three endobronchial biopsies in children, which we consider an acceptable increase in the duration of fiberoptic bronchoscopy for the purpose of research.