Clinical and prognostic significance of genetic markers of ApoE gene in traumatic brain injury

The review focuses on the analysis of available data about association of polymorphic genetic markers of gene encoding apolipoprotein E (APOE) with traumatic brain injury (TBI). The most investigated genetic marker of poor outcome after TBI is presence of 4 allele of APOE gene. According to most authors, carriers of this allele have worse functional outcome and lower indices of restoration of cognitive functions. Studies of association of polymorphic markers A(-491)T, T(-427)C and G(-219)T, located in promoter area of APOE gene, with course and outcome of TBI in Europeans, demonstrated that only carriers of TT genotype of polymorphic marker G(-219)T had much poorer recovery in comparison with carriers of GT and TT of this marker. However, in patients with TBI belonging to Chinese population association with higher risk of neurological deterioration was discovered for another polymorphic marker of the same area, A(-491). Increased risk was observed in carriers of AA genotype which determines raised level of APOE gene expression in combination with presence of 4 allele of the same gene. Analysis of the whole clinical and experimental investigations of association of different polymorphic markers of APOE gene with course and outcome of TBI allows to conclude that product of this gene, apolipoprotein E, in fact, plays important role in processes of recovery of brain and its functions being directly involved in neuroplasticity and neurotransmission thus facilitating functional integration of different brain areas.     

认识桡骨近端19项解剖学指标对人工假体及肘关节生物力学重建的价值*★

背景：制约桡骨近端骨折治疗及内固定物、假体设计和改进的一个重要因素是该部位的解剖学形态。 目的：测量桡骨近端19项解剖学指标, 为桡骨近端骨折内固定物的合理放置及桡骨头正确切除、假体的设计和改进提供参考依据。 设计、时间及地点：重复测量，对比观察实验，于2007-12/2008-04在江苏省南通大学附属医院创伤研究室完成。 材料：成人30对防腐尸体上肢标本，男、女各15对。 方法：对上述标本解剖并取出尺桡骨，利用精度0.01 mm的游标卡尺、分规、量角器对桡骨近端数项解剖学指标进行测量。 主要观察指标：①桡骨近端相关角度：桡骨颈干角、桡骨头环状关节面和尺骨桡骨切迹在前臂中立位时接触弧、前臂最大旋前位时接触弧度、前臂最大旋后位时接触弧度、非接触弧度；②桡骨近端相关高度、长度、横径、矢状径等：桡骨近端长度、环状关节面内侧、外侧、前侧及后侧高度、桡骨头凹最大深度、桡骨近端外侧弧长度、外侧弧的最大垂直高度、桡骨转子上缘桡骨颈横径、桡骨转子上缘-桡骨头近端距离、桡骨转子中部-桡骨头近端距离、桡骨头横径、桡骨头矢状径、桡骨头凹直径。 结果：男、女在桡骨近端相关角度方面测量值的差异无统计学意义(P > 0.05)；而在桡骨近端相关高度、长度、横径、矢状径等方面男性测量值大于女性(P < 0.05) 。 结论：桡骨近端骨折在行内固定或桡骨头切除、假体置换时, 需遵循桡骨近端各项解剖参数；因男性桡骨近端的解剖参数略大于女性，设计时应根据不同性别做成各种型号的假体。     

MMP-9、TIMP-1在实验性自身免疫性肌炎中的表达及甲基强的松龙的影响

目的探讨MMP-9在实验性自身免疫性肌炎(EAM)发病中的作用,以及甲基强的松龙对MMP-9、TIMP-1基因mRNA和蛋白表达的影响。方法应用RT-PCR及免疫组织化学技术,检测MMP-9、TIMP-1在EAM组、甲基强的松龙治疗组(EAMM组)和对照组大鼠外周血、脾脏、肌肉组织中的表达水平。结果(1)EAMM组大鼠发病程度低于EAM组,炎症细胞浸润和肌纤维坏死程度减轻。(2)MMP-9mRNA在EAM大鼠外周血、脾脏淋巴细胞中的表达上调;MMP-9蛋白在EAM组大鼠肌肉组织表达增加,与对照组比较,差异有显著性。EAMM组MMP-9mRNA及蛋白的表达均受到抑制,与EAM组比较差异有显著性。(3)与EAM组比较,EAMM组TIMP-1基因mRNA表达明显增加,同时TIMP-1蛋白表达上调更明显,差异有显著性。结论MMP-9表达增加可能与EAM发病有关;甲基强的松龙能减轻EAM发病程度,其作用机制可能与抑制MMP-9有关。     

A Comparative Analysis of Well-Being and Coping among Mothers of Toddlers and Mothers of Adolescents with ASD

The present study examined the impact of autism symptoms and coping strategies on the well-being of mothers of children with autism spectrum disorder (ASD). The sample consisted of 153 mothers of toddlers and 201 mothers of adolescents drawn from two ongoing, longitudinal studies of families of individuals with ASD. For mothers of toddlers, lower levels of emotion-focused coping and higher levels of problem-focused coping were generally associated with better maternal well-being, regardless of the level of child symptomatology. For mothers of adolescents, coping often acted as a buffer when autism symptoms were high. Although there was evidence of maternal distress in both groups, the presence of significant buffering effects reflects adaptation in the face of stress, particularly for mothers of adolescents.     

Caspase Activity and Expression in Lymphocytes of Patients with Borderline Personality Disorders

The pathogenesis of borderline personality disorders remains obscure. Depression is one of most common representatives of this group of diseases. Recently, we showed that the development of depression is accompanied by specific changes in the immune system. In the lymphocytes of patients with depression, the activities of apoptotic proteases of caspase family increase with increasing severity of depression, which may be indicative of augmented death of these cells [1]. Our goal was to explore the mechanisms of activation of caspases in this situation and study the expression of caspase family proteins in lymphocytes of patients with depression. Changes in the activity of caspase family enzymes in the lymphocytes of patients with depression were not accompanied by alterations in the expression of the respective proteins. Thus, in depression, the mechanism of lymphocyte caspase activity control is disturbed, but not expression of caspases.     

The basins of attraction of a new Hopfield learning rule

The nature of the basins of attraction of a Hopfield network is as important as the capacity. Here a new learning rule is re-introduced. This learning rule has a higher capacity than that of the Hebb rule, and still keeps important functionality, such as incrementality and locality, which the pseudo-inverse lacks. However the basins of attraction of the fixed points of this learning rule have not yet been studied. Three important characteristics of basins of attraction are considered: indirect and direct basins of attraction, distribution of sizes of basins of attraction and the shape of the basins of attraction. The results for the new learning rule are compared with those of the Hebb rule. The size of direct and indirect basins of attractions are generally larger for the new rule than for the Hebb rule, the distribution of sizes is more even, and the shape of the basins more round.     

Descending supraspinal effects under conditions of disturbance of the inhibitory processes in the nuclei of the medulla: the formation of the generators of excitation.

The descending effects produced by stimulation of the fastigial nucleus of cerebellum and the neuronal activity in the nuclei of the medulla were studied on cats under light Nembutal-chloralose anesthesia or on decerebrated animals at various times following injection of tetanus toxin. The latter was used as an agent producing suppression of the inhibitory processes. A significant enhancement of the descending facilitation of extensor monosynaptic reflexes after injection of tetanus toxin into the lateral vestibular nucleus was established, and of the descending inhibition of polysynaptic reflexes following injection of tetanus toxin into the gigantocellular nucleus. The characteristic feature was the reducing of latent periods of the descending effects, their abrupt increase up to maximum, and a significant lengthening of their duration. The poisoned nuclei showed an increase in amplitude and frequency of discharges in the integral background, and especially in evoked activity, and augmented number of neurons with cluster activity. The enhanced background activity in the examined areas of poisoned nuclei could be temporarily suppressed by strong direct electrical shock or injection of glycine into these regions. The obtained data suggest that the disturbance of the inhibitory processes in complex relay nuclei represents a condition contributing to formation in the latter of the generators of pathologically enhanced excitation. The mechanisms of formation and characteristic features of the activity of generators and their role in pathology of the nervous system are discussed. Also considered is the modeling of neurological syndromes by way of creation of generators of pathologically enhanced excitation in various regions of the CNS.     

L’évaluation des stades de changement dans les addictions

The assessment of stages of change, the main component of the Transtheoretical Model, is at the same time a very appealing and clinically useful task, but yet difficult. Several instruments of evaluation of these stages exist to date in the Anglo-Saxon countries. In France, this model remains relatively little used and only some treatment settings currently assess stages of change. This is due partly to the absence of validated instruments of assessment in French. The object of this article is to present the main instruments of assessment of stages of change in addictions and their advantages and limits. Another aim of this article is to present the last progress in the assessment of stages of change. Lastly, this article shows the clinical utility of the assessment of stages of change. Assessed in an adequate way, stages of change provide an interesting and useful way to segment the process of change. This can thus increase the comprehension by the clinicians of clients’ motivation and offer a differentiated and rich perspective on the process of behaviour change. Clinicians can also adapt the psychotherapeutical strategies to the stage of change or the degree of readiness to change of a client. The stage of change assessment has an important predictive value: readiness to change was the best predictor of treatment outcomes in several researches.     

THEORETICAL IMPLICATIONS OF THE USE OF L-DOPA IN PARKINSONISM.

The production of all the major symptoms of parkinsonism is attributed chiefly to the loss of the normal dopaminergic input into the striatum. This loss of dopaminergic input is due to degeneration of the cell bodies of the substantia nigra. An analogous loss of serotonin (5-hydroxytryptamine) may be of significance in the production of parkinsonian tremor. L-dopa ameliorates the symptoms of parkiusonism as a result of reinstitution of dopamine inhibition of the striatal neurons. L-dopa induced dyskinesias are felt to be related to denervation hypersensitivity of striatal neurons to dopamine produced by dopaminergic denervation. Failure to respond to L-dopa is related to degeneration of striatal dopaminergic receptors. The efficacy of amantadine hydrochloride is felt to be related to a block of the presynaptic reuptake of dopamine and thereby a prolongation of dopamine's effect at the receptor site.     

Laminar cell counts and geniculo-cortical boutons in area 17 of cat and monkey

Counts have been made of the number of cells in individual laminae of the cortex in area 17 of the macaque monkey and cat, and degenerating terminals of geniculo-cortical axons have been studied with the electron-microscope in laminae IVab and IVc of the cortex of area 17 and lamina IV of area 18 of the visual cortex of the cat. The increase in number of cells through the depth of cortex in area 17 of the monkey compared with the cat would appear to involve about equally all laminae. In lamina IVab of area 17 of the cat the axon terminals of Y-type geniculo-cortical fibres make many more synapses per bouton than those of X-type fibres ending in lamina IVc. The geniculo-cortical axons ending in lamina IV of area 18 also make more multisynaptic boutons than those in lamina IVc of area 17. Thus, the terminals in the cortex of the X and Y functional types of fibre show comparable differences in both the cat and monkey.     

Scripto continuo : destins du verbe dans la manie

The psychopathology of the mania as a modality of the psychosis constitutes a fundamental chapter of the corpora of psychiatry and phenomenology.This article proposes to study the place of mania in the psychoanalysis and in particular the function of Flight of ideas like a phenomenon of language.Flight of ideas has as a principal characteristic to induce a particular temporality on the level of the language and word. It highlights on the one hand the eclipse of the significance and on the other hand the levelling of the speech in the clinical field of the mania.This fact no product intended for the communication is formed and does not communicate of nothing; the statement of the maniac remains then without punctuation and address. Accordingly such a verbal production is not articulated at the rythm as a formative element of the report to the other and the report at time.Such an approach of Flight of ideas conditions the specificity of the report to the other of the patient maniac and the singular temporality which governed it.How to make occur to say it maniac like effect of have rythm? constitute the which question direct the act of the clinician.We then propose a clinical case which questions the possibilities of introduction of a place of address to the heart of the tranferential bond. This place a such topos common, true point of nomination, can allow a reorganization of the elements of the language and word and promulgate the passage of the state maniac to the development of a request for listening.     

Changes in the quantitative characteristics of the efferent activity of the scratching generator when the influence of the descending systems is removed

The effects of signals coming from descending systems of the spinal cord on parameters of the activity of scratching generators were investigated on the decerebrated immobilized animals. It was shown that the removal of modulation influences of the cerebellum on the nuclei of descending systems (decerebellation) caused changes in the ratio of the activity of the generator half-centres, rose instability of the generator work, weakened the statistical dependence between changes in parameters of the activity of the generator half-centres and strengthened the generators sensitivity to afferent signals. The total removal of influences of descending systems (after decapitation) induced reduction of the intensity of the efferent activity and afferent sensitivity of the scratching generator. The functional role of descending signals in the work of the scratching generator is discussed.     

Methodological obstacles encountered in the evaluation of psychotherapies of schizophrenic patients. A general review]

Through a critical review of literature, authors suggest a methodological reflexion about problems in evaluation of effects of psychotherapies of schizophrenics, taking into account not only individual techniques but also institutional ones with psychotherapeutic orientations. Among the main difficulties are: evaluation with too much unspecific and over simplified criteria, for example criterium of rehospitalisation; lack of real comparability between groups, or techniques, and lack of validity of randomisation, still considered as a pawn of methodological rigour; diversity of levels of experience, and education of therapists, too unmatched model of functional organisation of the different centers, and in the same time too unequal recruitment of patients and at length of proposed therapeutic programs. Moreover, and even before these methodological bias, a more basic obstacle must be considered. It is the non-opening of models to the falsification, denounced by Bignami as the impossible verification of the heuristic value of the proposed models, ie the impossible verification of the utility of the proposed programs for individual therapies of schizophrenics.     

French validation study of the levels of emotional awareness scale

According to a thesis based on the idea of an influence of cognitions in the structuring of internal reality, emotional awareness, ie the capacity of representing your own emotional experience and that of others, is a cognitive process that goes into maturation. Defining this concept, Lane and Schwartz present a cognitivo-developmental model in five stages of the processes of symbolization, accounting for the differences in levels of emotional awareness observed in individuals. The organization of these cognitive processes would thus be structured in well differentiated stages, in which the development of the emotions would be inseparable from the development of ego and of the relation to others. These authors focus on the capacity of representing in a conscious way the emotional experience and consider that verbal representations used to describe the contents of what is experience constitute a good reflection of the organization structural of the emotional awareness. Therefore, they worked out an instrument of evaluation: the Levels of Emotional Awareness Scale (LEAS), which measures the capacity to describe your own emotional experience and the one you allow to others, in an emotional situation. The system of quotation of this scale is based on the analysis of the verbal contents of the provided answers, in direct reference to the authors' theory of the levels of differentiation and integration of the emotional experience. It is therefore an empirical measurement which is centered specifically on the structural organization of the emotional experience. The various studies of validation of this instrument show that it presents solid metrological properties. This work presents the validation of the French version of Lane and Schwartz's LEAS. Validity and fidelity were studied in a group of 121 healthy subjects. This setting is part of a larger clinical evaluation, also including a collection of socio-demographic and clinical data, and other instruments of self-evaluation (Beck Depression Inventory, BDI, Hospital Anxiety and Depression Scale, HAD, and Toronto Alexithymia Scale, TAS). The face validity appears correct: the questionnaire was well accepted and seemed easy to complete. A principal components analysis of the correlation matrix of the set of items was used as the method of extraction of the various factors and made it possible to confirm the unidimensionality of the instrument. The number of factors to be retained was given according to Kaiser and Cattell criteria. The internal consistency was evaluated through computation of the Cronbach coefficient, whose value is 0.75 for the scale's global score. The confidence interval of the margin of error of LEAS scores was also measured; for the global score it is IC=[m 6.1]. The measure given by this rating scale may therefore be considered sufficiently accurate, since this interval is weak. A study of the frequency of quotation of each item of the instrument was carried out, in order to check the homogeneity and the uniformity of quotations, as well as a diagram of distribution of the score, showing that it follows a law which is close to a normal law. The concurrent validity could only be studied via the similar concept of alexithymia, measured with the TAS, for there is not other instrument validated in French evaluating the levels of emotional awareness, and these two instruments seem to measure different notions, because none of the correlations between the scores of these two questionnaires are significant. Concerning discriminant validity, the Pearson correlation coefficients between the global score for the LEAS, the BDI score and the HAD sub-scores for depression and anxiety were measured; it is clear that the level of emotional awareness is independent from negative affects. Furthermore, the study of the reliability made it possible to highlight excellent intra-class correlation coefficients (r=0.993). The French version of the Levels of Emotional Awareness Scale thus appears to be valid and accurate and should allow the study of levels of emotional awareness on psychopathology. It is about an easily acceptable and simple questionnaire of use in varied clinical circumstances.     

Effects of classical and microsurgical methods of exclusion of cerebral aneurysms on the structural and functional changes near the operation site]

The effects of classical and microsurgical methods of exclusion of supratentorial intracranial aneurysms on the development of ischaemic changes at the site of approach to the aneurysm were studied. In cases of internal carotid artery aneurysms and middle cerebral artery aneurysms the use of microscope reduced the occurrence of ischaemic changes at the site of approach. In cases of aneurysms of the anterior cerebral artery system the frequency of these changes was similar with both methods. The size and location of these changes and the degree of psychical changes caused by them were similar with both methods.     

Application of SPECT/CT in neurosurgical practice

The paper presents the experience of application of single-photon emission computed tomography (SPECT) and CT in neurosurgery. Combination of these two techniques in the single system provides higher precision of both methods. The novel technique allows assessment of tumor spread in the brain, differential diagnosis of tumor regrowth and radiation-induced necrosis, evaluation of cerebral perfusion in epilepsy, traumatic brain injury (TBI), and diagnostics of secondary CNS lesions. Examples of primary diagnosis, dynamic follow-up and differential diagnosis of cerebral neoplasms, localization of epileptogenic foci in planning of surgery, prediction of outcome after TBI and evaluation of spread of metastatic skeletal involvement and further application of acquire data are presented.     

Surabondance des objets

A certain number of recent writings observe a drift of the subject, which they explain by the collapse of the fathers, itself effect of the disappearance of the reference marks of symbolic system. Another point of view is possible which would show that it acts less one change of the structure of the subject than an evolution of the imaginary representations that the society gives itself of itself. The multiplication of the objects, even their real abundance, is the axis which the author follows to show how can be constructed; such representations they are described through daily clinical situations, the psychopathology of eating behavior, and certain forms of a return of the religious fanatasism. It appears whereas the denunciation of the situation of the postmodern subject paradoxically finds the accents of the pleas for strong ego.     

Genetic epidemiologic studies of affective disorders in childhood and adolescence

Summary The application of the methods of genetic epidemiology appears to be one of the most promising avenues to unravel the complex mechanisms through which genes may exert their influence. The approaches of genetic epidemiology are particularly important for those diseases which are characterized by moderate degrees of heritability and lack of direct correspondence between the underlying vulnerability factors and the ultimate expression of the disease, as is the case for affective disorders. The application of the methods of genetic epidemiology to children of affected parents may also elucidate environmental risk factors and early signs of the disorder. Perhaps the most important implication of the identification of genetic markers for affective disorders is the opportunity for prevention of the disorders. Early identification of youngsters who do manifest early signs of the disorders would facilitate secondary and tertiary prevention of the consequences of those conditions.