Anxiety and defense styles in eating disorders

This study investigates anxiety and defense styles in eating disorders. Seventy eating disorder (ED) patients and fifty-one female matched control subjects completed State and Trait Anxiety Inventory (STAI) and 88-items Defense Style Questionnaire (DSQ). ED patients were more anxious in actual situations and more anxiety prone in general. They relied on maladaptive action and Image distorting defense style. Bulimic anorexic (BAN) patients and bulimia nervosa (BN) patients differed in defense styles from restrictive anorexic (RAN) patients who displayed no significant difference in either state and trait anxiety or in defense styles when compared to healthy patients. Different levels of anxiety and ego defense maturity are present in ED patients. The almost normal ego functioning of RAN patients could be explained by pseudomaturity, tendency to control external and internal environment and the unconscious efforts to imitate normality to avoid conflicts.     

Synthesis and characterization of new dinuclear complexes of molybdenum(V) with β′-hydroxy-β-enaminones

New dinuclear molybdenum(V) complexes have been obtained by the reaction of [Mo₂O₃(acac)₄] (acac=acetilacetonate ion) with the polydentate ligands, β′-hydroxy-β-enaminones. All prepared complexes consist of Mo₂O₄ ²⁺ core coordinated by two ligands as in the β-diketonates only through two donor oxygen atoms. Such bonding gives the opportunity for the sixth coordination place around molybdenum to be completed by the monodentate solvent molecule D. All compounds have been characterized by means of elemental analyses, one- and two-dimensional NMR spectroscopy, IR spectroscopy as well as by thermal analyses. The molecular and crystal structures of the molybdenum(V) complexes 1a and 1b coordinated by two different isomeric ligands as well as of the isomer a itself have been determined by a single crystal X-ray diffraction method.     

Association of refractory complex partial seizures with a polymorphism of ApoE genotype

Apolipoprotein E (ApoE) is a constituent of many types of lipoproteins that play a role in metabolism of cholesterol and lipids in the body as well as in the brain. ApoE is synthesised in astrocytes and microglia and enter to neurons through LDL, LRP and VLDL receptors. Recently it was shown that ApoE is also produced in neurons. ApoE has a role in modulating learning and memory, structural plasticity, mobilization of cholesterol in repair, growth and maintenance of myelin and neuronal membranes during development and aging, and cell death after ischemic, convulsive, or other type of brain injury. The aim of this research was to investigate the possible association of ApoE gene polymorphism with the development of resistance to pharmacological therapy in patients with partial complex seizures with or without secondary generalization. In this prospective matched-pair controlled study, 60 patients with cryptogenic epilepsy with complex partial seizures, with or without secondary generalization, who have been suffering for five or more years, were studied. The first group comprised 30 patients refractory to the current therapy, while the second group consisted of patients with well-controlled seizures. The refractory and non-refractory groups of patients differed significantly in their phenotypes. Phenotype E3/4 was six times more frequent in refractory group than among non-refractory group. The lack of response was shown to be significantly associated with the presence of epsilon4 allele. This study provided evidence that the presence of epsilon4 allele is more often associated with a lack of response to current antiepileptic drugs as compared to epsilon2 and epsilon3 alleles.     

A mathematical model for interpretable clinical decision support with applications in gynecology

Background

Over time, methods for the development of clinical decision support (CDS) systems have evolved from interpretable and easy-to-use scoring systems to very complex and non-interpretable mathematical models. In order to accomplish effective decision support, CDS systems should provide information on how the model arrives at a certain decision. To address the issue of incompatibility between performance, interpretability and applicability of CDS systems, this paper proposes an innovative model structure, automatically leading to interpretable and easily applicable models. The resulting models can be used to guide clinicians when deciding upon the appropriate treatment, estimating patient-specific risks and to improve communication with patients.

Methods and Findings

We propose the interval coded scoring (ICS) system, which imposes that the effect of each variable on the estimated risk is constant within consecutive intervals. The number and position of the intervals are automatically obtained by solving an optimization problem, which additionally performs variable selection. The resulting model can be visualised by means of appealing scoring tables and color bars. ICS models can be used within software packages, in smartphone applications, or on paper, which is particularly useful for bedside medicine and home-monitoring. The ICS approach is illustrated on two gynecological problems: diagnosis of malignancy of ovarian tumors using a dataset containing 3,511 patients, and prediction of first trimester viability of pregnancies using a dataset of 1,435 women. Comparison of the performance of the ICS approach with a range of prediction models proposed in the literature illustrates the ability of ICS to combine optimal performance with the interpretability of simple scoring systems.

Conclusions

The ICS approach can improve patient-clinician communication and will provide additional insights in the importance and influence of available variables. Future challenges include extensions of the proposed methodology towards automated detection of interaction effects, multi-class decision support systems, prognosis and high-dimensional data.     

A proactive approach to migraine in primary care: a pragmatic randomized controlled trial

Background:

Migraine is a common, disabling headache disorder that leads to lost quality of life and productivity. We investigated whether a proactive approach to patients with migraine, including an educational intervention for general practitioners, led to a decrease in headache and associated costs.

Methods:

We conducted a pragmatic randomized controlled trial. Participants were randomized to one of two groups: practices receiving the intervention and control practices. Participants were prescribed two or more doses of triptan per month. General practitioners in the intervention group received training on treating migraine and invited participating patients for a consultation and evaluation of the therapy they were receiving. Physicians in the control group continued with usual care. Our primary outcome was patients’ scores on the Headache Impact Test (HIT-6) at six months. We considered a reduction in score of 2.3 points to be clinically relevant. We used the Kessler Psychological Distress Scale (K10) questionnaire to determine if such distress was a possible effect modifier. We also examined the interventions’ cost-effectiveness.

Results:

We enrolled 490 patients in the trial (233 to the intervention group and 257 to the control group). Of the 233 patients in the intervention group, 192 (82.4%) attended the consultation to evaluate the treatment of their migraines. Of these patients, 43 (22.3%) started prophylaxis. The difference in change in score on the HIT-6 between the intervention and control groups was 0.81 (p = 0.07, calculated from modelling using generalized estimating equations). For patients with low levels of psychological distress (baseline score on the K10 ≤ 20) this change was −1.51 (p = 0.008), compared with a change of 0.16 (p = 0.494) for patients with greater psychological distress. For patients who were not using prophylaxis at baseline and had two or more migraines per month, the mean HIT-6 score improved by 1.37 points compared with controls (p = 0.04). We did not find the intervention to be cost-effective.

Interpretation:

An educational intervention for general practitioners and a proactive approach to patients with migraine did not result in a clinically relevant improvement of symptoms. Psychological distress was an important confounder of success. (Current Controlled Trials registration no. ISRCTN72421511.)Migraine is a common, disabling headache disorder that results in lost quality of life and productivity, both during and between attacks.^1–8 Many patients with migraine suffer unnecessarily because they are not using their medications appropriately, or they are unaware of the possibility of prophylactic treatment. In the Netherlands, 3% of patients who take triptans consume 12 or more doses of the drug each month.⁹ These patients account for almost half of the costs associated with triptan use.¹⁰ In addition, although more than 25% of patients with migraine have two or more attacks each month, making them eligible for preventive treatment, only 8%–12% of patients use prophylaxis.^2,3,11–13 More than half of the patients with migraine in Dutch primary care who have an indication for prophylaxis have not discussed that option with their general practitioner.¹³We investigated whether a proactive approach to identifying patients with migraine who are receiving suboptimal treatment (i.e., inviting them to a consultation to evaluate their current treatment regimen and advising them about the options available for treating their migraine) could increase the use of preventive treatment and reduce the overuse of triptans, thereby reducing headache recurrence and associated costs. Our intervention involved educational sessions for general practitioners. Earlier studies aimed at reducing the overuse of other medications in primary care, such as benzodiazepines and acid-repressive drugs, showed that a proactive intervention led to a reduction in the use of medications.^14,15Because most patients with migraine in the Netherlands are treated by their general practitioner, we evaluated the costs and effects of a proactive approach to migraine in primary care. We included patients who had two or more attacks per month, because improvement could be reasonably expected in this group.     

Tissue distribution of lipid peroxidation product acrolein in human colon carcinogenesis

Lipid peroxidation product acrolein, well-known pollutant in tobacco and automotive smoke, accumulates in vivo bound to proteins. It suppresses p53 synthesis acting as potent carcinogenic factor for oral, respiratory and bladder carcinomas, while its possible association with colon carcinogenesis was not studied so far. We used genuine monoclonal antibody to evaluate immunohistochemical distribution of acrolein-protein adducts in 113 human colon tumours. The presence of acrolein-protein adducts was increasing with respect to colon carcinogenesis, from moderate appearance in tubular and villotubular low-grade adenomas to abundant and diffuse distribution in high-grade villotubular adenomas and Dukes A carcinomas. However, in advanced Dukes B and C carcinomas acrolein was hardly noticed, although, its protein adducts were found abundant in non-malignant colon epithelium of these patients. There was no relationship between p53 and acrolein distribution. According to these findings, acrolein seems to be lipid peroxidation product associated with transition from benign into malignant colon tumours.     

Quality of Life after Gastric Bypass Surgery: A Cross-Sectional Study

Objective: Numerous reports document significant weight loss after gastric bypass; however, there is little objective data on postsurgical changes in health-related quality of life (HRQL). Research Methods and Procedures: This study examined HRQL in four groups of patients: presurgery (T1), several weeks postsurgery (T2), 6 months postsurgery (T3), and 1 year postsurgery (T4). Subjects were given three HRQL measures: the short form 36 (SF-36), the Impact of Weight on Quality of Life-Lite Questionnaire (IWQOL-Lite), and the Bariatric Analysis and Reporting Outcome System (BAROS). Subjects also completed the Beck Depression Inventory (BDI) and the Rosenberg Self-Esteem Scale (RSE). Results: There were no significant differences among the groups on demographics or presurgical body mass index. Results showed significant differences between T1 and T2 on several SF-36 and IWQOL-Lite subscales, as well as the RSE and BDI. Significant differences were found on all measures between T2 and T3. Significant differences were found on all subscales of the IWQOL-Lite, but no subscales of the SF-36, the RSE, or the BDI between T3 and T4. Discussion: This study is the first to objectively document these differences in several objective measures of HRQL, depression, and self-esteem after gastric bypass in a large sample. It is notable that many differences are apparent within several weeks after surgery. Furthermore, results indicate that the IWQOL-Lite may be more sensitive than the SF-36 to the changes of quality of life that gastric bypass patients report.