Influence of Patient-Specific Covariates on Test Validity of Two Delirium Screening Instruments in Neurocritical Care Patients (DEMON-ICU)

Background: Delirium screening instruments (DSIs) should be used to detect delirium, but they only show moderate sensitivity in patients with neurocritical illness. We explored whether, for these patients, DSI validity is impacted by patient-specific covariates. Methods: Data were prospectively collected in a single-center quality improvement project. Patients were screened for delirium once daily using the Intensive Care Delirium Screening Checklist (ICDSC) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Reference was the daily assessment using criteria from the Diagnostic and Statistical Manual, 4th Edition, Text Revision (DSM-IV-TR). In a two-step receiver operating characteristics regression analysis adjusting for repeated measurements, the impact of acute diagnosis of stroke or transient ischemic attack (TIA), neurosurgical intervention, Richmond Agitation Sedation Scale, and ventilation status on test validity was determined. Results: Of 181 patients screened, 101 went into final analysis. Delirium incidence according to DSM-IV-TR was 29.7%. For the first complete assessment series (CAM-ICU, ICDSC, and DSM-IV-TR), sensitivity for the CAM-ICU and the ICDSC was 73.3% and 66.7%, and specificity was 91.8% and 94.1%, respectively. Consideration of daily repeated measurements increased sensitivity for the CAM-ICU and ICDSC to 75.7% and 73.4%, and specificity to 97.3% and 98.9%, respectively. Receiver operating characteristics regression revealed that lower Richmond Agitation Sedation Scale levels significantly impaired validity of the ICDSC (p = 0.029) and the CAM-ICU in its severity scale version (p = 0.004). Neither acute diagnosis of stroke or TIA nor neurosurgical intervention or mechanical ventilation significantly influenced DSI validity. Conclusions: The CAM-ICU and ICDSC perform well in patients requiring neurocritical care, regardless of the presence of acute stroke, TIA, or neurosurgical interventions. Yet, even very light or moderate sedation can significantly impair DSI performance

Top-down contingent feature-specific orienting with and without awareness of the visual input

In the present article, the role of endogenous feature-specific orienting for conscious and unconscious vision is reviewed. We start with an overview of orienting. We proceed with a review of masking research, and the definition of the criteria of experimental protocols that demonstrate endogenous and exogenous orienting, respectively. Against this background of criteria, we assess studies of unconscious orienting and come to the conclusion that so far studies of unconscious orienting demonstrated endogenous feature-specific orienting. The review closes with a discussion of the role of unconscious orienting in action control

Inhibitors of Dipeptidyl Peptidase IV and Aminopeptidase N Target Major Pathogenetic Steps in Acne Initiation

Acne is a chronic disease hallmarked by sebaceous hyperplasia, follicular hyperkeratosis, and inflammation. Parallel targeting of these factors is required to treat acne effectively. Inhibitors of dipeptidyl peptidase IV (DP IV) and aminopeptidase N (APN) show strong anti-inflammatory effects on immune cells and therapeutic efficacy in autoimmune disorders. Our investigation focused on the expression and functional relevance of these ectopeptidases in three cell types which exhibit an altered phenotype in early acne lesions. We showed for the first time expression of DP IV and APN on human sebocytes. In the SZ95 sebocyte cell line, the DP IV inhibitors Lys[Z(NO2)]-thiazolidide and Lys[Z(NO2)]-pyrrolidide and the APN inhibitors actinonin and bestatin suppressed proliferation, enhanced terminal differentiation, and slightly decreased total neutral lipid production. The anti-inflammatory and differentiation-restoring cytokine IL-1 receptor antagonist was significantly upregulated in SZ95 sebocytes and the HaCaT keratinocyte cell line in the presence of inhibitors. Furthermore, the inhibitors suppressed proliferation and IL-2 production of Propionibacterium acnes-stimulated T cells ex vivo and enhanced the expression of the immunosuppressive cytokine transforming growth factor-β1. Our data provide first evidence for a functional role of DP IV and APN in the sebaceous gland apparatus and for their inhibitors, used alone or in combination, as completely new substances possibly affecting acne pathogenesis in a therapeutic manner

Identification of Histological Patterns in Clinically Affected and Unaffected Palm Regions in Dupuytren's Disease

Dupuytren's disease is a fibro-proliferative disease characterized by a disorder of the extracellular matrix (ECM) and high myofibroblast proliferation. However, studies failed to determine if the whole palm fascia is affected by the disease. The objective of this study was to analyze several components of the extracellular matrix of three types of tissues—Dupuytren's diseased contracture cords (DDC), palmar fascia clinically unaffected by Dupuytren's disease contracture (NPF), and normal forehand fascia (NFF). Histological analysis, quantification of cells recultured from each type of tissue, mRNA microarrays and immunohistochemistry for smooth muscle actin (SMA), fibrillar ECM components and non-fibrillar ECM components were carried out. The results showed that DDC samples had abundant fibrosis with reticular fibers and few elastic fibers, high cell proliferation and myofibroblasts, laminin and glycoproteins, whereas NFF did not show any of these findings. Interestingly, NPF tissues had more cells showing myofibroblasts differentiation and more collagen and reticular fibers, laminin and glycoproteins than NFF, although at lower level than DDC, with similar elastic fibers than DDC. Immunohistochemical expression of decorin was high in DDC, whereas versican was highly expressed NFF, with no differences for aggrecan. Cluster analysis revealed that the global expression profile of NPF was very similar to DDC, and reculturing methods showed that cells corresponding to DDC tissues proliferated more actively than NPF, and NPF more actively than NFF. All these results suggest that NPF tissues may be affected, and that a modification of the therapeutic approach used for the treatment of Dupuytren's disease should be considered.This work was supported by CTS-115 (Tissue Engineering Group), University of Granada/Spain

Top-down contingent attentional capture during feed-forward visual processing

Ansorge U, Horstmann G, Scharlau I. Top-down contingent attentional capture during feed-forward visual processing. ACTA PSYCHOLOGICA. 2010;135(2):123-126

More efficient rejection of happy than of angry face distractors in visual search

Horstmann G, Scharlau I, Ansorge U. More efficient rejection of happy than of angry face distractors in visual search. PSYCHONOMIC BULLETIN & REVIEW. 2006;13(6):1067-1073.In the present study, we examined whether the detection advantage for negative-face targets in crowds of positive-face distractors over positive-face targets in crowds of negative faces can be explained by differentially efficient distractor rejection. Search Condition A demonstrated more efficient distractor rejection with negative-face targets in positive-face crowds than vice versa. Search Condition B showed that target identity alone is not sufficient to account for this effect, because there was no difference in processing efficiency for positive- and negative-face targets within neutral crowds. Search Condition C showed differentially efficient processing with neutral-face targets among positive- or negative-face distractors. These results were obtained with both a within-participants (Experiment 1) and a between-participants (Experiment 2) design. The pattern of results is consistent with the assumption that efficient rejection of positive (more homogenous) distractors is an important determinant of performance in search among (face) distractors

Spatial mislocalization as a consequence of sequential coding of stimuli

In three experiments, we tested whether sequentially coding two visual stimuli can create a spatial misperception of a visual moving stimulus. In Experiment 1, we showed that a spatial misperception, the flash-lag effect, is accompanied by a similar temporal misperception of first perceiving the flash and only then a change of the moving stimulus, when in fact the two events were exactly simultaneous. In Experiment 2, we demonstrated that when the spatial misperception of a flash-lag effect is absent, the temporal misperception is also absent. In Experiment 3, we extended these findings and showed that if the stimulus conditions require coding first a flash and subsequently a nearby moving stimulus, a spatial flash-lag effect is found, with the position of the moving stimulus being misperceived as shifted in the direction of its motion, whereas this spatial misperception is reversed so that the moving stimulus is misperceived as shifted in a direction opposite to its motion when the conditions require coding first the moving stimulus and then the flash. Together, the results demonstrate that sequential coding of two stimuli can lead to a spatial misperception whose direction can be predicted from the order of coding the moving object versus the flash. We propose an attentional sequential-coding explanation for the flash-lag effect and discuss its explanatory power with respect to related illusions (e. g., the Fröhlich effect) and other explanations

Visual search for a motion singleton among coherently moving distractors

Ansorge U, Scharlau I, Labudda K. Visual search for a motion singleton among coherently moving distractors. Psychological Research - Psychologische Forschung. 2006;70(2):103-116.In the current study, we tested whether search for a visual motion singleton presented among several coherently moving distractors can be more efficient than search for a motion stimulus presented with a single distractor. Under a variety of conditions, multiple spatially distributed and coherently moving distractors facilitated search for a uniquely moving target relative to a single-motion-distractor condition (Experiments 1, 3, and 4). Color coherencies among static distractors were not equally effective (Experiments I and 2). These results confirm that humans are highly sensitive to antagonistically directed motion signals in backgrounds compared with spatially more confined regions of visual images