Subjective memory complaints and memory performance in patients with borderline personality disorder

Beblo T, Mensebach C, Wingenfeld K, Rullkoetter N, Schlosser N, Driessen M. Subjective memory complaints and memory performance in patients with borderline personality disorder. BMC Psychiatry. 2014;14(1): 255.Background It is still a matter of debate as to whether patients with Borderline Personality Disorder (BPD) suffer from memory deficits. Existing studies indicate no or small impairments in memory test performance. However, it was shown in patients with related disorders, such as depression, that self-reported impairment exceeds test malfunction. In the present study we assessed memory performance of BPD patients through the use of memory tests and a questionnaire for subjective memory complaints (SMC) in everyday life. Methods Thirty-two patients with BPD and 32 healthy control subjects were included in the study. The groups of subjects were comparable with respect to age, education, and gender. Subjects completed verbal and nonverbal memory tests, as well as the everyday memory questionnaire (EMQ). Results BPD patients reported severe SMC but did not show memory test impairment. The results remained stable even when all BPD patients with acute or lifetime depression comorbidity were excluded from analyses. In both groups, SMC and test performances were not related but in BPD patients SMC were related to BPD symptoms. Conclusions Our data indicate memory impairment of BPD patients in everyday life. However, it cannot be ruled out that increased memory complaints result from patients’ negative self-perception. Future research needs to clarify the reasons for memory complaints of BPD patients

HCC biomarkers – state of the old and outlook to future promising biomarkers and their potential in everyday clinical practice

Hepatocellular carcinoma (HCC) is one of the most common and deadly tumors worldwide. Management of HCC depends on reliable biomarkers for screening, diagnosis, and monitoring of the disease, as well as predicting response towards therapy and safety. To date, imaging has been the established standard technique in the diagnosis and follow-up of HCC. However, imaging techniques have their limitations, especially in the early detection of HCC. Therefore, there is an urgent need for reliable, non/minimal invasive biomarkers. To date, alpha-fetoprotein (AFP) is the only serum biomarker used in clinical practice for the management of HCC. However, AFP is of relatively rather low quality in terms of specificity and sensitivity. Liquid biopsies as a source for biomarkers have become the focus of clinical research. Our review highlights alternative biomarkers derived from liquid biopsies, including circulating tumor cells, proteins, circulating nucleic acids, and exosomes, and their potential for clinical application. Using defined combinations of different biomarkers will open new perspectives for diagnosing, treating, and monitoring HCC

Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables

Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial

<p>Abstract</p> <p>Background</p> <p>Secondary hyperparathyroidism (sHPT) is common in patients with chronic renal failure. Despite the initiation of new therapeutic agents, several patients will require parathyroidectomy (PTX). Total PTX with autotransplantation of parathyroid tissue (TPTX+AT) and subtotal parathyroidectomy (SPTX) are currently considered as standard surgical procedures in the treatment of sHPT. Recurrencerates after TPTX+AT or SPTX are between 10% and 12% (median follow up: 36 months).</p> <p>Recent retrospective studies demonstrated a lower rate of recurrent sHPT of 0–4% after PTX without autotransplantation and thymectomy (TPTX) with no higher morbidity when compared to the standard procedures. The observed superiority of TPTX is flawed due to different definitions of outcomes, varying follow up periods and different surgical treatment strategies (with and without thymectomy).</p> <p>Methods/Design</p> <p>Patients with sHPT (intact parathyroid hormone > 10 times above the upper limit of normal) on long term dialysis (>12 months) will be randomized either to TPTX or TPTX+AT and followed for 36 months. Outcome parameters are recurrence rates of sHPT, frequencies of reoperations due to refractory hypoparathyroidism or recurrent/persistent hyperparathyroidism, postoperative morbidity and mortality and quality of life. 50 patients per group will be randomized in order to obtain relevant frequencies of outcome parameters that will form the basis for a large scale confirmatory multicentred randomized controlled trial.</p> <p>Discussion</p> <p>sHPT is a disease with a high incidence in patients with chronic renal failure. Even a small difference in outcomes will be of clinical relevance. To assess sufficient data about the rate of recurrent sHPT after both methods, a multicentred, randomized controlled trial (MRCT) under standardized conditions is mandatory.</p> <p>Due to the existing uncertainties the calculated number of patients necessary in each treatment arm (n > 4000) makes it impossible to perform this study as a confirmatory trial. Therefore estimates of different outcomes are performed using a pilot MRCT comparing 50 versus 50 randomized patients in order to establish a hypothesis that can be tested thereafter.</p> <p>If TPTX proves to have a lower rate of recurrent sHPT, no relevant disadvantages and no higher morbidity than TPTX+AT, current surgical practice may be changed.</p> <p>Trial registration</p> <p>International Standard Randomized Controlled Trial Number Registration (ISRCTN86202793)</p

Total versus near-total thyroidectomy in Graves’ disease and their outcome on postoperative transient hypoparathyroidism: study protocol for a randomized controlled trial?

Abstract Background Graves’ disease is an independent risk factor for transient postoperative hypoparathyroidism. Besides the disease itself, preparation techniques are influential. Transient postoperative hypoparathyroidism has severe consequences for patients’ physical and psychological state. It can be life threatening during the acute phase and may impair patients’ health, psyche and quality of life thereafter. For the surgical therapy of Graves’ disease, total thyroidectomy is recommended according to the national S2-guideline. The evidence- based on a metaanalysis- is criticized by the Cochrane diagnostic review commentary for substantial methodological deficits. Two randomized controlled trials lead to the hypothesis that a near-total resection with bilateral remnants of ≤ 1g on each side compared to total thyroidectomy will significantly reduce the occurrence of transient postoperative hypoparathyroidism with equal therapeutic safety. Methods/Design Patients with Graves’ disease indicated for definite surgery are eligible for the trial. Trial-specific exclusion criteria are: conservative treatment, malignancy, previous thyroid surgery and coincident hypoparathyroidism. The trial is created for therapeutic purpose through process innovation. It is designed as a prospective randomized controlled patient and observer blinded multicentered trial in a parallel design including an active comparator and an intervention group. The intervention addresses the surgical procedure: near-total thyroidectomy leaving bilateral remnants of ≤ 1g on each side in the intervention group and total thyroidectomy in the control group. The occurrence of transient postoperative hypoparathyroidism is defined as primary endpoint. Secondary endpoints are: reoperations due to bleeding, recurrent laryngeal nerve palsy, permanent hypoparathyroidism, recurrent disease, changes of endocrine orbitopathy and quality of life within a one-year follow-up period. The primary efficacy analysis follows the intention-to-treat principle. A binary logistic regression model will be applied. Complications and serious adverse events will be descriptively analyzed. Discussion The trail is expected to balance out the shortcomings of the current evidence. It will define the surgical gold standard for the surgical therapy of Graves’ disease. Patients’ safety and quality of life are assumed to be enhanced. Therapy costs are likely to be reduced and health care optimized. The conduction of the trial is feasible through the engagement and commitment of the German association of endocrine surgeons and the National Network for Surgical Trials. Trial registration German clinical trials register (DRKS) DRKS00004161</p

Müdigkeit nach Bereitschaftsdienst - subjektive Wahrnehmung oder objektives Faktum?

Einleitung Die Auswirkungen von akutem Schlafmangel auf die chirurgische Leistungsfähigkeit werden kontrovers diskutiert. Die vorliegende Studie wurde konzipiert, um physiologische Parameter der Übermüdung mit objektiven, technischen und kognitiven Fähigkeiten und mit subjektiv empfundener Schläfrigkeit von Chirurgen zu korrelieren. Ziel dieser Studie war es, Auswirkungen eines akuten partiellen Schlafdefizits auf chirurgische Leistungen zu untersuchen. Methoden 38 Chirurgen wurden am Morgen dreier aufeinanderfolgender Tage untersucht: vor einem 24 stündigen Nachtdienst, nach einem Nachtdienst und nach 24 stündiger Erholung. Die jeweilige Schlafdauer wurde erfasst. Die subjektive Schläfrigkeit wurde mit Hilfe der standardisierten Stanford Sleepiness Scale (SSS) gemessen. Die Cortisolkonzentration im Speichel und der Pupillenunruheindex wurden mittels der standardisierten ELISA (Enzyme Linked Immunosorbent Assay) Untersuchung sowie der Pupillographie, als objektivierbare physiologische Parameter für Ermüdung, gemessen. Der virtuelle Realitäts (VR) Simulator LapSim® wurde zur Messung von technischen sowie von kognitiven Fähigkeiten verwendet. Basisaufgaben („low fidelity“) wie „Schneiden“ und „Clip-Applikation“ dienten zur Beurteilung von technischen Fähigkeiten. Anspruchsvollere Aufgaben am VR Simulator („high fidelity“) wie „intrakorporales Nähen“ und „VR Cholezystektomie“ untersuchten die kognitiven Fähigkeiten. Die objektive Aufmerksamkeit wurde mit Hilfe des standardisierten D2 Durchstreichtests ermittelt. Ergebnisse Die Schlafdauer (p = 0,001) und die subjektive Schläfrigkeit (SSS) (p = 0,001) verschlechterten sich signifikant nach dem Nachtdienst. Weder der Cortisolspiegel im Speichel (p = 0,80) noch der Pupillenunruheindex (p = 0,64) oder die technische Leistung in den Basisaufgaben des VR Simulators zeigten einen signifikanten Unterschied zwischen den einzelnen Messzeitpunkten. Interessanterweise konnte eine signifikante Verbesserung in den anspruchsvolleren Aufgaben des VR Simulators zum Zeitpunkt nach dem Nachtdienst dargestellt werden. Diese war insbesondere in den Einzelanalysen „Fehlerscore“ (p = 0,045), „Durchführungszeit“ (p = 0,0001) und „Ökonomie der Instrumentenbewegung“ (p = 0,0001) nachweisbar. Analog dazu verbesserte sich die objektive Aufmerksamkeit, gemessen mit dem D2 Durchstreichtest (p = 0,027), zum Messzeitpunkt nach dem Nachtdienst ebenfalls signifikant. Schlussfolgerung Akute, mit dem Nachtdienst assoziierte Übermüdung scheint größtenteils eine subjektive Empfindung zu sein. Physiologische Faktoren scheinen die zu erwartende Müdigkeits assoziierte Beeinträchtigung von technischer Leistung in den Basisaufgaben des VR Simulators auszugleichen. Akuter, partieller Schlafmangel scheint einen kurzzeitigen positiven Effekt auf die kognitiven Fähigkeiten von Chirurgen zu haben. Dies führt zu verbesserten technischen Leistungen und gesteigerter objektiver Aufmerksamkeit bei der Ausführung komplexer Aufgaben. Ausblick in die Zukunft Trotz der kontroversen Datenlage bezüglich der Auswirkungen von Schlafmangel nach 24 stündigem Nachtdienst ist von einer Beeinträchtigung der ärztlichen Funktionsfähigkeit auszugehen. Die Arbeitszeitlimitierung ist ein wichtiger Schritt zur Verbesserung der ärztlichen Arbeitssituation und zur Gewährleistung einer sicheren Patientenversorgung. Dennoch bedarf es weiterer Studien auf diesem Gebiet, um die Effekte von Schlafmangel zu spezifizieren und dadurch die bereits vorhandenen Regelungen optimieren zu können