X-ray study in the diagnosis of traumatic mediastinitis and its complications

The study was based on the clinical and X-ray analysis of 68 patients treated at the Thoracoabdominal Surgery, N.V. Sklifosovsky Research Institute of Emergency Care, in 1992-1997. The paper gives pre- and postoperative X-ray findings of patients with mediastinitis. It shows it possible to define the precise location of a mediastinal inflammatory process, its severity and possible complications. The X-ray symptomatology of mediastinitis is presented according to the location and developmental stage of a mediastinal process. Jointly with surgeons, the authors have developed a procedure for X-ray examination of patients in the postoperative period, which involves the study of the course of the disease and the evaluation of the adequacy of performed treatment. The paper analyzes the most specific and severe complications of traumatic mediastinitis. Special emphasis is laid on the fact that during control X-ray studies it is important to keep the procedure that permits timely diagnosis of complications at different developmental stages of mediastinitis.     

Psychological evaluation of young women after medical treatment for central precocious puberty

OBJECTIVE: This study aimed at the evaluation of the subjective experience and long-term behavioral and psychological effects of precocious puberty (PP). METHODS: 19 female patients who had been treated with GnRH agonists participated in a semistructured interview and completed two standardized checklists. Their parents completed the Child Behavior Checklist (CBCL). RESULTS: The CBCL yielded significantly elevated Internalizing and Total Behavior Problem scores. An elevated risk was found for patients with short adult stature and a relatively late onset of PP. The latter tended to neuroticism, to accentuation of their physical appearance, and felt significantly more insecure than age-related non-PP girls. CONCLUSION: Our findings suggest that PP can lead to specific behavioral problems, and that patients with a risk factor may need psychosocial support.     

Behavioral evaluation and demographic information in the assessment of aggressiveness in shelter dogs

Behavioral evaluations of 2017 shelter dogs were used for identifying dogs with aggressive tendencies and for predicting post-adoption behavior problems. Associations between failure of the behavioral evaluation and demographic factors (age, breed, and sex) and the dog's behavioral history, evaluated by logistic regression, were highly significant (P < 0.0005), except for “old” dogs (age > 72 months). Dogs that failed the behavior evaluation were not placed for adoption; therefore it was not possible to study prospectively the capability of behavioral evaluation to predict future aggressiveness in these dogs. Instead we developed tests for classifying dogs as aggressive or not aggressive based on their demographic factors and behavior evaluation outcomes. The results were compared retrospectively to the dogs’ known behavioral histories, which were obtained at intake to the shelter. This allowed estimation of the sensitivity, specificity, and accuracy of the classification tests. The most significant postdictor (i.e., “retrospective predictor”) of aggressiveness was failure of the behavioral evaluation (odds ratio 11.83, P < 0.0005). Among dogs that passed the behavioral evaluation, classification as “unsocial” by the behavioral evaluation was associated with nonaggressive behavior problems reported at 6-month follow-up (P = 0.005), and classification as “borderline” was associated with return to the shelter for aggressive behavior (P = 0.028). Behavioral evaluations reduced the rate of returns of adopted dogs from 19% in the year prior to their institution to 14% (P = 0.001) during the 2-year study period. Returns for aggression were reduced from 5% to 3.5% (P = 0.05), with many fewer incidents of serious aggression. The majority of dogs (86%) that failed the behavioral evaluation failed multiple component tests, indicating general aggressive tendencies in these dogs. Together with demographic information and behavioral history, behavioral evaluations can help to improve decisions regarding the disposition of shelter dogs.     

The role of stereotactic amygdalotomy in the treatment of temporal lobe epilepsy associated with behavioral disorders

The efficacy of bilateral stereotactic amygdalotomy for the treatment of aggressive behavioral disorders has been evaluated in a retrospective study of 67 cases. In addition 4 cases with complex partial seizures accompanied by aggressive outbursts revealing a unilateral epileptogenic focus in the amygdala or periamygdala region during preoperative stereoelectroencephalographic (SEEG) evaluation received a unilateral stereotactic amygdalotomy. Long-term follow-up of these 4 cases shows that 3 patients had considerable improvement in seizure frequency and severity as well as behavioral disturbances. The results in the remaining patients evaluated by surface EEG were inconclusive.     

Review and Meta‐analysis of Pharmacotherapy for Binge‐eating Disorder

This study evaluated available controlled treatment studies to determine utility of pharmacotherapy for binge‐eating disorder (BED). The authors identified randomized placebo‐controlled trials testing pharmacotherapy‐only treatments and controlled trials testing pharmacotherapy with psychotherapy treatments. Meta‐analysis was performed on placebo‐controlled trials with data for attrition, remission, and weight loss. Qualitative review was performed on remaining controlled treatment literature. A total of 33 studies were considered of which 14 studies with a total of 1,279 patients were included in the meta‐analysis of pharmacotherapy‐only treatment and 8 studies with a total of 683 patients were included in the qualitative review of pharmacotherapy combined with psychotherapy interventions. No evidence suggested significant differences between medication and placebo for attrition. Evidence suggested that pharmacological treatments have a clinically significant advantage over placebo for achieving short‐term remission from binge eating (48.7% vs. 28.5%) and for weight loss, although weight losses are not substantial. No data exist to allow evaluation of longer‐term effects of pharmacotherapy‐only treatment for BED. Combining medications with psychotherapy interventions failed to significantly enhance binge outcomes, although specific medications (orlistat, topiramate) enhanced weight losses achieved with cognitive behavioral therapy and behavioral weight loss. In summary, BED patients can be advised that certain pharmacotherapies may enhance likelihood of stopping binge eating short term, but that longer‐term effects are unknown. Although some weight loss may occur, it is unlikely to be substantial with available medications. Combining medications with cognitive or behavioral treatments is unlikely to enhance binge outcomes, but specific medications (orlistat, topiramate) may enhance weight losses, albeit modestly.     

Complex of immunological characteristics for the diagnostics of pancreatogenic immunodeficiency

The results of the immunological study of blood in 89 patients with severe acute pancreatitis (SAP) were analyzed. Immune reactions in SAP were characterized by the presence of moderate leukocytosis, an increase in the phagocytic and metabolic activity of neutrophils, relative lymphopenia, a decrease in the number of B-lymphocytes. The average values of the parameters of the immunogram of patients with the favorable course of the disease on days 2 - 3 were analogous to the average population values in 89 examinees. The direction and the degree of manifestation were slightly variable and could be registered within one standard quadratic deviation. Such heterogeneity in the character of immune reactions made it possible to regard the average values of the immunogram parameters of these patients as "the norm". For the objective evaluation of the immune status of SAP patients a scale for the evaluation, in points, of disturbances in immune reactions to the destructive process in the pancreas was developed. This scale for the evaluation, in points, of the severity of disturbances in the immune status of SAP patients made it possible to prognosticate the development of complications.     

Information measures: statistical confidence limits and inference

This paper presents tested statistical methods for reducing sampling bias in, for assigning approximate confidence bounds to, and for testing hypotheses about information-theoretic measures used in the study of animal communication and in behavioral sequence analysis. These procedures are also applicable in fields other than animal behavior, including psychology and ecology. Results of a Monte Carlo evaluation of the methods, including comparison of these techniques with possible alternative procedures, are presented.     

Behavioral flexibility in rats and mice: contributions of distinct frontocortical regions

Research examining the contribution of genetics to behavior is increasingly focused on higher order behavioral and cognitive processes including the ability to modify behaviors when environmental demands change. The frontal cortices of mammals, including rodents, subserve a diverse set of behavioral and cognitive functions including motor planning, social behavior, evaluation of expected outcomes and working memory, which may be particularly sensitive to genetic factors and interactions with experience (e.g. stress). Behavioral flexibility is a core attribute of these functions. This review orients readers to the current landscape of the literature on the frontocortical bases of behavioral flexibility in rodent laboratory experiments. Studies are divided into three broad categories: reversal learning, inhibitory learning and set‐shifting. Functional dissociations within the broader scope of behavioral flexibility are reviewed, followed by discussion of the associations between specific components of frontal cortex and specific aspects of relevant behavioral processes. Finally, the authors identify open questions that need to be addressed to better establish the constituents of frontal cortex underlying behavioral flexibility.     

SOCIAL, ECONOMIC AND CULTURAL DIMENSIONS OF SENSORY EVALUATION AND ITS POSSIBLE APPLICATIONS TO THE VARIOUS DISCIPLINES OF HOME ECONOMICS IN THE PHILIPPINES

Sensory evaluation is a scientific method that deals with precision, accuracy and sensitivity. Its basic principles are in large part anchored on the natural sciences, such as biology, chemistry, mathematics and physics. However, sensory evaluation goes beyond such platforms and has its own social, economic and cultural facets. Sensory evaluation has been extensively used in the study of consumer items such as food and clothing, and lately on behavioral and physiological reactions. It has been an integral part of the food science curriculum in various universities. However, the other disciplines of home economics, such as clothing technology, family life and child development, home economics education, hotel, restaurant and institution management, interior design and community nutrition, which deal with the needs of families and consumers, have not fully maximized the use of sensory evaluation. The multidisciplinary nature of home economics will push sensory evaluation to a more diverse level of relevance and purpose. This paper presented the social, economic and cultural dimensions of sensory evaluation along with its possible applications in the various disciplines of home economics in the Philippines.

PRACTICAL APPLICATIONS

The paper provided a wholistic view of sensory evaluation not merely as a scientific method but its important social, cultural and economic dimensions. This document can serve as a guide for students, teachers and professionals in the conduct of sensory assessments. Likewise, this will help home economists not only in the Philippines but also in other countries to maximize the use of sensory evaluation in improving the quality of life of families and consumers. Moreover, this can drive multidisciplinary undertakings utilizing sensory evaluation as the key concept and thus enrich the pool of knowledge both in the natural and social sciences and their interaction.     

Current data on the exploration and the evaluation of clinical pain]

Pain is a complex, multidimensional and multifactorial neuropsychological phenomenon with sensory-discriminative, affective, cognitive and behavioral components. Issues on pain assessment are related to the objective evaluation of a subjective phenomenon. Different levels of evaluation are to be considered. Some methods like visual analogue scale, numerical scale and verbal permit a global pain estimation. The aim of other methods like the McGill Pain Questionnaire is a quantitative and qualitative evaluation of the sensory and affective pain components. The measure of objective behavioral changes is an interesting approach, but at the present time there is no valid, simple and commonly used method. There is also a need for methods permitting a better exploration of a pain, and in particular a selective evaluation of organic and functional factors. The limits of psychological factors evaluation are reported.     

糖化血红蛋白与糖尿病及其并发症的关系

目的：探讨糖化血红蛋白（HbAlc）与糖尿病诊断、疗效评价及并发症的关系。方法：选择2型糖尿病患者250例和健康体检者150例,分别测定空腹血糖（FPG）、2h血糖（2hPG）及糖化血红蛋白（HbAlc）,统计学分析HbAlc与FPG、2hPG的相关性;分析HbAlc与糖尿病并发症发生的关系。结果：糖尿病组FPG、2hPG及HbAlc水平均显著高于对照组（P〈0．01）;糖尿病伴有并发症患者的HbAlc明显高于无并发症者（P〈0．05）,HbAlc水平与糖尿病并发症的发生率存在高度相关性（P〈0．01）。结论：检测外周血中HbAlc水平对2型糖尿病诊断、疗效评价具有重要,临床价值,控制糖化血红蛋白对预防糖尿病并发症的发生具有重要意义。     

Privileged Communications—The Effect of California's New Evidence Code As It Concerns Physicians and Psychotherapists

A physician has an ethical duty to hold in confidence communications made to him by his patient. A legal recognition of this ethical duty is found in the concept of privilege, which is the subject of this article. January 1967 will bring to California physicians a new protection for patients'' communications. The physician-patient privilege has been redefined to include confidential communications made during diagnostic evaluation, those made to non-licensed physicians, interns and medical aides, and those overheard by eavesdroppers. There has been added a psychotherapist-patient privilege designed to facilitate communications required in psychotherapy as well as in behavioral research.This paper first presents a brief historical background and discusses the protections and limitations afforded by the new California Evidence Code. There follows a section on the psychotherapist-patient privilege with the recommendation that in the context of psychotherapy, patients of physicians who are not psychiatrists should be afforded the additional benefits of the psychotherapist-patient privilege. Lastly, advice is given concerning the physician''s conduct in relation to his duty to claim privilege under the new code.     

Recent Advances in Behavioral Research in Geriatric Dentistry1

This paper examines recent studies in behavioral science and health services aspects of geriatric dentistry. With the increased focus on special needs of older patients, researchers have become concerned with psychological and sociocultural factors that influence older people's oral health status, behavior, and attitudes. Studies of dental service utilization patterns among subgroups of the elderly, including those in long-term care settings, will be reviewed. Research on methods to improve oral health care behaviors will be discussed, with their implications for developing oral health promotion and service delivery programs. The special oral health needs of cognitively impaired and frail elderly will be reviewed. Studies of clinical decision-making in geriatric dentistry have been conducted. These studies have revealed significant gaps in dental professionals' knowledge and attention to the special needs of older patients. This and other aspects of behavioral research suggest the need for better methods to disseminate research findings in geriatric dentistry to clinical practice in this field. The presentation will discuss ways of improving dissemination and transfer of research findings to the clinical management of aged patients.     

Automated sleep breath disorders detection utilizing patient sound analysis

Results of clinical studies suggest that there is a relationship between breathing-related sleep disorders and behavioral disorder and health effects. Apnea is considered one of the major sleep disorders with great accession in population and significant impact on patient's health. Symptoms include disruption of oxygenation, snoring, choking sensations, apneic episodes, poor concentration, memory loss, and daytime somnolence. Diagnosis of apnea and breath disorders involves monitoring patient's biosignals and breath during sleep in specialized clinics requiring expensive equipment and technical personnel. This paper discusses the design and technical details of an integrated low-cost system capable for preliminary detection of sleep breath disorders at patient's home utilizing patient sound signals. The paper describes the proposed architecture and the corresponding HW and SW modules, along with a preliminary evaluation.     

Early amygdala reaction to fear spreading in occipital, temporal, and frontal cortex: a depth electrode ERP study in human

The amygdala involvement in fear processing has been reported in behavioral, electrophysiological, and functional imaging studies. However, the literature does not provide precise data on the temporal course of facial emotional processing. Intracranial event-related potentials to facial expressions were recorded in epileptic patients implanted with depth electrodes during a presurgical evaluation. Specific potentials to fear beginning 200 ms poststimulus were observed in amygdala, both individually in two patients and in a ten patient population study. These potentials occurred 100 ms earlier than potentials to disgust recorded in insula in a previous study. Potentials to fear were confined in amygdala during a first transient period and then, during a second period of sustained activity, spread to occipito-temporal, anterior temporal, and orbitofrontal cortex in two patients. This study clarifies the temporal course of the involvement of these structures known to be part of a neural network recruited to process emotional information.     

Cost effectiveness of biofeedback and behavioral medicine treatments: A review of the literature

This paper reviews multicomponent behavioral medicine studies that contain cost-effectiveness andor cost-benefit data relevant to the field of biofeedback and relaxation training, primarily when assisted by biofeedback, with or without stress management, in the treatment of psychosomatic illness and pain. A model for evaluating biofeedback treatment is presented. Cost-effectiveness data concerning reduction in physician visits and/or medication use, decrease in medical care costs to patients, reduction in hospital stays and rehospitalization, reduction of mortality, and enhanced quality of life are reviewed. Evidence suggests that multicomponent behavioral medicine treatments are cost-effective on all dimensions reviewed. Cost/benefit ratios range between 1:2 and 1:5, with a median of 1:4. Evidence that could increase the cost effectiveness of biofeedback is reviewed.This work first appeared in a paper presented as the presidential address at the 18th annual meeting of the Biofeedback Society of America, Boston, March 15, 1987.     

Influencia de la enfermedad psiquiátrica previa en la evolución de los pacientes sometidos a cirugía bariátrica

IntroductionPresurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.Patients and methodsRetrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up > 6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).ResultsPatients in group 1 showed a greater tendency for weight gain. They regained a 9,4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p < 0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19,6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 ± 1.6 nutritional deficiencies per patient in group 1 and 2.5 ± 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).ConclusionsThe presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.     

Deficits in Facial Emotion Recognition Indicate Behavioral Changes and Impaired Self-Awareness after Moderate to Severe Traumatic Brain Injury

Traumatic brain injury (TBI) is a leading cause of disability, specifically among younger adults. Behavioral changes are common after moderate to severe TBI and have adverse consequences for social and vocational functioning. It is hypothesized that deficits in social cognition, including facial affect recognition, might underlie these behavioral changes. Measurement of behavioral deficits is complicated, because the rating scales used rely on subjective judgement, often lack specificity and many patients provide unrealistically positive reports of their functioning due to impaired self-awareness. Accordingly, it is important to find performance based tests that allow objective and early identification of these problems. In the present study 51 moderate to severe TBI patients in the sub-acute and chronic stage were assessed with a test for emotion recognition (FEEST) and a questionnaire for behavioral problems (DEX) with a self and proxy rated version. Patients performed worse on the total score and on the negative emotion subscores of the FEEST than a matched group of 31 healthy controls. Patients also exhibited significantly more behavioral problems on both the DEX self and proxy rated version, but proxy ratings revealed more severe problems. No significant correlation was found between FEEST scores and DEX self ratings. However, impaired emotion recognition in the patients, and in particular of Sadness and Anger, was significantly correlated with behavioral problems as rated by proxies and with impaired self-awareness. This is the first study to find these associations, strengthening the proposed recognition of social signals as a condition for adequate social functioning. Hence, deficits in emotion recognition can be conceived as markers for behavioral problems and lack of insight in TBI patients. This finding is also of clinical importance since, unlike behavioral problems, emotion recognition can be objectively measured early after injury, allowing for early detection and treatment of these problems.     

Enhanced persistency of resting and active periods of locomotor activity in schizophrenia

Patients with schizophrenia frequently exhibit behavioral abnormalities associated with its pathological symptoms. Therefore, a quantitative evaluation of behavioral dynamics could contribute to objective diagnoses of schizophrenia. However, such an approach has not been fully established because of the absence of quantitative biobehavioral measures. Recently, we studied the dynamical properties of locomotor activity, specifically how resting and active periods are interwoven in daily life. We discovered universal statistical laws ("behavioral organization") and their alterations in patients with major depressive disorder. In this study, we evaluated behavioral organization of schizophrenic patients (n?=?19) and healthy subjects (n?=?11) using locomotor activity data, acquired by actigraphy, to investigate whether the laws could provide objective and quantitative measures for a possible diagnosis and assessment of symptoms. Specifically, we evaluated the cumulative distributions of resting and active periods, defined as the periods with physical activity counts successively below and above a predefined threshold, respectively. Here we report alterations in the laws governing resting and active periods; resting periods obeyed a power-law cumulative distribution with significantly lower parameter values (power-law scaling exponents), whereas active periods followed a stretched exponential distribution with significantly lower parameter values (stretching exponents), in patients. Our findings indicate enhanced persistency of both lower and higher locomotor activity periods in patients with schizophrenia, probably reflecting schizophrenic pathophysiology.     

Liquid chromatographic method for the quantitative determination of Nepsilon-carboxymethyllysine in human plasma proteins

The modification of the lysine moieties of proteins to Nepsilon-carboxymethyllysine (CML) is supposed to play a major role in the development of long-term complications in patients with diabetes mellitus. This paper presents an analytical method for the quantitative determination of CML in plasma proteins, which could be used for studying the development of diabetic complications. The method is based on isolating proteins from plasma by precipitation with trichloroacetic acid and hydrolysing these under acidic conditions (6M hydrochloric acid at 110 degrees C for 20 h) to the individual amino acids. After hydrolysis, CML is derivatised along with the other amino acids to 9-fluorenylmethoxycarbonyl (FMOC) derivatives, which are subsequently separated by reversed-phase column liquid chromatography using a 150 mm x 4.6 mm C8 column and a mobile phase of 25 mM potassium phosphate buffer (pH 2.0) and acetonitrile (80:20 (v/v)) and detected using fluorescence detection (excitation at 260 nm and emission at 310 nm). Quantification of the protein-bound CML content of a plasma sample is achieved using standard addition. The impact of several aspects of the sample preparation and chromatography on method performance is discussed. Method evaluation results are reported and show that this method is capable of determining CML with good accuracy and precision (below 10%) in the relevant concentration range (1-10 microg/ml), with a limit of detection of 0.2 microg/ml.