Infants’ behavioral and physiological profile and mother–infant interaction

This study aims to (a) identify and profile groups of infants according to their behavioral and physiological characteristics, considering their neurobehavioral organization, social withdrawal behavior, and endocrine reactivity to stress, and to (b) analyze group differences in the quality of mother–infant interaction. Ninety seven 8-week-old infants were examined using the Neonatal Behavioral Assessment Scale and the Alarm Distress Baby Scale. Cortisol levels were measured both before and after routine inoculation between 8 and 12 weeks. At 12 to 16 weeks mother–infant interaction was assessed using the Global Rating Scales of Mother–Infant Interaction. Three groups of infants were identified: (a) ‘‘withdrawn’’; (b) ‘‘extroverted’’; (c) ‘‘underaroused.’’ Differences between them were found regarding both infant and mother behaviors in the interaction and the overall quality of mother–infant interaction. The identification of behavioral and physiological profiles in infants is an important step in the study of developmental pathways.

Infant’s psychophysiological profile and temperament at 3 and 12 months

This study is intended to analyze (1) differences in infant temperament at 3 and 12 months according to infants' psychophysiological profiles: "withdrawn" "extroverted", and "underaroused" and (2) changes in infant temperament from 3 to 12 months, namely according to the infant psychophysiological profile and the quality of mother-infant interaction. Ninety-four 8-week-old infants were assessed using the Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) and the Alarm Distress Baby Scale (ADBB, Guedeney & Fermanian, 2001). Saliva samples were collected at 8-12 weeks old, both before and after a routine inoculation for cortisol reactivity measurement. Mother-infant interaction was evaluated at 12-16 weeks, using the Global Rating Scales (GRS, Murray, Fiori-Cowley, Hooper, & Cooper, 1996). Mothers' reports on infant temperament at 3 and 12 months were collected using the Infant Behavior Questionnaire (IBQ, Rothbart, 1981). Significant differences in mothers' perception of infant temperament were found at both 3 and 12 months in infants with distinct psychophysiological profiles. Stability was observed in most of the temperament's dimensions from 3 to 12 months old; still, there were changes in mothers' perception of infant temperament in terms of level of distress, cuddliness, sadness and approach. Infant psychophysiological profile and mother-infant interaction both influence with the pattern of those changes. The results corroborate that infant's characteristics early in life as well as contextual factors influence with mothers' perception of infant temperament and with changes across the 1st year of life.

Study of validation of the Portuguese version of the inventory «Experiences in Close Relationships»

The Experiences in Close Relationships Inventory permits to evaluate attachment in close relationships during adulthood based on two dimensions able to be present in this kind of relationships: the avoidance of proximity and the anxiety related with to abandonment. It is a self-report 7- points likert scale composed by 36 items. The Portuguese version was administered to a sample of 551 university students (60% female), the majority with ages between 19 and 24 years old (88%) in a dating relationship (86%). The principal components analysis with oblimin rotation was performed. The total scale has good internal consistency (α=.86), as also has the 2 sub-scales: anxiety (α=.86) and avoidance (α=.88). The two dimensions evaluated are significantly correlated with socio-demographics, relational characteristics (jealousy, relationship distress, and compromise), wishes (enmeshment versus differentiation) and fears (abandonment versus control) related to attitudes in significant relationships, which testify the construct validity of the instrument. The results obtained are coherent with the original version and other ECR‘s adaptations. Practitioners and researchers in the context of clinical psychology and related areas have now at their disposal the Portuguese version of the ECR inventory, which has shown its very high usefulness in the study of close relationships, and specifically attachment in adulthood.

Ultrasound Blocks for the Anterior Abdominal Wall - Adult and Pediatric Surgery

Somatic post-surgical pain is invalidating and distressing to patients and carries the risk of important complications. The anterior abdominal wall is involved in most surgical procedures in general, gynecologic, obstetric, urological, vascular and pediatric surgery. Combined multimodal strategies involving nerve blocks, opiates, and non-steroidal anti-inflammatory drugs for systemic analgesia are necessary for optimal pain modulation. Anterior abdominal wall blocks, transverse abdominal plexus block, iliohypogastric and ilioinguinal nerveblock, genitofemoral nerve block and rectus sheath block have an important role as components of multimodal analgesia for somatic intraoperative and postoperative pain control. Ultrasound visualization has improved the efficacy and safety of abdominal blocks and implemented the application in the clinical setting. For this reason, they are a very important tool for all anesthesiologists who aim to treat effectively patients’ pain. This guide provides an evidence based comprehensive and necessary overview of anatomical, anesthesiological and technical information needed to safely perform these blocks.

Uma nova modalidade de sexo-determinação no grilo sul-americano eneoptera surinamensis

The male of Eneoptera surinamensis (Orthoptera-Eneopteridae) is provided with 9 chromosomes, that is, with 3 pairs of autosomes and 3 sex chromosomes. Spermatogonia. - The autosomes of the spermatogonia are of the same size and U-shaped. One of the sex chromosomes approximately equalling the autosomes in size is telocentric, while the other two are much larger and V-shaped. One of the latter is smaller than the other. The sex chromosomes as showed in Figs. 1 and 2 are designated by X, Yl and Y2, X being the larger V, Yl the smaller one and Y2 the rod-shaped. Primary spermatocytes. - Before the growth period of the spermatocytes all the three sex chromosomes are visible in a state of strong heteropycnosis. X is remarkable in this stage in having two long arms well separated by a wide commissural segment. (Figs. 4, 5 and 6). During the growth period Y2 disappears, while X and Yl remain in a condensed form until metaphase. These may be separated from one another or united in the most varied and irregular manner. (Fig. 7 to 12). In the latter case the segments in contact seem to be always different so that we cannot recognize any homology of parts in the sense os genetics. At diplotene Y2 reappears together with the autosomal tetrads. X and Yl may again be seen as separate or united elements. (Figs. 13 and 14). At later diakinesis and metaphase the three sex chromosomes are always independent from each other, Y2 being typically rod-shaped, X and Yl V-shaped, X being a little larger than Yl. (Fig. 15 to 18). At metaphase the three condensed tetrads go to the equatorial plane, while the sex chromosomes occupy any position at both sides of this plane. In almost all figures which could be perfectly analysed X appeared at one side of the autosomal plate an Yl together with Y2 far apart at the other side. (Figs. 16 and 18). Only a few exception have been found. (Figs. 17 and 19). At anaphase X goes in precession to one pole, Yl and Y2 to the other (Figs. 20 and 21). As it is suggested by the few figures in which a localization of the sex chromosomes different from the normal has been observed, the possibility of other types of segregation of these elements cannot be entirely precluded. But, if this does happen, the resulting gametes should be inviable or give inviable zygotes. Early in anaphase autosomes and sex chromosomes divide longitudinally, being maintained united only by the kinetochore. (Figs. 20 and 21). At metaphase the three sex chromosomes seem to show no special repulsion against each other, X being found in the proximity of Yl or Y2 indifferently. At anaphase, however, the evidences in hand point to a stronger repulsion between X on the one side and both Ys on the other, so that in spite of the mutual repulsion of the latter they finish by going to the same pole. Secondary spermatocytes. - At telophase of the primary spermatocytes all the chromosomes enter into distension without disappearing of view. A nuclear membrane is formed around the chromosomes. All the chromosomes excepting Y2 which has two arms, are four-branched. (Fig. 22). Soon the chromosomes enter again into contraction giving rise to the secondary metaphase plate. Secondary spermatocytes provided as expected with four and five chromosomes are abundantly found. (Figs. 23 and 24). In the former all chromosomes are X-shaped while in the latter there is one which is V-shaped. This is the rod- shaped Y2. In the anaphase of the spermatocytes with four chromosomes all the chromosomes are V-shaped, one of them (X) being much larger than the others. In those with five there is one rod-shaped chromosome (Y2). (Fig. 25), Spermatids. Two classes of spermatids are produced, one with X and other with Yl and Y2. All the autosomes as well as Y2 soon enter into solution, X remaining visible for long time in one class and Yl in the other. (Figs. 26 and 27). Since both are very alike at this stage, one cannot distinguish the two classes of spermatids. Somatic chromosomes in the famale. - In the follicular cells of the ovary 8 chromosomes were found, two of which are much larger than the rest. (Figs. 29 and 30). These are considered as being sex chromosomes. CONCLUSION: Eneoptera surinamensis has a new type of sex-determining mechanism, the male being X Yl Y2 and the female XX. The sex chromosomes segregate without entering into contact at metaphase or forming group. After a review of the other known cases of complex sex chromosome mechanism the author held that Eneoptera is the unique representative of a true determinate segregation of sex chromosomes. Y2 behaving as sex chromosome and as autosome is considered as representing an intermediary state of the evolution of the sex chromosomes.

Provas adicionais da dicentricidade dos cromossômios dos Hemípteros

In order to test Piza's conclusions regarding the dicentricity of Hemipteran chromosomes, two species of bugs of the family Coreidae, namely, Anasa sp. and Leptoglossus stigma (Herbst), are studied in the present paper. a) Anasa sp. - The male of this species has 21 chromosomes, that is, 20 pairs of autosomes and a single sex chromosome. The latter divides equationally in the first division of the spermatocytes and passes undivided to one cell in the second division. In this it moves with its longer axis parallelly to the spindle axis and shows fibrillar connections with both poles. Special attention was paid to the behavior of the chromosomes in the anaphase of the spermatogonia. As it was previously stated (Piza 1946 and 1946a) with regard to other species, the chromosomes are here attached to the spindle by both ends and begin to move toward the poles strongly curved to them. No intercalary fibers could be detected although their existente may not be denied by theoretical reasons developed in another paper (Piza 1946). Mitoses in somatic tissues of the embryo were equally studied. Careful examination of anaphase chromosomes in a great number of cells showed that the chromosomes behave exactly as in the spermatogonia, being equally attached to the spindle by the extremities alone and moving with their ends looking to the pole. A weak median constriction sometimes replaced by a slightly clearer space was observed in prometaphase and even in metaphase chromosomes of the spermatogonia as well as the somatic cells, having already been referred to in the case of Diactor bilineatus. (Piza 1945). Hemipteran chromosomes being considered as iso-chromosomes originated by a longitudinal spliting of the monocentric chromosomes resulting from the second division of the spermatocytes, the median aspect just mentioned may be regarded as the point of union of the separated halves. (See origin of dicentricity in Piza 1946). b) Leptoglossus stigma - This species has spermatogonia provided with 20 pairs of autosomes and one sex chromosome whose behavior differs in nothing from what was stated in regard of the preceding species. In the primary spermatocytes nothing meriting special mention was observed. Orientation, connection with the poles and movements of the sex chromosome in the secondary spermatocytes confirm the views already developed.

Notas sobre cromossômios de alguns escorpiões brasileiros

Three species of Scorpions beloging to two different families were studied cytologically: a) Tityus mattogrossensis Borelli (Fam. Buthidae), - This species presents spermatogonia provided with 20 short chromosomes which orient at metaphase with their axis parallelly to the plane of the equator and move toward the poles without changing this position, from the stage pachytene to metaphase the bivalents become, as in Tityus bahiensis, progressivery shorter and thicker, without showing that chiasmata occured at any time. The paired chromosomes never open themselves, out to form loops as in orthodox meioses. As in Tityus bahiensis the bivalents are inserted In the spindle before reaching their maxim contraction. No diakinesis has been observed. The primary spermatocyte metaphases are provided, with 10 pairs of chromosones, two of which are larger and two smaller than the rest. The bivalents orient as in Tityus bahiensis with their length in the plane of the equator and separate parallelly. Spindle fibres are seen alongst their entire body. While, in Tityus bahiensis the ends of the chromosomes are pronouncedly turned to opposite poles at metaphase, nothing like this was observed in the present species. Only late in anaphase the chromosomes of Tityus mattogrossensis show a bending to the poles. The secondary spermatocytes present 10 short chromosomes, two being larger than, the others. Here, on the contrary, the chromosomes are strongly curved toward the poles since the beginning of anaphase. Some chromosomal anomalies have been noticed. Primary spermatocytes with 14 bivalents, some of which representing probably free fragments, were observed. Primary spermatocytes with 8 bivalents and one cross of 4 chromosomes were interpreted as resulting from breakages followed by translocations Primary spermatocytes with 9 bivalents, one of which being much longer than the longst of the normal plates, show that fusion by the extremities of two non homologous chromosomes on the onde side, and of their respective homologous in the same way on tre other, have occured. Orientation of bivalents with their body parallelly to the spindle axis and anaphasic bridges have been encountered. All in all points to the conclusion that the chromosomes of Tityus mattogrossesis, like those of Tityus bahiensia are provided with one kinetochore at each end. Ananteris balzani Thorell - (Fam. Buthidae). - This species which belongs to the same family as Tityus, is provided with 12 chromosomes (diploid). These studied in embryonic tissues, showed the same behavior as the somatic chromosomes of Tityus bahiensis. Bothrirus sp. (Bothriuridae). - Only spermatogonia were found in the testis, of the single male hitherto investigated. The chromosomes, in number of 36, are of different sizes but small and provided, as ordinarily, with a single kinetochore. They behave therefore in an orthodox manner in mitosis.

Meiose em Rhinocricus Padbergi Verhoeff, 1938

In the present paper the behaviour of the chromosomes in the spermatogenesis of the Myriapod Rhinocricus Padbergi Verhoeff, 1938 is studied. The primary spermatocytes are provided with 10 independent bivalents which separate normally giving rise to equivalent secondary spermatocytes. No indication of sex chromosomes has been found. Fusion of two bivalents or of four, two by two, has been observed, giving origin to secondary spermatocytes with 9 and 8 chromosomes respectively, in which fused chromosomes could be discovered. For analysing the facts the chomosomes of both, primary and secondary metaphases were separately counted from a total of 190 celis of four individuals and statistically treted. The X2-test gave insignificant results. Twenty chomosomes were counted in somatic tissues. The heterochròmatic parts of the leptotene threads were usually arranged in the periphery of the nucleus. In resting nuclei chromocenters can be observed in varyng number. Their chromosomal nature is revealed by the fact that when treated by KCÑ or KNOS they begin uncoiling.

Sobre o comportamento mitótico e meiótico de cromossomas policêntricos ou com ponto de inserção difuso

Material: Studies were made mainly with Ascaris megalocephála Cloq. univalens and bivalens, and also with Tityus bahiensis Perty. 1) Somatic pairing of heterochromatic regions. The heterochromatic ends of the somatic chromosomes in Ascaris show a very strong tendency for unspecifical somatic pairing which may occur between parts of different chromosomes (Figs. 1, 2, 3, 7, 10, 11, 12, 13, 14, 16, 18,), between the two ends of the same chromosome either directly (Figs. 4, 5, 7, 8, 11, 12, 13, 15, 16, 17, 18) or inversely (Fig. 8, in the arrow) and also within a same chromosomal arm (Fig. 6). 2) During the early first cleavage division the chomosomes are an isodiametric cylinder (Figs. 6, 9, 11, 13, 14). But in later metaphase the ends become club shaped (Figs. 1, 2, 3, 4, 5, 7, 10) which is interpreted as the beginning of migration of chromatic substance from the central euchromatic region towards the heterochromatic regions. This migration becomes more and accentuated in anaphase (Figs. 19, 22, 23) and in the vegetative cells where euchromatic region looses more and more staing power, especially in the intersititial zones between the individual small spherical chromosomes into which the euchromatic region desintegrates. The emigrated chromatin material is finally eliminated with the heterochromatic chromosome ends (Fig. 23 and 24). 3) It seems a general rule that during mitotic anaphase all chromosomes with diffuse or multiple spindle fiber attachement (Ascaris, Tityus, Luzula, Steatococcus, Homoptera and Heteroptera in general) move to the poles in the form of an U with precedence of the chromosomal ends. In Ascaris, the heterocromatic regions are pulled passively towards the poles and only the euchromatic central portion may be U-shaped (Fig. 19, 22, 25). While in the other species this U-shape is perfect since the beginning of anaphase, giving the impression that movement towards the poles begins at both ends of a chromosome simultaneously, this is not the case in Ascaris. There the euchromatic region is at first U-shaped, passing then to form a straight or zig-zag line and becoming again U-shaped during late anaphase. This is explained by the fact that the ends of the euchromatic regions have to pull the weight of the passive heterochromatic portions. 4) While it is generally accepted that, during first meio-tic division untill second anaphase, all attachement regions remain either undivided or at least united closely, this is not the case in chromosomes with diffused or multiple attachment. Here one clearly sees in all cases so far studied four parallel chromatids at first metaphase. In Luzula and Tityus (for Tityus all figs. 26 to 31) this division is allready quite clear in paraphase (pro-metaphase) and it cannot be said wether in other species the division in sister chromatids is allready present, but not visible at this stage. During first anaphase the sister chromatids of Titbits remain more or less in contact, while in Luzula and especially in Ascaris they are quite separated. Thus one can count in late anaphase or telophase of Ascaris megalocephala bivalens, nearly allways, four separate chromosomes near each pole, or a total of eight chromatids per division figure (Figs. 35, 36, 37, 38, 39, 40, 41).

Vocalizações e interações acústicas em Hyla raniceps (Anura, Hylidae) durante a atividade reprodutiva

The vocalizations of H. raniceps (Cope, 1826) and their functions are described, including an analysis of the influence of temperature, weight, or SVL (snout-vent length) of males on the acoustic parameters. The vocalizations were recorded in three areas in Fazenda Lagoa Grande, Municipality of Pontalina, State of Goiás, central Brazil. Males began their vocalizations just before sunset, extending them, in some cases, to dawn of the following day. The peak of activities happened between 21h and 23h. The height of calling sites varied plenty, being the position horizontal in about 50% of them. Males defended sites in different areas during consecutive nights. Rain and strong winds interrupted the calling activities. Males emitted three vocalizations: advertisement, territorial and distress calls. The advertisement call has pulsionated structures and it is the most common, being emitted in the presence/absence of females. Significant correlation was found between number of notes and air temperature, notes duration and both male weight and air temperature, calling rate and both male SVL or weight, and frequency and male weight.

Comentario ao esquema de classificação das Salmonellas de Kauffmann-White

The classification of salmonellae in accordance with the Kauffmann-White schema accepted by the presents various inconveniences and difficulties to application. Among these is the necessity of preparing, dosing and preserving a considerable number of specific sera whose validity as is well known, is limited. The criterion of Kauffmann’s classification is exclusively, for it abandoned cultural tests, leaving therefore only a unilateral criterion. By following it one might include Chromobacterium typhi-flavum in the Salmonella genus as well as other bacteria which differ completely from the Salmonella, as long as they are antigenically related. On the other hand, the chart approximates or separates in the different groups of antigen O species or types of salmonellae which are biologically close or almost indistinguishable. The chart has given rise to an excessive number of species and lypes of salmonellae which from 44 in the chart approved by the in 1934 rose ro 60 in Bergey’s Manual and everything leads one to believe that the end is not yet for every day new lypes or species are found. And perforce this must be so for new antigenic factors have been found which give rise to new structural combinations. Applying the formula of combinations (formule) to the factors already known, there are probable possibilities of having 260 different antigenic combinations in group A, or 3260 lypes or species if all the flagellate antigens of the other groups should be found, in it combined 2 and 2. Futher applying the formula of combinations to the other groups there would be possibility of so many combinations that the number of salmonellae would exceed the number of known bacterian species or perhaps the number of those existing on earth. Undoubledly Kauffmann-White’s chart is an improvement, but the bacterian analysis made with it was exaggerated and exceeded the limit of the present possibilities of the realities of life. It revealed interesting aspects of the somatic complexity of bacteria but seems untenable because of its use in pratical sense.

Análise citológica e cariométrica da ação da colchina sôbre a espermatogênese dos hemípteros

The action of colchicine upon the spermatogenesis of Triatoma infestans, (Hemipt. Heteroptera), has been studied and the different categories of giant spermatids that appear during the treatment have been compared with the nuclear volumes of the whole series of normal spermatogenetic stages. The following facts have been ascertained: 1) 4 hours after the treatment the gonial mitotic metaphases, and the 1st. and 2nd. metaphases of meiosis are stopped. The prophasic stages of meiosis and diakynesis appear to be normal. After 9 days of treatment, all the tetrads are broken in the meiotic metaphases and the cells appear with 44 and 22 chromosomes respectively, scattered in the cytoplasm. 2) At 9 days, practically all spermatogenetic stages have disappeared except for a few cysts of spermatogonia, and practically the whole testicle is full of cysts of spermatozoa and spermatid, with some large zones of necrosis with pycnotic nuclei. The spermatids appear to be of different sizes and the statistical analysis of the nuclear volumes gives a polymodal hystogram with 4 modes, whose volumes are in the ratio of 1:2:4:8. Ripe spermatozoa seem to have a certain volume variability, that has not been possible to analyse quantitatively. All these facts confirm what DOOLEY found in the colchicinized Orthoptera testicle. 3) The caryometric analysis conducted statistically on the normal stages of the spermatogenesis (resting spermatogonia, gonial prophases, leptotene, "confused stage", diakynesis, and spermatid) revealed the following facts: a) Considering the volume of the resting, spermatogonia as 1, their mitotic prophases have a volume of 2. Some rare prophases appear to have a volume of 4 and probably belong to tetraployd spermatogonia normally present in the testicle of Hemiptera. b) The first spermatocyte at the beginning of the auxocitary growth (leptotene) has a volume of 2, which is equal to that of them gonial prophase. It grows further during the "confused stage" and reduplicates, reaching thus the volume of 4. Diakynesis has a rather variable nuclear volume and it is higher than volume 4. This is probably of physico-chemical nature and not a growth increase. c) The spermatid at the beginning of the spermiogenetic process has a volume of 1 which is very constant and homogeneous. 4) These results can be summarized concluding that the meiotic process begins from a spermatogonium at the end of his mitotic interphasic growth (vol. 2) and instead of entering into the mitotic prophase transforms itself into the leptotene spermatocyte. During the diplotene ("confused stage") the volume of the nucleus doubles once more and reaches volume 4. In consequence of the two successive meiotic divisions the spermatid, although having an haploid number of chromosomes, has a nuclear volume of 1, just like the diploid spermatogonium. The interpretation of this strange result probably comes from the existence of the "tertiary split" in the chromosomes of the haploid set, that has been illustrated in the Hemiptera by HUGUES SCHRADER and in Orthoptera by MICKEY and co-workers. The tertiary split indicates that the chromosomes of the haploid set are constituted from almost two chromonemata, and this double constitution corresponds to the double cycle of reduplication that takes place during the spermatogenesis starting from the resting gonia. In Triatoma infestans the tertiary split appears in the chromosomes in the 1st. and 2nd. metaphases and in the diakynesis. In the blocked metaphases at the 9th. day of colchicinization some of the 44 elements scattered in the cytoplasm, show, when properly oriented, the split very clearly. Some new and strange facts revealed by SCHRADER and LEUCHTEMBERGER in Arvelius suggest the possibility of other interpretations of the rhythmic growth in special cases. There appears the necessity of more knowledge about the multiple or simple constitution of the chromosomes in somatic and spermatogonial mitosis.

Insertion dans les soins après une première hospitalisation dans un secteur pour psychose [Linkage to care after first hospitalisation for psychosis]

BACKGROUND: First hospitalisation for a psychotic episode causes intense distress to patients and families, but offers an opportunity to make a diagnosis and start treatment. However, linkage to outpatient psychiatric care remains a notoriously difficult step for young psychotic patients, who frequently interrupt treatment after hospitalisation. Persistence of symptoms, and untreated psychosis may therefore remain a problem despite hospitalisation and proper diagnosis. With persisting psychotic symptoms, numerous complications may arise: breakdown in relationships, loss of family and social support, loss of employment or study interruption, denial of disease, depression, suicide, substance abuse and violence. Understanding mechanisms that might promote linkage to outpatient psychiatric care is therefore a critical issue, especially in early intervention in psychotic disorders. OBJECTIVE: To study which factors hinder or promote linkage of young psychotic patients to outpatient psychiatric care after a first hospitalisation, in the absence of a vertically integrated program for early psychosis. Method. File audit study of all patients aged 18 to 30 who were admitted for the first time to the psychiatric University Hospital of Lausanne in the year 2000. For statistical analysis, chi2 tests were used for categorical variables and t-test for dimensional variables; p<0.05 was considered as statistically significant. RESULTS: 230 patients aged 18 to 30 were admitted to the Lausanne University psychiatric hospital for the first time during the year 2000, 52 of them with a diagnosis of psychosis (23%). Patients with psychosis were mostly male (83%) when compared with non-psychosis patients (49%). Furthermore, they had (1) 10 days longer mean duration of stay (24 vs 14 days), (2) a higher rate of compulsory admissions (53% vs 22%) and (3) were more often hospitalised by a psychiatrist rather than by a general practitioner (83% vs 53%). Other socio-demographic and clinical features at admission were similar in the two groups. Among the 52 psychotic patients, 10 did not stay in the catchment area for subsequent treatment. Among the 42 psychotic patients who remained in the catchment area after discharge, 20 (48%) did not attend the scheduled or rescheduled outpatient appointment. None of the socio demographic characteristics were associated with attendance to outpatient appointments. On the other hand, voluntary admission and suicidal ideation before admission were significantly related to attending the initial appointment. Moreover, some elements of treatment seemed to be associated with higher likelihood to attend outpatient treatment: (1) provision of information to the patient regarding diagnosis, (2) discussion about the treatment plan between in- and outpatient staff, (3) involvement of outpatient team during hospitalisation, and (4) elaboration of concrete strategies to face basic needs, organise daily activities or education and reach for help in case of need. CONCLUSION: As in other studies, half of the patients admitted for a first psychotic episode failed to link to outpatient psychiatric care. Our study suggests that treatment rather than patient's characteristics play a critical role in this phenomenon. Development of a partnership and involvement of patients in the decision process, provision of good information regarding the illness, clear definition of the treatment plan, development of concrete strategies to cope with the illness and its potential complications, and involvement of the outpatient treating team already during hospitalisation, all came out as critical strategies to facilitate adherence to outpatient care. While the current rate of disengagement after admission is highly concerning, our finding are encouraging since they constitute strategies that can easily be implemented. An open approach to psychosis, the development of partnership with patients and a better coordination between inpatient and outpatient teams should therefore be among the targets of early intervention programs. These observations might help setting up priorities when conceptualising new programs and facilitate the implementation of services that facilitate engagement of patients in treatment during the critical initial phase of psychotic disorders.

Acute Eosinophilic and Neutrophilic Pneumonia following Transarterial Chemoembolization with Drug-Eluting Beads Loaded with Doxorubicin for Hepatocellular Carcinoma: A Case Report.

At an intermediate or advanced stage, i.e. stage B or C, based on the Barcelona Clinic Liver Cancer classification of hepatocellular carcinoma (HCC), transarterial chemoembolization (TACE) may be offered as a treatment of palliative intent. We report the case of a patient suffering from acute respiratory distress syndrome after TACE with drug-eluting beads loaded with doxorubicin for HCC. To our knowledge, this is the first case described where a bronchoalveolar lavage was performed, and where significant levels of alveolar eosinophilia and neutrophilia were evident, attributed to a pulmonary toxicity of doxorubicin following liver chemoembolization. © 2014 S. Karger AG, Basel.

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting a blood glucose < 150 mg/dL after initial stabilization (2C); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); and a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSIONS: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.