Trauma Exposure and Posttraumatic Stress Disorder in Adolescents: A National Survey in Switzerland

There are a limited number of epidemiological studies that have focused on trauma exposure and prevalence of posttraumatic stress disorder (PTSD) in representative general population samples of adolescents, especially outside of the United States. We therefore aimed to assess the lifetime prevalence of traumatic events (TEs) and current prevalence of PTSD, and to examine demographic risk factors for TEs and PTSD in a representative sample of adolescents. Data were collected by a school survey among a sample of 6,787 9th‐grade students in Switzerland. Roughly 56% of the adolescents (females 56.6%; males 55.7%) reported having experienced at least 1 TE. Non‐Swiss nationality (OR = 1.80), not living with both biological parents (OR = 1.64), and lower parental education (OR = 1.18) were associated with a higher risk of trauma exposure. The current prevalence of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000) criteria was 4.2% (females 6.2%; males 2.4%). Female gender (OR = 2.70), not living with both biological parents (OR = 1.47), lower parental education (OR = 1.51), and exposure to multiple TEs (OR = 9.56) were significant risk factors for PTSD. Results suggest considerably high rates of TEs and PTSD among adolescents. Intervention efforts must be intensified to reduce trauma exposure and treat PTSD.     

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: A randomised controlled trial

Background

In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans.

Objective

The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences.

Design

A randomised, single-blind controlled trial study design was used.

Settings

This study involved seven hospitals and 10 obstetricians in Taiwan.

Participants

Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n = 155) or control (n = 141) groups.

Methods

The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations.

Results

The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t = 2.48, p = 0.01). The experimental group also showed a higher degree of childbirth control (t = 9.60, p < 0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t = 2.63, p = 0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t = 3.74, p < 0.001) in the experimental group than in the control group.

Conclusions

The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.     

Effects of sulfonylureas on the synthesis and secretion of plasminogen activator from bovine aortic endothelial cells.

The effects of sulfonylureas on the production of plasminogen activator (PA) and antiactivator (PAI) were investigated using bovine aortic endothelial cells. All compounds studied stimulated PA release (1.3- to 5.2-fold), with glipizide being the most potent, followed by tolazamide, chlorpropamide, and tolbutamide, in that order, while glyburide was the least effective. Both tissue-type and urokinase-type PA production was enhanced. Studies using metabolic inhibitors indicated that both RNA and protein syntheses are required for the sulfonylurea-mediated stimulation of PA release. In addition to continuous release of the two PAs, there was also a continuous release of a single PAI, which did not show an increase after the sulfonylureas. These results suggest that, in addition to their beneficial effects in the treatment of diabetes mellitus, some sulfonylurea compounds may also have significant thrombolytic effects. These results also suggest that pharmacological enhancement of PA production by vascular endothelial cells may be a promising antithrombotic mechanism.     

Plumbagin (5-hydroxy-2-methyl-1,4-naphthoquinone) induces apoptosis and cell cycle arrest in A549 cells through p53 accumulation via c-Jun NH2-terminal kinase-mediated phosphorylation at serine 15 in vitro and in vivo

This study first investigates the anticancer effect of plumbagin (5-hydroxy-2-methyl-1,4-naphthoquinone) in human nonsmall cell lung cancer cells, A549. Plumbagin has exhibited effective cell growth inhibition by inducing cancer cells to undergo G2/M phase arrest and apoptosis. Blockade of cell cycle was associated with increased levels of p21 and reduced amounts of cyclinB1, Cdc2, and Cdc25C. Plumbagin treatment also enhanced the levels of inactivated phosphorylated Cdc2 and Cdc25C. Blockade of p53 activity by dominant-negative p53 transfection partially decreased plumbagin-induced apoptosis and G2/M arrest, suggesting it might be operated by p53-dependent and independent pathway. Plumbagin treatment triggered the mitochondrial apoptotic pathway indicated by a change in Bax/Bcl-2 ratios, resulting in mitochondrial membrane potential loss, cytochrome c release, and caspase-9 activation. We also found that c-Jun NH2-terminal kinase (JNK) is a critical mediator in plumbagin-induced cell growth inhibition. Activation of JNK by plumbagin phosphorylated p53 at serine 15, resulting in increased stability of p53 by decreasing p53 and MDM2 interaction. SP600125 (anthra [1,9-cd]pyrazol-6(2H)-one-1,9-pyrazoloanthrone), a specific inhibitor of JNK, significantly decreased apoptosis by inhibiting the phosphorylation of p53 (serine 15) and subsequently increased the interaction of p53 and MDM2. SP6000125 also inhibited the phosphorylation of Bcl-2 (Ser70) induced by plumbagin. Further investigation revealed that plumbagin's inhibition of cell growth effect was also evident in a nude mice model. Taken together, these results suggest a critical role for JNK and p53 in plumbagin-induced G2/M arrest and apoptosis of human nonsmall cell lung cancer cells.     

High 18F-Fluorothymidine Uptake for Invasive Thymoma

ABSTRACT: We report an invasive thymoma discovered incidentally by an F-FLT (fluorothymidine) PET study on a 48-year-old woman. The patient had equivocal breast lesions in her bilateral breasts. She entered a clinical F-FLT PET trial in our hospital to differentiate malignant breast tumors from benign ones. No F FLT-avid lesions in her breasts were revealed. But an intense F-FLT uptake lesion was noted in her right anterior mediastinum. However, an F-FDG PET scan showed only mild F-FDG uptake in the lesion. Video-assisted thoracic surgery thymectomy was subsequently performed, and the final pathology showed invasive thymoma.     

Decreased Cerebellar Activity on FDG PET/CT Secondary to Diffuse Idiopathic Cerebellar Calcification

ABSTRACT: Cerebellar hypometabolism on FDG PET has been described in several conditions, for example, chronic alcohol abuse, antiepileptic medication use, multiple system atrophy, and cerebellar infarction. Corresponding cross-sectional examination is paramount in distinguishing possible etiologies because each condition has a relatively characteristic appearance. We present a case of an asymptomatic patient with diffuse cerebellar hypometabolism found incidentally on FDG PET/CT performed for suspected recurrence of gastric carcinoma. Accompanying CT images demonstrated calcification of the cerebellum and therefore confirmed the etiology of diffuse idiopathic cerebellar calcification. Identifying this diagnosis is critical for using the cerebellum as a standard to evaluate other brain structures.     

Brain natriuretic peptide (BNP) testing in the emergency department

In the past decade a large amount of attention has been focused on brain natriuretic peptide (BNP) testing in the evaluation of patients with acute dyspnea as well as the screening of patients for congestive heart failure (CHF). Because BNP is secreted by myocytes in response to ventricular stretch, it has long been thought that BNP could become a biochemical marker for CHF. Rapid assays have been developed and BNP testing has been studied in detection of CHF and predictive outcomes in a large variety of settings. We review the clinical evidence associated with the use of BNP testing in the acute care setting. We conclude with a discussion of clinical utility in the emergency department for the evaluation of patients presenting with acute dyspnea.     

Resuscitation from experimental traumatic brain injury by agmatine therapy

Both nitric oxide and glutamate contribute to ischaemic brain injury. Agmatine inhibits all isoforms of nitric oxide synthase and blocks N-methyl-d-aspartate receptors. In this study, we gave agmatine intraperitoneally and assessed its effect on fluid percussion brain injury in rats. Anaesthetised rats, immediately after the onset of fluid percussion traumatic brain injury (TBI), were divided into two major groups and given the vehicle solution (1mL/kg) or agmatine (50mg/kg) intraperitoneally. Mean arterial pressure, intracranial pressure, cerebral perfusion pressure, and levels of glutamate, nitric oxide, lactate/pyruvate ratio, and glycerol in hippocampus were monitored continuously within 120min after TBI. The weight loss was determined by the difference between the first and third day of body weight after TBI. The maximal grip angle in an inclined plane was measured to determine motor performance whereas the percent of maximal possible effect was used to measure blockade of proprioception. The triphenyltetrazolium chloride staining procedures were used for cerebral infarction assay. Compared to those of the sham-operated controls, the animals with TBI had higher values of extracellular levels of glutamate, nitric oxide, lactate-to-pyruvate ratio, and glycerol in hippocampus and intracranial pressure, but lower values of cerebral perfusion pressure. Agmatine administered immediately after TBI significantly attenuated the TBI-induced increased hippocampal levels of glutamate, nitric oxide, lactate-to-pyruvate ratio, and glycerol, intracranial hypertension, and cerebral hypoperfusion. In addition, the TBI-induced cerebral infarction, motor and proprioception deficits, and body weight loss evaluated 3 days after TBI were significantly attenuated by agmatine therapy. The present data indicate that agmatine may attenuate TBI by reducing the excessive accumulation of both glutamate and nitric oxide in the brain.     

The lived experience of postpartum women receiving rooming-in care

A phenomenological study was conducted to explore the lived experience of postpartum women receiving rooming-in care. Subjects (n = 21) were recruited from a medical center in Taichung. Data were collected by a demographic questionnaire, open-ended interview guide and a tape recorder. Content analysis by Giorgi's method was used, and identified four themes. Because of early contact women who receive rooming-in care in postpartum can perceive the happiness and suffering of nursing their baby, promote the success of breastfeeding, and increase family cohesion, but in this process women also have some needs and concerns. The results of this study can enable professional staff to understand the lived experience of postpartum woman receiving rooming-in care, so that nurses can provide care that meets their needs and enhance their willingness to participate. In this way, rooming-in care can be extended into family-centered maternity care and create baby-friendly hospitals.     

Vascular morphologic information of three-dimensional power Doppler ultrasound is valuable in the classification of breast lesions

Doppler ultrasound imaging provides vascular information that could characterize benign and malignant breast masses in many previous publications. In this study, we applied vascular quantification and morphology features derived from three-dimensional power Doppler ultrasound as classifiers based on support vector machine. An Az value under the receiver operating characteristic (ROC) curve was used to measure the significance of each vascularization feature. Sixty solid breast tumors were assessed. According to the Az value for the ROC curve of the selected features, the classification performance of the proposed method was 0.8423, indicating that vascular morphologic information is valuable in the classification of breast lesions.