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Critical Care (London, England) Jul 2023Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT).... (Observational Study)
Observational Study
Prognostic and predictive value of endothelial dysfunction biomarkers in sepsis-associated acute kidney injury: risk-stratified analysis from a prospective observational cohort of pediatric septic shock.
BACKGROUND
Sepsis-associated acute kidney injury (SA-AKI) is associated with high morbidity, with no current therapies available beyond continuous renal replacement therapy (CRRT). Systemic inflammation and endothelial dysfunction are key drivers of SA-AKI. We sought to measure differences between endothelial dysfunction markers among children with and without SA-AKI, test whether this association varied across inflammatory biomarker-based risk strata, and develop prediction models to identify those at highest risk of SA-AKI.
METHODS
Secondary analyses of prospective observational cohort of pediatric septic shock. Primary outcome of interest was the presence of ≥ Stage II KDIGO SA-AKI on day 3 based on serum creatinine (D3 SA-AKI SCr). Biomarkers including those prospectively validated to predict pediatric sepsis mortality (PERSEVERE-II) were measured in Day 1 (D1) serum. Multivariable regression was used to test the independent association between endothelial markers and D3 SA-AKI SCr. We conducted risk-stratified analyses and developed prediction models using Classification and Regression Tree (CART), to estimate risk of D3 SA-AKI among prespecified subgroups based on PERSEVERE-II risk.
RESULTS
A total of 414 patients were included in the derivation cohort. Patients with D3 SA-AKI SCr had worse clinical outcomes including 28-day mortality and need for CRRT. Serum soluble thrombomodulin (sTM), Angiopoietin-2 (Angpt-2), and Tie-2 were independently associated with D3 SA-AKI SCr. Further, Tie-2 and Angpt-2/Tie-2 ratios were influenced by the interaction between D3 SA-AKI SCr and risk strata. Logistic regression demonstrated models predictive of D3 SA-AKI risk performed optimally among patients with high- or intermediate-PERSEVERE-II risk strata. A 6 terminal node CART model restricted to this subgroup of patients had an area under the receiver operating characteristic curve (AUROC) 0.90 and 0.77 upon tenfold cross-validation in the derivation cohort to distinguish those with and without D3 SA-AKI SCr and high specificity. The newly derived model performed modestly in a unique set of patients (n = 224), 84 of whom were deemed high- or intermediate-PERSEVERE-II risk, to distinguish those patients with high versus low risk of D3 SA-AKI SCr.
CONCLUSIONS
Endothelial dysfunction biomarkers are independently associated with risk of severe SA-AKI. Pending validation, incorporation of endothelial biomarkers may facilitate prognostic and predictive enrichment for selection of therapeutics in future clinical trials among critically ill children.
Topics: Humans; Child; Shock, Septic; Prognosis; Sepsis; Biomarkers; Acute Kidney Injury
PubMed: 37400882
DOI: 10.1186/s13054-023-04554-y -
Nursing Science Quarterly Apr 2023Perseverance is a living phenomenon that is uniquely important with individuals, groups, and community. Persevering is persistently choosing one direction from another...
Perseverance is a living phenomenon that is uniquely important with individuals, groups, and community. Persevering is persistently choosing one direction from another in spite of the urgings of others and the unknown consequences. The action of persevering reflects prized and cherished values reflective of the person's unique identity. It is an ethic of choice to be honored. This article begins an ethical straight-thinking discussion of the ethos of honoring human dignity while bearing witness with others who are persevering with life-altering turbulence with the passing of a life. A humanbecoming ethos of enduring truths will be applied to a family story.
Topics: Humans; Respect; Awards and Prizes
PubMed: 36994954
DOI: 10.1177/08943184221150256 -
Psychopharmacology Jun 2021Beneficial effects of aripiprazole on cognition in schizophrenia have been previously reported, but not in recent onset schizophrenia. Cognitive impairments have also...
RATIONALE
Beneficial effects of aripiprazole on cognition in schizophrenia have been previously reported, but not in recent onset schizophrenia. Cognitive impairments have also been associated with catechol-O-methyltransferase (COMT), methylenetetrahydrofolate reductase (MTHFR), and serotonin transporter (SERT) gene polymorphisms which were earlier implicated in the pathophysiology of schizophrenia.
OBJECTIVES
This study examined the short-term influence of aripiprazole long-acting injectable (LAI) as well as of COMT, MTHFR, and SERT gene polymorphisms and their interactions on clinical features and cognitive functions in inpatients with recent onset schizophrenia.
METHODS
This study included 98 inpatients suffering from recent onset schizophrenia diagnosed according to DSM-5 criteria. Three months after initiating aripiprazole LAI, the severity of symptoms was assessed by the Positive and Negative Syndrome Scale (PANSS), while cognitive functions were measured by 5-KOG test for cognition. Genotypes of SERT, MTHFR, and COMT gene were determined by different polymerase chain reaction (PCR) methods.
RESULTS
Three-month aripiprazole LAI treatment was associated with a statistically significant change of PANSS total (p<0.001) and subscale scores as well as cognitive parameters of delayed recall (p<0.03), attention (p<0.01), and executive functions in the form of less perseverations (p<0.03), without influencing other examined cognitive functions. However, it significantly influenced composite cognitive score (p<0.02). In regard to the investigated genetic polymorphisms, we established a positive association between the COMT polymorphism (M/M allele carriers) and attention (p<0.01). Additionally, we also established a positive association between the COMT - MTHFR interaction and attention (p<0.02), as well as perseveration item belonging to executive functions (p<0.01). Two other investigated polymorphisms (MTHFR and SERT) were not significantly associated with cognitive indices. Investigated genetic polymorphisms and their interactions were not associated with PANSS scores.
CONCLUSIONS
Our findings suggest that aripiprazole LAI improves individual cognitive functions in recent onset schizophrenia. Investigated COMT polymorphism (Met/Met genotype), as well as the COMT-MTHFR interaction, were positively associated with attention and executive functioning (perseveration), potentially implying COMT's biomarker potential in terms of cognition in schizophrenia.
Topics: Adolescent; Adult; Alleles; Aripiprazole; Attention; Catechol O-Methyltransferase; Cognition; Executive Function; Female; Genotype; Humans; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Genetic; Schizophrenia; Young Adult
PubMed: 33580813
DOI: 10.1007/s00213-021-05788-w -
Biological Psychiatry Global Open... Jan 2024The nature of cognitive flexibility deficits in obsessive-compulsive disorder (OCD), which historically have been tested with probabilistic reversal learning tasks,...
BACKGROUND
The nature of cognitive flexibility deficits in obsessive-compulsive disorder (OCD), which historically have been tested with probabilistic reversal learning tasks, remains elusive. Here, a novel deterministic reversal task and inclusion of unmedicated patients in the study sample illuminated the role of fixed versus uncertain rules/contingencies and of serotonergic medication. Additionally, our understanding of probabilistic reversal was enhanced through theoretical computational modeling of cognitive flexibility in OCD.
METHODS
We recruited 49 patients with OCD, 21 of whom were unmedicated, and 43 healthy control participants matched for age, IQ, and gender. Participants were tested on 2 tasks: a novel visuomotor deterministic reversal learning task with 3 reversals (feedback rewarding/punishing/neutral) measuring accuracy/perseveration and a 2-choice visual probabilistic reversal learning task with uncertain feedback and a single reversal measuring win-stay and lose-shift. Bayesian computational modeling provided measures of learning rate, reinforcement sensitivity, and stimulus stickiness.
RESULTS
Unmedicated patients with OCD were impaired on the deterministic reversal task under punishment only at the first and third reversals compared with both control participants and medicated patients with OCD, who had no deficit. Perseverative errors were correlated with OCD severity. On the probabilistic reversal task, unmedicated patients were only impaired at reversal, whereas medicated patients were impaired at both the learning and reversal stages. Computational modeling showed that the overall change was reduced feedback sensitivity in both OCD groups.
CONCLUSIONS
Both perseveration and increased shifting can be observed in OCD, depending on test conditions including the predictability of reinforcement. Perseveration was related to clinical severity and remediated by serotonergic medication.
PubMed: 38298803
DOI: 10.1016/j.bpsgos.2023.06.004 -
Brain Sciences May 2023Persistence is defined as, among other ways, the need to achieve the goals and strive for the goal. Persistence can also be considered from the perspective of the...
UNLABELLED
Persistence is defined as, among other ways, the need to achieve the goals and strive for the goal. Persistence can also be considered from the perspective of the resource concept, as a positive factor related to an individual's adaptive behaviour, psychological resilience, and normal self-regulation. In contrast, tendencies behaviourally similar to perseverance, but which may have psychopathological features, are persistence and perfectionism. The main goal of our study was to: (I) Build non-clinical Persistence Scale (PS) in Polish and English; (II) translate in Polish and validate the Persistence, Perfectionism and Perseveration Questionnaire (PPPQ); (III) analyse properties of both scales.
METHODS
The study was conducted on a non-clinical group of 306 subjects. The mean age was 27.6 and ranged from 18 to 58 years. The properties of both scales were analysed using the NEO-FFI personality inventory, PSS-10 Perceived stress level scale, The UPPS-P Impulsive Behaviour Scale, the SPSRQ Sensitivity to Punishment and Reward scale, Grit scale and NAS-50 Self-Control Scale.
RESULTS
The psychometric features of the scales fulfil the requirements for psychometric tools. The factorial structure of both versions of the PS-20 scale proved to be unifactorial. Openness was the only variable to co-occur with the persistence scales of both the PS-20 and the PPPQ-10, and did not co-occur with scales intended to indicate psychopathology (Perseveration, Perfectionism). Negative correlations occurred with variables describing Persistence with levels of perceived stress, anxiety and depressive symptoms. Impulsivity measured by the SUPPS scale also showed negative correlations with the study variables.
CONCLUSIONS
In the present work, we postulate that persistence is an umbrella construct that gathers and integrates many other traits to form a multi-trait persistence. Perseveration should be regarded as an undesirable trait characterising psychopathological behaviour. Desirable and indicative traits of an individual's good functioning are persistence and, to some extent, perfectionism. Individuals with low persistence and high perseveration may be characterised by a repertoire of psychopathological behaviours.
PubMed: 37371344
DOI: 10.3390/brainsci13060864 -
Headache Jan 2023Reversible cerebral vasoconstriction syndrome (RCVS) and transient global amnesia (TGA) are acute and self-limiting intra-cerebral conditions. Although previously... (Review)
Review
Reversible cerebral vasoconstriction syndrome (RCVS) and transient global amnesia (TGA) are acute and self-limiting intra-cerebral conditions. Although previously studied as independent phenomena, there are increasing reports of co-occurrence of these two pathologies. We report a 55-year-old male who presented to the hospital with recurrent thunderclap headaches over the course of 1 week with sudden onset of anterograde memory loss. His medications included a selective serotonin reuptake inhibitor and intermittent use of pseudoephedrine. On examination he was amnestic to recent events and notably perseverating. Magnetic resonance imaging of the brain without contrast showed a small, punctate focus of restricted diffusion in the left hippocampus. He was diagnosed with TGA based on his clinical presentation. His headaches and amnesia resolved over the next 12 h throughout the course of his stay with acetaminophen and oral verapamil and he was discharged. Repeat computed tomography angiogram at 2 weeks revealed diffuse and segmental narrowing of the anterior and posterior intracranial circulation, which resolved on follow-up imaging at 3 months, confirming RCVS. The acute and reversible nature of these conditions and increasing reports of co-occurrence suggests a common pathophysiologic link. We review the literature highlighting similar cases and the presumed pathophysiology.
Topics: Male; Humans; Middle Aged; Amnesia, Transient Global; Vasoconstriction; Vasospasm, Intracranial; Headache Disorders, Primary; Cerebrovascular Disorders; Headache
PubMed: 36588462
DOI: 10.1111/head.14432 -
Indian Journal of Orthopaedics May 2020Athletes that excel in their field, and are hence declared "elite", have many challenges and problems in their career. The path to glory is often littered with personal...
Athletes that excel in their field, and are hence declared "elite", have many challenges and problems in their career. The path to glory is often littered with personal sacrifice, rigorous schedules and many related medical issues from orthopaedic injuries specific to individual sports, to mental health issues that are often not diagnosed. Coupled with that, the lack of support to these sportspersons in underdeveloped countries, makes their road to the top much more challenging. Commitment of time, continuance of effort and perseverance are key components. The current account of a difficult journey and the issues that were overcome serves as a guide to aspiring athletes and to support staff ranging from doctors to physiotherapists and perhaps even the sports administrators.
PubMed: 32399140
DOI: 10.1007/s43465-020-00091-w -
Journal of Behavioral Medicine Apr 2021A number of studies have shown that self-rated health reliably predicts mortality. This study assessed the impact of perseveration on self-rated health, physical...
A number of studies have shown that self-rated health reliably predicts mortality. This study assessed the impact of perseveration on self-rated health, physical functioning, and physical symptoms (pain, fatigue, breast cancer symptoms) among breast cancer patients. We hypothesized that cancer-related distress would serve as an intervening variable between both worry and rumination and self-rated health, physical functioning, and physical symptoms. Women (N = 124) who were approximately 7 weeks post-surgery but pre adjuvant treatment completed the Impact of Events Scale, the Penn State Worry Questionnaire, and the Rumination Scale. They also rated their pain, fatigue, physical functioning, and self-rated health using the RAND-36 and breast cancer symptoms with the Breast Cancer Prevention Trial Symptom Checklist (BCPT). Covariates included body mass index, age, cancer stage, menopause status, and physical comorbidities. Worry was associated with higher cancer-related distress, which in turn predicted greater pain and breast cancer symptoms, poorer physical functioning, and lower self-rated health. Rumination also predicted greater cancer-related distress, which ultimately contributed to greater pain along with poorer physical functioning and self-rated health. Models with fatigue as an outcome were not significant. These findings suggest that perseveration can heighten cancer-related distress and subsequent perceptions of physical symptoms and health among breast cancer patients prior to adjuvant treatment. Perseveration early in the cancer trajectory can adversely increase the impact of a cancer diagnosis and treatment on functioning and quality of life.
Topics: Anxiety; Breast Neoplasms; Fatigue; Female; Humans; Pain; Quality of Life; Surveys and Questionnaires
PubMed: 33135103
DOI: 10.1007/s10865-020-00192-9 -
Aging & Mental Health 2023A randomized trial was conducted to investigate the effects of computerized cognitive training (CCT) and tai chi exercise (TCE) vs. health education (HE) on cognitive... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A randomized trial was conducted to investigate the effects of computerized cognitive training (CCT) and tai chi exercise (TCE) vs. health education (HE) on cognitive functions in 189 older adults with mild cognitive impairment (MCI).
METHODS
Cognitive functions were assessed by the five-domain Mattis Dementia Rating Scale (MDRS) (attention, initiation/perseveration, construction, conceptualization, and memory) and the modified Telephone Interview of Cognitive Status (TICS-M), while the timed up and go (TUG), Tinetti's balance, activities of daily living (ADLs), and Activities-specific Balance Confidence (ABC) were also evaluated. Each intervention was delivered once a week for 6 months. All outcomes were followed up at 6 and 12 months of the study.
RESULTS
Compared to HE, CCT increased scores on the MDRS's total, initiation/perseveration, construction, and conceptualization domains and on the TICS-M at 6 months and those on the MDRS's total, attention, construction, conceptualization, and memory domains and on the TICS-M at 12 months; TCE increased scores on the MDRS's total and construction domains and on the TICS-M at 6 months and those on the MDRS's total, attention, initiation/perseveration, and conceptualization domains and on the TICS-M at 12 months. Moreover, CCT improved the TUG at 6 and 12 months and Tinetti's balance at 12 months, and TCE improved the TUG at 6 and 12 months, Tinetti's balance, and ABC at 6 and 12 months, and ADLs at 12 months.
CONCLUSIONS
The effects of CCT and TCE on improving global cognition and certain cognitive domains for older MCI adults may have been small but they lasted for at least 12 months.
Topics: Aged; Humans; Activities of Daily Living; Cognition; Cognitive Dysfunction; Cognitive Training; Tai Ji
PubMed: 37365961
DOI: 10.1080/13607863.2023.2225430 -
Aging & Mental Health 2023: To investigate the associations of specific cognitive functions and with the frailty trajectory among older Taiwanese adults. At baseline, 730 community-dwelling older...
: To investigate the associations of specific cognitive functions and with the frailty trajectory among older Taiwanese adults. At baseline, 730 community-dwelling older adults were recruited from outpatient clinics of a general hospital. Frailty status was defined using phenotype criteria. Global cognition was assessed using the modified Telephone Interview of Cognitive Status and Mini-Mental State Examination (MMSE). The Mattis Dementia Rating Scale (MDRS) and Digit Symbol Substitution Test were used to evaluate 6 cognitive domains: attention, initiation/perseveration, construction, conceptualization, memory, and processing speed. The group-based trajectory model was used to identify latent frailty trajectory groups and the multinomial logistic regression was to examine the relationships of specific cognitive functions with frailty trajectory. Among 485 participants (168 men, 317 women, and mean age: 71.1 ± 5.5 years) completed 2 annual follow-up assessments, three frailty trajectory groups of improvement, no-change, and progression were identified. After adjusting for baseline frailty status, age, sex, global cognition, regular exercise habit, and number of comorbidities, higher scores on MDRS's initiation/perseveration (odds ratio [OR] = 0.85; 95% CI = 0.75-0.95) and attention (OR = 0.63; 95% CI = 0.38-1.00), respectively, were significantly associated with lower risk of frailty progression. Conversely, no significant association was detected between MMSE or TICSM scores and frailty improvement or progression. Specific cognitive functions of initiation/perseveration and attention, rather than global cognition, may be more useful to predict frailty progression, thus allowing the identification of at-risk older adults.
PubMed: 36016472
DOI: 10.1080/13607863.2022.2116393