Cesare Cerri

Risk factors for fatal and nonfatal repetition of suicide attempts: a literature review

Objectives This review aimed to identify the evidence for predictors of repetition of suicide attempts, and more specifically for subsequent completed suicide. Methods We conducted a literature search of PubMed and Embase between January 1, 1991 and December 31, 2009, and we excluded studies investigating only special populations (eg, male and female only, children and adolescents, elderly, a specific psychiatric disorder) and studies with sample size fewer than 50 patients. Results The strongest predictor of a repeated attempt is a previous attempt, followed by being a victim of sexual abuse, poor global functioning, having a psychiatric disorder, being on psychiatric treatment, depression, anxiety, and alcohol abuse or dependence. For other variables examined (Caucasian ethnicity, having a criminal record, having any mood disorders, bad family environment, and impulsivity) there are indications for a putative correlation as well. For completed suicide, the strongest predictors are older age, suicide ideation, and history of suicide attempt. Living alone, male sex, and alcohol abuse are weakly predictive with a positive correlation (but sustained by very scarce data) for poor impulsivity and a somatic diagnosis. Conclusion It is difficult to find predictors for repetition of nonfatal suicide attempts, and even more difficult to identify predictors of completed suicide. Suicide ideation and alcohol or substance abuse/dependence, which are, along with depression, the most consistent predictors for initial nonfatal attempt and suicide, are not consistently reported to be very strong predictors for nonfatal repetition.

Comparison of Active Stretching Technique and Static Stretching Technique on Hamstring Flexibility

Objectives:To compare a passive and an active stretching technique to determine which one would produce and maintain the greatest gain in hamstring flexibility. To determine whether a passive or an active stretching technique results in a greater increase in hamstring flexibility and to compare whether the gains are maintained. Design:Randomized controlled trial. Setting:Institutional. Participants:Sixty-five volunteer healthy subjects completed the enrollment questionnaire, 33 completed the required 75% of the treatment after 6 weeks, and 22 were assessed 4 weeks after the training interruption. Intervention:A 6-week stretching program with subjects divided into 2 groups with group 1 performing active stretching exercises and group 2 performing passive stretching exercises. Main Outcome Measures:Range of motion (ROM) was measured after 3 and 6 weeks of training and again 4 weeks after the cessation of training and compared with the initial measurement. Results:After 3 weeks of training, the mean gain in group 1 (active stretching) on performing the active knee extension range of motion (AKER) test was 5.7°, whereas the mean gain in group 2 (passive stretching) was 3° (P = .015). After 6 weeks of training, the mean gain in group 1 was 8.7°, whereas the mean gain in group 2 was 5.3° (P = .006). Twenty-two subjects were reassessed 4 weeks after the cessation of the training with the maintained gain of ROM in group 1 being 6.3°, whereas the maintained gain in group 2 was 0.1° (P = .003). Conclusions:Active stretching produced the greater gain in the AKER test, and the gain was almost completely maintained 4 weeks after the end of the training, which was not seen with the passive stretching group. Active stretching was more time efficient compared with the static stretching and needed a lower compliance to produce effects on flexibility.

The syndrome of carnitine deficiency: morphological and metabolic correlations in two cases.

Two cases of systemic carnitine deficiency are described. In both patients, carnitine concentration was lower than normal in serum and muscle tissue. In the first case, the illness began at age 35; the clinical manifestations were only muscular. In the second case, the illness began in childhood; there were intermittent episodes of hepatic enlargement and coma. An excessive lipid content was present in muscle tissue, especially in type 1 fibers, of both cases, and in the liver of the second patient. Ultrastructural studies of muscle tissue revealed important changes of mitochondria. During muscular exercise, aerobic and anaerobic metabolism were investigated. For a given relative work intensity, these patients showed abnormally high blood lactic acid concentration and lactic acid/pyruvic acid ratios. These data, together with the morphological alterations observed in mitochondria, suggest an impaired function of the respiratory chain, leading to a shift of the red/ox potential of the tissue towards a non reduced state.

Responsiveness and minimal important changes for the knee injury and osteoarthritis outcome score in subjects undergoing rehabilitation after total knee arthroplasty

ObjectiveThe aim of this study was to evaluate the responsiveness and minimal important changes for the Knee Injury and Osteoarthritis Outcome Score (KOOS) in subjects undergoing rehabilitation after total knee arthroplasty. DesignAt the beginning and end of a rehabilitation program, 148 patients completed the KOOS. A global perception of change scale was also completed at the end of the program and collapsed to produce a dichotomous outcome (improved vs. stable). Responsiveness was assessed on the KOOS subscales and calculated by distribution methods (effect size; standardized response mean). The minimal important changes of the KOOS subscales were assessed using anchor-based methods (receiver operating characteristic curves) to compute the best cutoff levels between the improved and stable subjects. ResultsThe effect sizes ranged from 0.83 to 1.35, and the standardized response means ranged from 0.76 to 1.22. The receiver operating characteristic analyses revealed an area under the curve of 0.89, 0.88, 0.94, 0.93, and 0.85 for the Pain, Symptoms, Activities of Daily Living, Sport/Recreation, and Quality of Life subscales, respectively, showing discriminative capacities; the minimal important changes were 16.7 for Pain (sensitivity: 83%; specificity: 82%), 10.7 for Symptoms (80%; 80%), 18.4 for Activities of Daily Living (82%; 82%), 12.5 for Sport/Recreation (96%; 78%), and 15.6 for Quality of Life (88%; 67%). ConclusionsThe KOOS was sensitive in detecting clinical changes. The authors recommend taking the minimal important changes provided into account when assessing patient improvement or planning studies in this clinical context.

A case of lipid storage myopathy with carnitine deficiency: Biochemical and electromyographic correlations

Histochemical, biochemical and electromyographic studies were performed in a case of carnitine deficiency in serum and in muscle. Clinical features include proximal muscle weakness, predominant type I fiber impairment, excess of triglycerides and moderate glycogen accumulation in muscle. No abnormalities of palmityl CoA synthetase, carnitine palmityl transferase, carnitine acetyl transferase and lipase were evidenced. An interesting EMG decremental pattern was recorded. Correlations between electromyographic and biochemical findings are considered. A clinical improvement, a normal plasma carnitine level and a normal response at EMG repetitive stimulation were found after carnitine treatment.

Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms

In Diagnostic and Statistical Manual of Mental Disorders, fifth edition, psychogenic non-epileptic seizures (PNES) do not have a unique classification as they can be found within different categories: conversion, dissociative, and somatization disorders. The ICD-10, instead, considers PNES within dissociative disorders, merging the dissociative disorders and conversion disorders, although the underlying defense mechanisms are different. The literature data show that PNES are associated with cluster B (mainly borderline) personality disorders and/or to people with depressive or anxiety disorders. Defense mechanisms in patients with PNES with a prevalence of anxious/depressive symptoms are of “neurotic” type; their goal is to lead to a “split”, either vertical (dissociation) or horizontal (repression). The majority of patients with this type of PNES have alexithymia traits, meaning that they had difficulties in feeling or perceiving emotions. In subjects where PNES are associated with a borderline personality, in which the symbolic function is lost, the defense mechanisms are of a more archaic nature (denial). PNES with different underlying defense mechanisms have different prognoses (despite similar severity of PNES) and need usually a different treatment (pharmacological or psychological). Thus, it appears superfluous to talk about psychiatric comorbidity, since PNES are a different symptomatic expression of specific psychiatric disorders.

REGULATION of the CYCLIC GUANOSINE 3′-5′ MONOPHOSPHATE SYSTEM IN HUMAN BRAIN TUMORS

Several reports have suggested that cyclic guanosine 3′‐5′ monophosphate (cGMP) and cyclic 3′‐5′ adenosine monophosphate (cAMP) are involved in the regulation of cellular proliferation. Following our previous reports on the cAMP system in human brain tumors, we decided to investigate the cGMP system in the same pathological tissues by studying the activity of guanylate cyclase and cGMP‐phosphodiesterase (cGMP‐PDE). We found that the activity of both enzymes is lower in neurinomas and glioblastomas than in meningiomas or in normal cerebral cortex. Furthermore, the subcellular distribution of guanylate cyclase in human cerebral cortex differs from that of neurinomas and glioblastomas. On the basis of such ob servations we have discussed the possibility that the regulatory mechanism of the enzymes related to the cyclic nucleotide metabolism is altered in brain tumors.

Muscular carnitine synthesis and palmitate metabolism in vitro

SummaryThe carnitine content of the culture media for normal and pathological human muscles, including a case of systemic carnitine deficiency (SCD) was measured and the carnitine concentration was the same in all normal and pathological muscle culture media. Carnitine was never detected in growth medium. Some fibroblasts and myoblasts were filled with neutral lipids in SCD. 14C-palmitate added to the medium was incorporated by SCD fibroblasts or myoblasts to the same concentration as in normal or pathological cells. Factors other than carnitine seem to account for the lipid accumulation of SCD in cell culture.ZusammenfassungDer Carnitingehalt im Kulturmedium von Zellkulturen normalen und pathologischen menschlichen Muskels wurde in verschiedenen Fällen, unter anderem bei systemischem Carnitinmangel bestimmt. Der Carnitingehalt war sowohl in den Zellkulturen von normalem wie von pathologischem Muskel der gleiche. Es wurde nie Carnitin im Kulturmedium gefunden. Vereinzelte Fibroblasten und Myoblasten waren mit Neutralfett gefüllt. 14C-Palmitat, welches dem Kulturmedium zugefügt wurde, wurde durch S.C.D.-Fibroblasten oder Myoblasten in gleichem Ausmaß sowohl in normalen wie in pathologischen Zellen eingebaut. Es scheinen somit andere Faktoren als das Carnitin für die Fettansammlung in der S.C.D.-Zellkultur verantwortlich zu sein.

Chronic pain acceptance questionnaire: Confirmatory factor analysis, reliability, and validity in Italian subjects with chronic low back pain

Study Design. Cross-sectional evaluation of the psychometric properties of a translated questionnaire. Objective. To validate the Italian version of the Chronic Pain Acceptance Questionnaire (CPAQ) to allow its use with Italian-speaking patients with chronic low back pain (LBP). Summary of Background Data. Growing attention is being given to cognitive-behavioral measures to improve interventions for LBP. The CPAQ has never been validated in Italian subjects with chronic LBP. Methods. The psychometric testing included confirmatory factor analysis, reliability by internal consistency (Cronbach &agr;), test-retest reliability (intraclass correlation coefficient), sensitivity to change by calculating the smallest detectable change, and construct validity by comparing CPAQ with a pain numerical rating scale, the Roland-Morris Disability Questionnaire Scale, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, and the Tampa Scale of Kinesiophobia (Pearson correlations). Hierarchical multiple regression analyses were computed to further investigate construct validity of the CPAQ subscales. Results. The questionnaire was administered to 142 subjects with chronic LBP. Factor analysis confirmed a 2-factor (viz., Activities Engagement and Pain Willingness) 20-item solution, achieving a good data-model fit. Internal consistency (&agr; = 0.88) and test-retest reliability (intraclass correlation coefficient = 0.86) were good. The smallest detectable change was 22. Construct validity showed a moderate correlation between the CPAQ and numerical rating scale (r = −0.485), Roland-Morris Disability Questionnaire Scale (r = −0.594), and Tampa Scale of Kinesiophobia (r = −0.595), and a close correlation with Hospital Anxiety and Depression Scale (r = −0.610 for the Anxiety score and r = −0.659 for the Depression score) and Pain Catastrophizing Scale (r = −0.658). The standardized regression coefficients for Activity Engagement were significant in all of the equations, and those for Pain Willingness were significant in the anxiety, depression, and disability equations. Conclusion. The Italian CPAQ had a good factorial structure and psychometric properties that replicated the results of other versions. Its use is recommended for clinical and research purposes. Level of Evidence: 2

Progressive extrinsic ophthalmoplegia with peripheral neuropathy and storage of muscle glycogen

SummaryA case of progressive extrinsic ophthalmoplegia associated with peripheral neuropathy and hypertriglyceridemia type IV is described. Motor and sensory conduction velocities of the spinal nerves were severely decreased, while the EMG of the facial muscles was more suggestive of a myopathic disorder.Electron microscopic study of biopsies of biceps and peroneus brevis muscles disclosed many ragged red fibers, mainly type I, which contained typical abnormal mitochondria. Other fibers, all type II, contained increased amounts of glycogen between myofibrils or beneath the sarcolemmal membrane, but the mitochondria were normal. These fibers were more abundant in the peroneus brevis than in the biceps muscle. Nerve biopsy revealed marked loss of myelinated fibers, but neither mitochondrial changes nor glycogen storages were evident in Schwanns cells.Biochemical investigations confirmed the increased amount of glycogen in both muscle biopsies and revealed a decrease of guanilcyclase. Phosphorylase, phosphorylase b kinase, adenilcyclase, and carnitine concentrations were all normal.The pathogenesis of this syndrome is discussed and the relationship between mitochondrial abnormalities and glycogen accumulation in muscle tissue are considered.ZusammenfassungBeschreibung eines Falles von Ophthalmoplegia externa mit Polyneuropathie und einer Hypertriglyzeridämie vom Typ IV. Hochgradige Verlangsamung der motorischen und sensiblen Erregungsleitung im peripheren Nerven. Im Gesicht war das Ergebnis der Nadelmyographie eher auf Myopathie verdächtig.In der Biopsie des Musculus biceps und Musculus peronaeus brevis zeigten sich zahlreiche „ragged red fibers“, vorwiegend vom Typ I, die im elektronenmikroskopischen Bild abnorme Mitochondrien enthielten. Andere Fasern, sämtliche vom Typ II, wiesen einen erhöhten Glykogengehalt zwischen den Myofibrillen oder Subsarkolemmal auf, während die Mitochondrien normal erschienen. Diese letztgenannten Fasern waren zahlreicher im Musculus peronaeus brevis. Die Nervenbiopsie zeigte einen ausgesprochenen Verlust an myelinisierten Fasern, jedoch waren in den Schwannschen Zellen weder Anomalie der Mitochondrien noch Glykogenspeicherung sichtbar.Biochemische Untersuchungen bestätigten den vermehrten Glykogengehalt in beiden Muskelbiopsien und zeigten eine Verminderung der Guanilzyklase. Hingegen waren Phosphorylase, Phosphorylase-b-Kinase, Adenilzyklase und Karnitin in normaler Konzentration vorhanden.Es wird die Pathogenese des Syndromes diskutiert und die Beziehung zwischen den mitochondrialen Anomalien und der Vermehrung des Glykogens im Muskelgewebe besprochen.