Why Psychiatrists are Reluctant to Diagnose: Borderline Personality Disorder.

Clinicians can be reluctant to make a diagnosis of borderline personality disorder (BPD). One reason is that BPD is a complex syndrome with symptoms that overlap many Axis I disorders. This paper will examine interfaces between BPD and depression, between BPD and bipolar disorder, and between BPD and psychoses.

Mega-trials vs. meta-analysis: precision vs. heterogeneity?

In recent years, several authors have suggested there is a need for more very large or "mega-trials" (defined in this manuscript as a trial powered to address subgroup differences/interactions/secondary analyses) to answer important clinical questions. Because mega-trials are expensive and funding for clinical research is limited, increasing the number of mega-trials limits funding for other research. The advantages of this approach compared with funding more focused RCTs needs to be debated.

Angiotensin II/AT2 receptor-induced vasodilation in stroke-prone spontaneously hypertensive rats involves nitric oxide and cGMP-dependent protein kinase.

Background: Angiotensin II (Ang II) induces vasodilation, in part, through angiotensin type 2 receptor (AT2R)-induced actions in conditions associated with angiotensin type 1 receptor (AT1R) blockade and AT2R upregulation. Ang II/AT2R-induced vasodilation involves nitric oxide (NO)-cyclic guanosine monophosphate (cGMP)-dependent processes. We previously demonstrated that AT2R-mediated effects involve inhibition of the RhoA/Rho kinase pathway.

Documentation on the anesthetic record: Correlation with clinically important variables.

Purpose: A survey was undertaken at a single Academic Health Sciences Centre to document the opinions of anesthesiologists regarding what variables are important to document on the anesthetic record. A subsequent chart review of anesthetic records was undertaken to determine the extent to which these anesthesiologists record the variables they consider important.

Methods: A survey form was mailed to all practicing staff anesthesiologists at the four adult McGill University affiliated hospitals.

Documentation on the anesthetic record: correlation with clinically important variables : [Documentation sur le dossier anesthésique : corrélation avec les variables cliniques importantes].

Purpose: A survey was undertaken at a single Academic Health Sciences Centre to document the opinions of anesthesiologists regarding what variables are important to document on the anesthetic record. A subsequent chart review of anesthetic records was undertaken to determine the extent to which these anesthesiologists record the variables they consider important.

Methods: A survey form was mailed to all practicing staff anesthesiologists at the four adult McGill University affiliated hospitals.

The effect of information level and coping style on pain and anxiety in needle liver biopsy.

Biopsy of the liver is an important diagnostic procedure. The procedure is invasive and may be painful for patients. Sedative drugs are not used because the associated drop in blood pressure mimics hemorrhage, a major complication of the procedure.

Canadian guidelines for training in adult perioperative transesophageal echocardiography. Recommendations of the Cardiovascular Section of the Canadian Anesthesiologists' Society and the Canadian Society of Echocardiography.

Purpose: To establish Canadian guidelines for training in adult perioperative transesophageal echocardiography (TEE).

Methods: Guidelines were established by the Canadian Perioperative Echocardiography Group with the support of the cardiovascular section of the Canadian Anesthesiologists' Society (CAS) in conjunction with the Canadian Society of Echocardiography. Guidelines for training in echocardiography by the American Society of Echocardiography, the American College of Cardiology and the Society of Cardiovascular Anesthesiologists were reviewed, modified and expanded to produce the 2003 Quebec expert consensus for training in perioperative echocardiography.

Transforming growth factor-beta pathway disruption and infiltration of colorectal cancers by intraepithelial lymphocytes.

Aims: Colorectal cancers deficient in DNA mismatch repair (MMR) are often characterized by the presence of numerous intraepithelial lymphocytes (IELs). These CD8+ T cells selectively express CD103, which is upregulated locally by transforming growth factor (TGF)-beta, and adhere to E-cadherin expressed by mucosal epithelia. Many of these cancers also possess inactivating mutations in the type II TGF-beta receptor and are believed to be insensitive to TGF-beta.

A pilot study on the effects of pre-event manipulation on jump height and running velocity.

Purpose: To compare changes in jump height and running velocity with and without pre-event high-velocity, low-amplitude manipulation (HVLA).

Methods: A crossover study design with elite healthy athletes was used. After a 15 min warm-up, the subjects were tested for countermovement jump height (CMJ) and flying 40 m sprint time (SPRINT).

Frequency and determinants of the postthrombotic syndrome after venous thromboembolism.

Purpose Of Review: Postthrombotic syndrome (PTS) is the most common complication of deep venous thrombosis (DVT). Identifying which patients are at high risk of developing PTS would help improve the management of patients with DVT and allow physicians to provide patients with individualized information on their expected prognosis. This review discusses the knowledge gained from key studies over the last decade on the incidence and determinants of PTS, with special emphasis on published studies from the last 2 years.

Cobalt and chromium ions induce nitration of proteins in human U937 macrophages in vitro.

The in situ localization of nitrotyrosine, a product of the nitration of tyrosine residues by peroxynitrite, in the interface membranes from Co--Cr--Mo and Ti--Al--V prostheses provided evidence of nitric oxide-induced oxidative damage in the periprosthetic environment. In the present study, we compared the effects of different wear products from hip prostheses on the nitration of proteins in macrophages in vitro. Nitration of proteins was measured by Western blot using a polyclonal antibody directed against nitrotyrosines.

Approach to injuries in active people.

Objective: To review the basic principles underlying treatment of injuries in active people.

Sources Of Information: Basic science texts and reports of observational and randomized trials on treatment of musculoskeletal injuries were retrieved during previous exhaustive systematic reviews published by the author on a variety of musculoskeletal injury topics.

Main Message: After an injury, further damage or re-injury can be prevented either by decreasing the stress on the tissue or increasing the stress the tissue can withstand.

Limitations of using aggrecan and type X collagen as markers of chondrogenesis in mesenchymal stem cell differentiation.

The study was initially designed to differentiate human bone marrow-derived mesenchymal stem cells (MSC) into chondrocyte-like cells, for use in tissue engineering. We cultured MSCs in defined chondrogenic medium as pellet cultures supplemented with transforming growth factor (TGF)-beta1 or -beta3 and dexamethazone, as they are commonly used to promote in vitro chondrogenesis. Markers of chondrogenesis used were type II collagen and aggrecan, with type X collagen being used as a marker of late-stage chondrocyte hypertrophy (associated with endochondral ossification).

Brief and distinct empirical sleepiness and fatigue scales.

Objective: Sleepiness and fatigue are conceptually distinct but pervasively confounded in research, measurement instruments, clinical settings, and everyday spoken language. The purpose of the present study was to construct two scales that represent unconfounded measures of sleepiness and fatigue, using widely used questionnaires.

Method: Four questionnaires purporting to measure sleepiness [Stanford Sleepiness Scale (SSS); Epworth Sleepiness Scale (ESS)] or fatigue [Fatigue Severity Scale (FSS); Chalder Fatigue Scale (CFS)] were administered, as well as a battery measuring sleep, psychological, and health functioning variables, to three samples: 19 individuals with chronic fatigue syndrome, 14 with narcolepsy, and 11 normal control subjects.

Understanding the relationship between risks and odds ratios.

Background: Many articles provide only odds ratios (OR) and non relative risks (RR) as the effect estimate. For a variety of important reasons, multiple logistic regression used to adjust for confounders routinely provides only the adjusted OR (ORadj). However, from the clinician's perspective, the ORadj is only easily interpretable when it approximates the adjusted RR (RRadj).

Conservative non-pharmacological treatment options are not frequently used in the management of hip osteoarthritis.

Osteoarthritis (OA) is the most frequent joint disorder in seniors. Systematic reviews suggest that conservative treatment is effective and preferred in mild-moderate cases. The objective of this study was to examine the proportion of patients receiving physiotherapy, exercise or walking aids, and to explore factors associated with their prescription.

Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada.

Background: Venous thromboembolism (VTE) prophylaxis in acutely ill medical patients has been shown to be safe and effective. Underutilization of this patient safety practice may result in avoidable mortality and morbidity.

Objectives: We aimed to determine the proportion of hospitalized, acutely ill medical patients across Canada who were eligible to receive thromboprophylaxis and to evaluate the frequency, determinants and appropriateness of its use.

Maternal anxiety: an emerging prognostic factor in neonatology.

Unlabelled: Symptoms of anxiety in pregnant and postpartum women are of considerable concern due to their association with adverse obstetrical outcomes, postpartum depression, and emotional and behavioral problems in the children. Certain mothers are at particularly high risk for anxiety in the immediate postpartum period: those who have experienced preterm birth or other perinatal complications, as well as those lacking a satisfactory marital relationship or other forms of social support.

Conclusion: Programs to detect and intervene with anxious mothers in the early postpartum period are warranted.

Personal standards and evaluative concerns dimensions of "clinical" perfectionism: a reply to Shafran et al. (2002, 2003) and Hewitt et al. (2003).

Shafran, Cooper, and Fairburn (2002, 2003) provided a cognitive-behavioral analysis of "clinical" perfectionism, a construct they considered to involve both the determined pursuit of self-imposed standards and extremely vulnerable self-evaluation. They argued against a multidimensional perspective to studying perfectionism. We respond to Shafran et al.

Outcome and epidemiological research on personality disorders: implications for classification.

The construct of personality disorder has an overall definition that describes chronicity. However, the findings of outcome research indicate that while many patients stop meeting criteria for specific categories of disorder over time, they often continue to suffer from dysfunctional traits. One can also interpret epidemiological findings on personality disorders as overestimating disorders due to a failure to distinguish them from traits.

Humoral response to Mycobacterium tuberculosis antigens in patients with tuberculosis in the Gambia.

Objective: To determine and compare the sensitivity and specificity of four common mycobacterial antigens with three RD-1 region antigens in the serological diagnosis of active pulmonary tuberculosis (PTB) in the Gambia.

Design: Serum from 300 Gambians (100 with active PTB, 100 of their household contacts, and 100 community controls) was tested using an ELISA method to detect antibodies to seven mycobacterial antigens (three encoded in the RD-1 region [ESAT-6, CFP-10 and Rv3871] and four common [38 kDa, GLU-S, 19 kDa and 14 kDa]). Individuals with active TB were recruited from one of the National Leprosy and TB Control Program clinics in the western region of the Gambia, and neighborhood controls were an age-matched individual living within five houses of the case.

Hemodilution and surgical hemostasis contribute significantly to transfusion requirements in patients undergoing coronary artery bypass.

Objective: We sought to determine the incidence of and risk factors for the development of low intraoperative hematocrit levels and of excessive postoperative bleeding in patients undergoing coronary artery bypass grafting, whether the risk factors are the same, and their effect on blood product transfusions.

Methods: We performed a prospective cohort study of 613 adult patients who underwent coronary artery bypass grafting in 3 tertiary, university-affiliated hospitals during the period from October 1, 2000, to March 31, 2001.

Results: Low intraoperative hematocrit levels (<19%) were found in 131 (24%) patients who had operations performed with extracorporeal circulation compared with in 3 (4%) patients with operations performed off pump.