A prospective four-year follow-up of neuropsychological function in HIV seropositive and seronegative methadone-maintained patients

The evolution of central nervous system (CNS) impairments associated with human immunodeficiency virus (HIV) infection was assessed by a prospective, longitudinal study of patients in a methadone maintenance clinic. At a mean of 47 months after baseline testing, which included physical exams, HIV antibody testing and a neuropsychological (NP) screening battery, 121 subjects received a second NP assessment. Forty subjects (33%) who were seropositive at baseline showed statistically significant declines in NP function over the 4 years compared with 81 seronegatives, on the Finger Tapping and Trail Making B tests. This relatively long-term follow-up suggests that subtle cognitive deficits develop over time and can be identified early, but their course is slow and appears generally to parallel that of non-CNS symptoms/signs of HIV infection.     

Threshold increases in soil lead and mercury from tropospheric deposition across an elevational gradient

Atmospheric deposition is the primary mechanism by which remote ecosystems are contaminated, but few data sets show how fluxes change and control soil metal burdens at the landform scale. We present mercury (Hg), lead ((210)Pb and total Pb), and cosmogenic beryllium-7 ((7)Be) measurements in organic (O) soil horizons at high-resolution elevation intervals of ～60 m from 540 to 1160 m on Camels Hump in northern Vermont, USA. Across this gradient, average O horizon Hg ranges from 0.99 mg m(-2) in the low elevation deciduous forest zone to 7.6 mg m(-2) in the higher elevation coniferous forest at 1030 m. We measure two pronounced threshold increases in soil metal burdens above 801 and 934 m, corresponding to the two most common altitudes of cloud base, which coincide with changes in vegetation species. Lead-210, a unique tracer of tropospheric deposition, also increased from 3200 Bq m(-2) to 11?500 Bq m(-2) in O horizons, exhibiting threshold responses at the same elevations as Hg and total Pb. Concentrations of (210)Pb and Hg in foliage double from 760 to 900 m elevation, indicating enhanced deposition across the transition from deciduous to coniferous forest. In contrast, (7)Be is constant across the entire elevational gradient because of its upper atmospheric source. This indicates that the effects of orographic precipitation have a smaller control on soil contaminant burdens than the coupled cloudwater deposition-vegetation scavenging effect in the presence of upwind sources. By measuring soil contaminants and unique tracers of atmospheric deposition, we show that tropospheric fluxes of Hg and Pb are higher by a factor of 2 in high-elevation coniferous forests than in adjacent lowlands. Total O horizon Hg and Pb burdens increase by over 4-fold with elevation because of the compounding effects of enhanced deposition and longer metal residence times at higher elevations (>50 years).     

Cervical reconstruction of the supra-aortic trunks: a 16-year experience

PURPOSE: The purpose of this study was to review 182 consecutive cervical reconstructions of supra-aortic trunks, which were performed over a 16-year period. METHODS: A total of 182 innominate, common carotid, or subclavian arteries were reconstructed with a cervical approach in 173 patients aged 23 days to 83 years. Indications included hemispheric (n = 79), vertebrobasilar (n = 56), upper extremity (24), and internal mammary/cardiac ischemia (n = 5), asymptomatic severe common carotid disease (n = 33), or other (n = 3). Primary atherosclerotic innominate (n = 6), common carotid (n = 84), and subclavian (n = 66) lesions underwent reconstruction. Thirty-one operations were performed for multiple trunk involvement, recurrent disease, arteritis, infection, dissection, coarctation, or aneurysm. There were 122 bypass grafting procedures (98 ipsilateral, 24 contralateral) and 60 arterial transpositions. RESULTS: One death (0.5%) and 7 nonfatal strokes (3.8%) occurred, none in patients who were asymptomatic. Perioperative morbidity included four asymptomatic occlusions (2%), 6 myocardial infarctions (3%), 10 pulmonary complications (5%), and 2 graft infections (1%). Follow-up periods ranged from 1 to 190 months (mean, 53 +/- 5 months). Nineteen patients (10%) were lost to follow-up. Fifty-seven late deaths occurred, most from cardiac causes. Seven reconstructions necessitated late revision. The cumulative primary patency rate at 5 and 10 years was 91% +/- 2% and 82% +/- 5%, respectively. The survival rate at 5 years was 72% +/- 4% and at 10 years was 41% +/- 6%. The stroke-free survival rate was 92% +/- 2% at 5 years and 84% +/- 2% at 10 years. CONCLUSION: Cervical reconstruction of symptomatic and asymptomatic supra-aortic trunk lesions carries acceptable death and stroke rates and provides a long-term patient benefit. This should be the preferred approach for asymptomatic lesions and for patients with significant comorbidity because it carries less morbidity than direct transmediastinal aortic-based reconstruction.     

Domestic protection orders and the prediction of subsequent criminality and violence toward protectees.

Conducted a random, comparative, archival study of select variables across a 6-yr period of time—3 yrs prior to, and 3 yrs after, the issuance of a protective (restraining) order against 200 persons (defendants). Logistic regression analyses were used to test hypotheses that certain variables would predict arrest for criminal and violently criminal acts toward the protectees. The most important finding was that most Ss were not arrested for a subsequent criminal or violent act toward protectees. Nonmutual service of a protection order, however, increased the risk of victim-related criminal arrests over no service and mutual service across all 3 racial groups (Blacks, Whites, and Hispanics), but was significant only for Hispanics. Nonmutual service also increased the risk of a victim-related violent criminal arrest over no service or mutual service, but race was not a significant predictor. The authors were able to correctly classify arrest or nonarrest with an 83.5% overall accuracy rate. Protection orders appear to be related to, and may deter, criminal and violently criminal offenses toward protectees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of cerebral blood flow reserve using functional magnetic resonance imaging

Imaging of activated brain areas based on changes of blood deoxyhemoglobin levels is now possible with MRI. Acetazolamide (ACZ) increases cerebral blood flow (CBF) without changing cerebral oxygen consumption; this results in signal changes observed in gradient echo MR images from the areas with an increase in CBF. We assessed signal changes after ACZ application in seven healthy subjects with a conventional 1.5-T MRI scanner. The susceptibility-sensitized three-dimensional fast low-angle shot (FLASH) sequence was used to visualize signal changes induced by ACZ. We analyzed anatomic localization of different ranges of detected signal changes. ACZ caused significant signal changes in the gray matter and at the edge of the cerebral cortex, the latter corresponding to draining surface veins. No significant differences were seen among different brain areas within the same slice. Using the maximal intensity projection technique, we were able to partially separate signal changes originating in draining veins from signal originating in the gray matter microvasculature. Signal changes from the microvessels reflect cerebrovascular reserve. Blood-oxygen-level-dependent (BOLD) based MRI can evaluate CBF reserve with high spatial and temporal resolution. To assess cerebrovascular reserve, it is necessary to separate signal changes originating in large vessels from signal from brain microvasculature.     

Cerebrovascular muscle atrophy is a feature of Alzheimer's disease

We examined vascular amyloid-beta deposition and other abnormalities in the posterior cerebral artery of consecutive cases of Alzheimer's disease (AD) compared to controls. Smooth muscle atrophy was a consistent feature in the cases of AD examined (p<0.01) and was surprisingly independent of adjacent amyloid-beta deposition. These findings suggest that vascular abnormalities are a consistent feature in AD and may be an important contributor to the pathogenesis and complications of AD.