Showing papers by "David Cohen published in 2012"

Interpersonal Synchrony: A Survey of Evaluation Methods across Disciplines

Abstract: Synchrony refers to individuals' temporal coordination during social interactions. The analysis of this phenomenon is complex, requiring the perception and integration of multimodal communicative signals. The evaluation of synchrony has received multidisciplinary attention because of its role in early development, language learning, and social connection. Originally studied by developmental psychologists, synchrony has now captured the interest of researchers in such fields as social signal processing, robotics, and machine learning. This paper emphasizes the current questions asked by synchrony evaluation and the state-of-the-art related methods. First, we present definitions and functions of synchrony in youth and adulthood. Next, we review the noncomputational and computational approaches of annotating, evaluating, and modeling interactional synchrony. Finally, the current limitations and future research directions in the fields of developmental robotics, social robotics, and clinical studies are discussed.

Pre-, peri- and neonatal risk factors for autism

Abstract: Objective. To identify pre-, peri- and neonatal risk factors for pervasive developmental disorders (PDD). Methods. We searched the Medline database through March 2011 for relevant case–control and population-based studies on pre-, peri- and neonatal hazards related to PDD, including autism. We identified 85 studies for this review. Data were extracted systematically and organized according to risk factors related to family history, pregnancy, gestational age, delivery, birth milestones and the neonate's condition at birth. Results. During the prenatal period, risk factors for PDD were advanced maternal or paternal ages, being firstborn vs. third or later, maternal prenatal medication use and mother's status as foreign born. During the perinatal and neonatal periods, the risk factors for PDD were preterm birth, breech presentation, planned cesarean section, low Apgar scores, hyperbilirubinemia, birth defect and a birthweight small for gestational age. The influence of maternal pre-eclampsia, diabetes, vomiting, infections and stress during pregnancy requires further study in order to determine risk for PDD. Discussion. Despite evidence for the association of some pre-, peri- and neonatal risk factors associated with PDD, it remains unclear whether these risks are causal or play a secondary role in shaping clinical expression in individuals with genetic vulnerability. A plausible hypothsesis is that improvements in obstetric and neonatal management have led to an increased rate of survivors with pre-existing brain damage. Given the variety of risk factors, we propose that future studies should investigate combinations of multiple factors, rather than focusing on a single factor.

Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis.

Abstract: In adults, second-generation antipsychotics (SGAs) have a low frequency of extrapyramidal syndrome (EPS) and a moderate frequency of metabolic adverse effects. Here we aimed to assess short-term adverse effects of SGAs in children and adolescents. We searched for relevant studies in MEDLINE and EMBASE (1996-2010), Food and Drug Administration and European Medicines Agency clinical trial registries, and reference lists of review articles. We found 41 were short-term (3-12 weeks) controlled studies that evaluated SGA adverse effects in youths. Using Bayesian meta-analysis, we analyzed odds ratios (ORs) or mean average effects. Numbers of arms (subjects) in the 41 trials were aripiprazole, 10 (n = 671); olanzapine, 14 (n = 413); quetiapine, 10 (n = 446); risperidone, 25 (n = 1040); ziprasidone, 4 (n = 228); clozapine, 5 (n = 79); and placebo/untreated, 23 (n = 1138), totaling 93 arms (4015 patients). Clozapine was assessed only for weight gain and somnolence. Compared with placebo, significant treatment-related increases were observed for weight gain with olanzapine (mean ± SD = 3.99 ± 0.42 kg; 95% credible interval, 3.17-4.84 kg), clozapine (2.38 ± 1.13 kg; 95% credible interval, 0.19-4.62 kg), risperidone (2.02 ± 0.32 kg; 95% credible interval, 1.39-2.66 kg), quetiapine (1.74 ± 0.38 kg; 95% credible interval, 0.99-2.5 kg), and aripiprazole (0.89 ± 0.32 kg; 95% credible interval, 0.26-1.51 kg); glucose levels with risperidone (3.7 ± 1.36 mg/dL; 95% credible interval, 1.08-6.42 mg/dL) and olanzapine (2.09 ± 1.08 mg/dL; 95% credible interval, 0.13-4.32 mg/dL); cholesterol levels with quetiapine (10.77 ± 2.14 mg/dL; 95% credible interval, 6.6-14.95 mg/dL) and olanzapine (4.46 ± 1.65 mg/dL; 95% credible interval, 1.24-7.73 mg/dL); triglyceride levels with olanzapine (20.18 ± 5.26 mg/dL; 95% credible interval, 9.85-30.53 mg/dL) and quetiapine (19.5 ± 3.92 mg/dL; 95% credible interval, 11.84-27.17 mg/dL); hyperprolactinemia with risperidone (OR, 38.63; 95% credible interval, 8.62-125.6), olanzapine (OR, 15.6; 95% credible interval, 4.39-41.1), and ziprasidone (OR, 9.35; 95% credible interval, 1.24-37.03); and EPS with ziprasidone (OR, 20.56; 95% credible interval, 3.53-68.94), olanzapine (OR, 6.36; 95% credible interval, 2.43-13.84), aripiprazole (OR, 3.79; 95% credible interval, 2.17-6.17), and risperidone (OR, 3.71; 95% credible interval, 2.18-6.02). All SGAs increased the risk of somnolence/sedation. We conclude that short-term metabolic effects and EPS are frequent in children treated with SGAs. Second-generation antipsychotics have distinct profiles of secondary effects, which should be considered in making treatment decisions.

Troponin criteria for myocardial infarction after percutaneous coronary intervention.

Abstract: Background The universal definition of myocardial infarction specifies creatine kinase–MB fraction (CKMB) or troponin values more than 3 times the 99th percentile of the upper reference limit as diagnostic after percutaneous coronary intervention, with a preference for the use of troponin. Methods Outcomes of 4930 patients with elective coronary stent placement between July 1, 2004, and September 30, 2007, as part of the EVENT (Evaluation of Drug Eluting Stents and Ischemic Events) registry were analyzed to test the association between 1-year mortality and postprocedure elevation of either CKMB or troponin. All values were normalized to the individual clinical center myocardial infarction diagnostic levels. Results Myocardial infarction occurred in 7.2% of patients by the CKMB criteria and in 24.3% of patients by the troponin criteria of greater than 3 times the diagnostic level. Both CKMB (hazard ratio [HR], 1.38; 95% CI, 1.22-1.55) and troponin (HR, 1.35; 95% CI, 1.18-1.54) as continuous values were associated with 1-year mortality. The mortality effect of a more than 3-fold increase was greater for CKMB (adjusted HR, 2.5; 95% CI, 1.5-4.1) than for troponin (adjusted HR, 1.7; 95% CI, 1.1-2.5). A troponin threshold more than 20 times the diagnostic level provided similar frequency (7.0%) and mortality risk (adjusted HR, 2.6; 95% CI, 1.6-4.3) as a 3-fold increase in CKMB. A regression spline model of the relationship between troponin and 1-year mortality demonstrated that the hazard of mortality increased from 1.02 at 3-fold to 1.67 at 20-fold troponin elevation. Conclusion Troponin and CKMB elevations after percutaneous coronary intervention are associated with increased 1-year mortality rates, but thresholds for similar event frequency and mortality hazard are much higher for troponin than for CKMB.

Analysis of the chromosome X exome in patients with autism spectrum disorders identified novel candidate genes, including TMLHE

Abstract: The striking excess of affected males in autism spectrum disorders (ASD) suggests that genes located on chromosome X contribute to the etiology of these disorders. To identify new X-linked genes associated with ASD, we analyzed the entire chromosome X exome by next-generation sequencing in 12 unrelated families with two affected males. Thirty-six possibly deleterious variants in 33 candidate genes were found, including PHF8 and HUWE1, previously implicated in intellectual disability (ID). A nonsense mutation in TMLHE, which encodes the ɛ-N-trimethyllysine hydroxylase catalyzing the first step of carnitine biosynthesis, was identified in two brothers with autism and ID. By screening the TMLHE coding sequence in 501 male patients with ASD, we identified two additional missense substitutions not found in controls and not reported in databases. Functional analyses confirmed that the mutations were associated with a loss-of-function and led to an increase in trimethyllysine, the precursor of carnitine biosynthesis, in the plasma of patients. This study supports the hypothesis that rare variants on the X chromosome are involved in the etiology of ASD and contribute to the sex-ratio disequilibrium.

Prenatal ultrasound screening: false positive soft markers may alter maternal representations and mother-infant interaction.

Abstract: Background In up to 5% of pregnancies, ultrasound screening detects a “soft marker” (SM) that places the foetus at risk for a severe abnormality. In most cases, prenatal diagnostic work-up rules out a severe defect. We aimed to study the effects of false positive SM on maternal emotional status, maternal representations of the infant, and mother-infant interaction. Methodology and Principal Findings Utilizing an extreme-case prospective case control design, we selected from a group of 244 women undergoing ultrasound, 19 pregnant women whose foetus had a positive SM screening and a reassuring diagnostic work up, and 19 controls without SM matched for age and education. In the third trimester of pregnancy, within one week after delivery, and 2 months postpartum, we assessed anxiety, depression, and maternal representations. Mother-infant interactions were videotaped during feeding within one week after delivery and again at 2 months postpartum and coded blindly using the Coding Interactive Behavior (CIB) scales. Anxiety and depression scores were significantly higher at all assessment points in the SM group. Maternal representations were also different between SM and control groups at all study time. Perturbations to early mother-infant interactions were observed in the SM group. These dyads showed greater dysregulation, lower maternal sensitivity, higher maternal intrusive behaviour and higher infant avoidance. Multivariate analysis showed that maternal representation and depression at third trimester predicted mother-infant interaction. Conclusion False positive ultrasound screenings for SM are not benign and negatively affect the developing maternal-infant attachment. Medical efforts should be directed to minimize as much as possible such false diagnoses, and to limit their psychological adverse consequences.

Psychiatric and Cognitive Phenotype of Childhood Myotonic Dystrophy Type 1.

Abstract: Aim To investigate the psychiatric and cognitive phenotype in young individuals with the childhood form of myotonic dystrophy type 1 (DM1). Method Twenty-eight individuals (15 females, 13 males) with childhood DM1 (mean age 17y, SD 4.6, range 7–24y) were assessed using standardized instruments and cognitive testing of general intelligence, visual attention, and visual–spatial construction abilities. Results Nineteen patients had repeated a school grade. The mean (SD) Full-scale IQ was 73.6 (17.5) and mean Verbal IQ was significantly higher than the mean Performance IQ: 80.2 (19.22) versus 72.95 (15.58), p=0.01. Fifteen patients had one or more diagnoses on the DSM-IV axis 1, including internalizing disorders (phobia, n=7; mood disorder, n=6; other anxiety disorders, n=5) and attention-deficit–hyperactivity disorder, inattentive subtype (n=8). Twelve out of 22 patients had alexithymia (inability to express feelings with words and to recognize and share emotional states). Cognitive testing found severe impairments in visual attention and visual–spatial construction abilities in four out of 18, and 14 out of 24 patients respectively. No diagnosis was correlated with the transmitting parent’s sex or with cytosine–thymine–guanine (CTG) repeat numbers. Patients with severe visual–spatial construction disabilities had a significantly longer CTG expansion size than those with normal visual–spatial abilities (p=0.04). Interpretation Children and adolescents with childhood DM1 have frequent diagnoses on DSM-IV axis 1, with internalizing disorders being the most common type of disorder. They also have borderline low intelligence and frequent impairments in attention and visual–spatial construction abilities.

Genome-wide association study of multiplex schizophrenia pedigrees

Abstract: ObjectiveThe authors used a genome-wide association study (GWAS) of multiply affected families to investigate the association of schizophrenia to common single-nucleotide polymorphisms (SNPs) and rare copy number variants (CNVs).MethodThe family sample included 2,461 individuals from 631 pedigrees (581 in the primary European-ancestry analyses). Association was tested for single SNPs and genetic pathways. Polygenic scores based on family study results were used to predict case-control status in the Schizophrenia Psychiatric GWAS Consortium (PGC) data set, and consistency of direction of effect with the family study was determined for top SNPs in the PGC GWAS analysis. Within-family segregation was examined for schizophrenia-associated rare CNVs.ResultsNo genome-wide significant associations were observed for single SNPs or for pathways. PGC case and control subjects had significantly different genome-wide polygenic scores (computed by weighting their genotypes by log-odds ratios from the family study) (be...

Use of drug-eluting stents as a function of predicted benefit: clinical and economic implications of current practice.

Abstract: Background Benefits of drug-eluting stents (DES) in percutaneous coronary intervention (PCI) are greatest in those at the highest risk of target-vessel revascularization (TVR). Drug-eluting stents cost more than bare-metal stents (BMS) and necessitate prolonged dual antiplatelet therapy (DAPT), which increases costs, bleeding risk, and risk of complications if DAPT is prematurely discontinued. Our objective was to assess whether DES are preferentially used in patients with higher predicted TVR risk and to estimate if lower use of DES in low-TVR-risk patients would be more cost-effective than the existing DES use pattern. Methods We analyzed more than 1.5 million PCI procedures in the National Cardiovascular Data Registry (NCDR) CathPCI registry from 2004 through 2010 and estimated 1-year TVR risk with BMS using a validated model. We examined the association between TVR risk and DES use and the cost-effectiveness of lower DES use in low-TVR-risk patients (50% less DES use among patients with Results There was marked variation in physicians' use of DES (range 2%-100%). Use of DES was high across all predicted TVR risk categories (73.9% in TVR risk 20%), with a modest relationship between TVR risk and DES use (relative risk, 1.005 per 1% increase in TVR risk [95% CI, 1.005-1.006]). Reducing DES use by 50% in low-TVR-risk patients was projected to lower US health care costs by $205 million per year while increasing the overall TVR event rate by 0.5% (95% CI, 0.49%-0.51%) in absolute terms. Conclusions Use of DES in the United States varies widely among physicians, with only a modest correlation to patients' risk of restenosis. Less DES use among patients with low risk of restenosis has the potential for significant cost savings for the US health care system while minimally increasing restenosis events.

Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients.

Abstract: BACKGROUND Aortic valve replacement (AVR) is the standard of care for patients with severe, symptomatic aortic stenosis who are suitable surgical candidates, benefiting both non-high-risk and high-risk patients. The purpose of this study was to report long-term medical resource use and costs for patients following AVR and validate our assumption that high-risk patients have worse outcomes and are more costly than non-high-risk patients in this population. METHODS Patients with aortic stenosis who underwent AVR were identified in the 2003 Medicare 5% Standard Analytic Files and tracked over 5 years to measure clinical outcomes, medical resource use, and costs. An approximation to the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) based on administrative data was used to assess surgical risk, with a computed logistic EuroSCORE > 20% considered high-risk. RESULTS We identified 1474 patients with aortic stenosis who underwent AVR, of whom 1222 (82.9%) were non-high-risk and 252 (17.1%) were high-risk. Among those who were non-high-risk, the mean age was 73.3 years, 464 (38.2%) were women, and the mean logistic EuroSCORE was 7%, whereas in those who were high-risk, the mean age was 77.6 years, 134 (52.8%) were women, and the mean logistic EuroSCORE was 37%. All-cause mortality was 33.2% for non-high-risk and 66.7% for high-risk patients at 5 years. Over this time period, non-high-risk patients experienced an average of 3.9 inpatient hospitalizations and total costs of $106,277 per patient versus 4.7 hospitalizations and total costs of $144,183 for high-risk patients. CONCLUSION Among elderly patients undergoing AVR, long-term mortality and costs are substantially greater for high-risk than for non-high-risk individuals. These findings indicate that further research is needed to understand whether newer approaches to aortic valve replacement such as transcatheter AVR may be a lower cost, clinically valuable alternative.

Autistic disorder in patients with Williams-Beuren syndrome: a reconsideration of the Williams-Beuren syndrome phenotype.

Abstract: Background: Williams-Beuren syndrome (WBS), a rare developmental disorder caused by deletion of contiguous genes at 7q11.23, has been characterized by strengths in socialization (overfriendliness) and communication (excessive talkativeness). WBS has been often considered as the polar opposite behavioral phenotype to autism. Our objective was to better understand the range of phenotypic expression in WBS and the relationship between WBS and autistic disorder. Methodology: The study was conducted on 9 French individuals aged from 4 to 37 years old with autistic disorder associated with WBS. Behavioral assessments were performed using Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) scales. Molecular characterization of the WBS critical region was performed by FISH. Findings: FISH analysis indicated that all 9 patients displayed the common WBS deletion. All 9 patients met ADI-R and ADOS diagnostic criteria for autism, displaying stereotypies and severe impairments in social interaction and communication (including the absence of expressive language). Additionally, patients showed improvement in social communication over time. Conclusions: The results indicate that comorbid autism and WBS is more frequent than expected and suggest that the common WBS deletion can result in a continuum of social communication impairment, ranging from excessive talkativeness and overfriendliness to absence of verbal language and poor social relationships. Appreciation of the possible co-occurrence of WBS and autism challenges the common view that WBS represents the opposite behavioral phenotype of autism, and might lead to improved recognition of WBS in individuals diagnosed with autism.

Guided Antithrombotic Therapy: Current Status and Future Research Direction Report on a National Heart, Lung and Blood Institute Working Group

Abstract: The National Heart, Lung, and Blood Institute (NHLBI) convened a working group to develop a research agenda to enhance the understanding and effectiveness of antithrombotic therapy. The working group brought together cardiologists, hematologists, interventionalists, clinical trialists, genetic epidemiologists, basic scientists, and other stakeholders to review (1) coagulation, platelet activation and aggregation, and antithrombotic therapy; (2) issues surrounding antithrombotic therapy failure – how to define it, how to predict and diagnose it, available tests and how to optimize them; (3) the factors that affect the efficacy, safety, and predictability of antithrombotic therapies; (4) how to optimize antithrombotic therapy, improve on present interventions, and individually tailor therapy to increase efficacy and safety and to avoid failure; and (5) the clinical applicability and cost-effectiveness of individually tailored antithrombotic therapy based on functional and genetic testing. The working group characterized and discussed challenges for guided antithrombotic therapy in 4 domains: therapeutic strategies, antithrombotic metrics, pharmacology and pharmacogenetics, and stakeholders' roles. Overall, the working group identified and prioritized the most pressing clinical needs to focus future research and translational efforts. This report presents highlights of these reviews and a summary of suggested research directions. There has been tremendous progress in the field of thrombosis in the past 2 decades.1–5 The ramifications on cardiovascular care have been profound. A greater appreciation of the central role of platelets in atherothrombosis and an increased understanding of the receptors involved in platelet activation and aggregation have led to pivotal randomized controlled trials (RCTs) of novel agents.6 Many of these agents have been associated with substantial reductions in adverse cardiovascular outcomes. Simultaneously, an appreciation of the complexity of the coagulation cascade and the artificiality of separating it from cellular and platelet interactions has promoted a deeper understanding of thrombosis and, consequently, identification of pharmacological targets to …

Do Differences in Repeat Revascularization Explain the Antianginal Benefits of Bypass Surgery Versus Percutaneous Coronary Intervention? Implications for Future Treatment Comparisons

Abstract: Background— Patients with multivessel coronary disease treated with coronary artery bypass graft (CABG) have less angina than those treated with percutaneous coronary intervention (PCI); however, there is uncertainty as to the mechanism of greater angina relief with CABG and whether more frequent repeat revascularization in patients treated with PCI could account for this treatment difference. Methods and Results— In the Synergy between percutaneous coronary intervention (PCI) with TAXUS and Cardiac Surgery trial, 1800 patients with 3-vessel or left main coronary artery disease were randomized to CABG or PCI with paclitaxel-eluting stents. Health status was assessed at baseline, 1, 6, and 12 months, using the Seattle Angina Questionnaire and the Medical Outcomes Study Short Form General Health Survey, and the association between repeat revascularization and health status during follow-up was assessed using longitudinal models. In adjusted analyses, patients who underwent repeat revascularization had worse angina frequency scores than patients who did not in both treatment groups, with differences of 8.5 points at 6 months and 3.1 points at 12 months in patients treated with PCI and 19.8 points at 6 months and 11.2 points at 12 months in patients with patients treated with CABG. Among patients who did not require repeat revascularization, the adjusted effect of CABG versus PCI on 12-month angina frequency scores was nearly identical to the overall benefit in the intention-to-treat analysis. Conclusions— Among patients with multivessel coronary artery disease treated with PCI or CABG, the occurrence of repeat revascularization during follow-up did not fully explain the antianginal benefit of CABG in the overall population. The differential association between repeat revascularization and anginal status, according to the type of initial revascularization procedure, suggests that this end point should play a limited role in any direct comparison of the 2 treatment strategies. Clinical Trial Registration— . Unique identifier: [NCT00114972][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00114972&atom=%2Fcirccvoq%2F5%2F3%2F267.atom

The Importance of Infrastructure Development to High-Quality Literacy Instruction

Abstract: Although the education community has identified numerous effective interventions for improving the literacy of U.S. schoolchildren, little headway has been made in raising literacy capabilities. David K. Cohen and Monica P. Bhatt, of the University of Michigan, contend that a major obstacle is the organizational structure of the U.S. education system. Three features in particular--the lack of educational infrastructure, a decentralized governance system, and the organization of teaching as an occupation--stymie efforts to improve literacy instruction. The authors emphasize that the education system in the United States has always been a patchwork of local school systems that share no common curricula, student examinations, teacher education, or means of observing and improving instruction. Although localities have broad powers over education, few have built the capability to judge or support quality in educational programs. The quality criteria that have developed chiefly concern teachers, not teaching. The decentralization and weak governance of U.S. schooling also deprives teachers of opportunities to build the occupational knowledge and skill that can inform standards for the quality of work, in this case instruction. And, unlike practitioners in other professions teachers have little opportunity to try to strengthen teaching quality by setting standards for entry to the occupation. Cohen and Bhatt review six types of organizational reforms undertaken over the past several decades to improve literacy and other academic outcomes for U.S. students. After briefly describing accountability, comprehensive school reforms, knowledge diffusion, improvement of human capital, and market-based reforms, the authors turn to the Common Core State Standards, an effort initiated by state governors and school leaders to raise student achievement. The authors conclude that the fundamental question about the Common Core, as with the other reforms they discuss, is whether educators and policy makers can mobilize the capability to help states and localities invent, adapt, and implement reliable ways to improve instruction.

Impact of Drug Eluting Stent Length on Outcomes of Percutaneous Coronary Intervention (from the EVENT Registry)

Abstract: In randomized trials, longer drug-eluting stent (DES) length has been associated with adverse clinical events. We used data from the EVENT registry to examine the impact of DES length on outcomes in routine clinical practice. We identified 5,425 unselected consecutive patients from the EVENT registry who had a single vessel treated with DES for nonemergency indications from 2004 through 2007. The association between stented length and short- and long-term outcomes was analyzed in ordinal categories ( 24 mm) and as a continuous variable. There were few differences in baseline characteristics across categories. At 1 year, there was a stepwise increase in major adverse cardiac events (composite of death, myocardial infarction [MI], and target lesion revascularization [TLR]) with increasing stent length (8.0%, 10.1%, 11.8%, and 14.8%, p <0.001) and a similar relation with TLR (3.0%, 3.1%, 3.3%, and 5.0%, p = 0.02). After adjusting for demographic, clinical, angiographic, and treatment characteristics, longer stent length remained associated with 1-year major adverse cardiac events (adjusted hazard ratio 1.17 per 10-mm increase stent length) and TLR (hazard ratio 1.20 per 10 mm), but not with stent thrombosis. In conclusion, longer DES length is associated with increased adverse events, predominantly periprocedural MI, but also an increased rate of TLR.

Repetitive transcranial magnetic stimulation to treat early-onset auditory hallucinations.

Abstract: believe that research from LMICs also allows further understanding of emotional, behavioral, and intellectual abilities in a variety of risk and protective contexts, thus leading to a deeper understanding of the biological and psychosocial processes underlying mental illness and health in general. This will require an expansion in the output of high-quality research focused on those most vulnerable in areas where it is most needed.

Patients overestimate the potential benefits of elective percutaneous coronary intervention.

Abstract: Although percutaneous coronary intervention (PCI) reduces mortality in the setting of myocardial infarction (MI), recent studies suggest that the benefits of PCI for chronic Coronary Artery Disease (CAD) are predominantly related to angina relief and improved quality of life. Whether patients in the current era understand these benefits of elective PCI, or perceive that they also derive protection against death and MI is unknown. We surveyed 498 consecutive elective PCI patients a mean of 13.7 months after being treated between 1/06-10/07, 2007, at two hospitals. We used a one-page questionnaire quantifying their perceptions of the benefits from PCI. Of 498 eligible subjects, 350 responded (70%). The mean age was 67.8 +/- 10.9 years, and 76% were male. One-third believed that their PCI was emergent (despite the fact that all were elective), 71% believed the procedure would prevent future heart attacks, 66% thought it would extend their life, 42% reported that it saved their life, 42% stated that it would improve abnormalities on their stress test, and only 31'% believed it would decrease their angina. Although considerable attention is given to facilitating informed consent at our center, patients' perceived benefits of elective PCI do not match existing evidence, as they overestimated both the benefits and urgency of their procedures. These findings suggest that an even greater effort at patient education is needed prior to elective PCI to facilitate fully informed decision-making.

Les antidépresseurs chez l’enfant et l’adolescent : mise au point des données d’efficacité et de tolérance

Abstract: Resume Au cours des dernieres annees, la necessite de disposer d’essais therapeutiques specifiques a la population pediatrique est apparue comme un enjeu important, du fait des particularites cliniques de cette population et des profils de tolerance et de securite qui montrent des differences significatives par rapport a ceux de l’adulte. Cela s’applique, en particulier, aux antidepresseurs, pour lesquels des effets psychocomportementaux specifiques a l’âge ont ete observes dans une proportion faible mais non negligeable de jeunes patients. Cet article propose une mise au point des donnees actuelles d’efficacite et de tolerance concernant les antidepresseurs chez l’enfant et l’adolescent. Le developpement d’etudes collaboratives multicentriques en psychopharmacologie pediatrique a permis de mieux comprendre la place des antidepresseurs parmi les autres strategies therapeutiques dans un certain nombre de troubles internalises de l’enfant et de l’adolescent. Dans la depression de l’enfant, la fluoxetine a obtenu l’autorisation de mise sur le marche (AMM) dans les troubles depressifs majeurs de l’enfant a partir de huit ans. L’efficacite des inhibiteurs selectifs de la recapture de la serotonine (ISRS) est documentee dans le trouble obsessionnel compulsif (TOC) de l’enfant, avec une AMM pour la sertraline et la fluvoxamine en France dans cette indication. Des arguments existent en faveur de l’efficacite des ISRS et de la venlafaxine dans les troubles anxieux – hors TOC – de l’enfant et de l’adolescent, mais sans AMM actuellement dans ces indications. Les donnees de tolerance et de securite (effets psychocomportementaux, incluant les idees et comportements suicidaires, tolerance a long terme, risque lethal) sont egalement passees en revue. Il s’ensuit des propositions de decision incorporant l’ensemble des modalites therapeutiques disponibles pour les trois indications considerees : depression, TOC et autres troubles anxieux de l’enfant et de l’adolescent.

Traumatismes et traces : données expérimentales

Abstract: Resume Si l’influence de l’environnement et en particulier des traumatismes precoces, sur le developpement de l’enfant et la survenue de psychopathologies est connue depuis les premieres etudes epidemiologiques de la discipline, les 20 dernieres annees ont ete marquees par des avancees importantes dans le champ des neurosciences, permettant de comprendre comment les traumatismes font trace au cours du developpement de l’enfant. A partir d’exemples paradigmatiques, comme ceux des separations precoces par abandon ou deuil, je propose d’etudier ces traces laissees : (1) au plan epigenetique dans l’etude de certains modeles animaux ; (2) dans quelques psychopathologies comme les troubles externalises ; (3) mais aussi dans les systemes biologiques fonctionnels ou anatomiques au cours du developpement. A partir de donnees experimentales issues de notre equipe, j’essaierai egalement de montrer comment ces traces peuvent rester inscrites a des niveaux non conscients, mais accessibles soit au travers d’une ecoute specifique soit au travers de l’experience des interactions precoces mere–bebe quel que soit le sens de la dynamique d’interaction consideree (mere vers bebe ou bebe vers mere).

Controverses actuelles dans le champ de l’autisme

Abstract: Resume L’autisme est un syndrome clinique dont la description si caracteristique a participe a la fondation de la psychiatrie de l’enfant. Pourtant, il reste le syndrome de tous les mysteres et de toutes les controverses. Une premiere controverse, reprise par le groupe de travail du DSM-V, concerne justement sa definition clinique et l’elargissement du spectre de l’autisme. Les justifications semblent d’ordre divers. Nous les interrogerons a partir de recherches menees sur les dysharmonies ou Multiplex Developmental Disorder, puisque ce sont des concepts a la frontiere du spectre. Une deuxieme controverse concerne son origine, sachant que les recherches actuelles insistent et revisitent les causes genetiques de publication en publication. Sans ignorer l’importance des facteurs genetiques, nous explorerons les facteurs environnementaux impliques et proposerons un modele developpemental probabiliste s’appuyant sur une perspective multifactorielle mieux a meme d’expliquer la possible augmentation de prevalence. Celle-ci est du reste une troisieme controverse. Assiste-t-on a une reelle augmentation de la prevalence des pathologies du spectre de l’autisme ? Ne s’agit-il que d’une definition plus large et d’un reperage plus systematique des cas ? Une autre controverse encore concerne l’âge auquel le diagnostic d’autisme peut etre porte precocement. Nous l’aborderons a partir de recherches centrees sur les interactions parent/enfant et montrerons que les parents d’enfants qui developperont un autisme, vont des l’âge de six mois significativement plus souvent rechercher activement les reponses de leur bebe. Enfin, nous terminerons par la controverse de la prise en charge et des methodes a privilegier. S’il faut reconnaitre que seules des methodes comportementales ou educatives ont fait l’objet d’etude controlees, il apparait un consensus pour une prise en charge intensive, la plus precoce possible, en rapport un pour un, avec le maximum d’integration en milieu ordinaire et impliquant les parents de maniere active.

In‐Hospital and 1‐year outcomes with drug‐eluting versus bare metal stents in saphenous vein graft intervention: A report from the EVENT registry

Abstract: Objectives To compare outcomes of patients receiving drug-eluting stents (DES) versus bare metal stents (BMS) during percutaneous coronary intervention (PCI) of saphenous vein bypass grafts (SVG). Background Long-term benefits of DES versus BMS are well established for native vessel PCI. Benefit in patients undergoing SVG intervention is less certain. We used data from a multicenter registry (evaluation of drug eluting stents and ischemic events, EVENT) to compare outcomes among patients treated with DES versus BMS 1-year following SVG interventions. Methods Between July 2004 and December 2007, 684 patients in EVENT underwent SVG PCI (515 DES only, 169 BMS only). The primary endpoint was a composite of death, myocardial infarction (MI), and target lesion revascularization between hospital discharge and 1-year follow-up. Propensity score stratification was used to adjust for differences between groups. Results Baseline demographic and clinical characteristics of patients treated with DES and BMS were similar. The DES group had fewer men and a higher prevalence of prior PCI. Patients receiving DES had less angiographic thrombus, less frequent use of embolic protection devices, greater total stent length, and smaller maximum stent diameters. Unadjusted outcomes between discharge and 1-year follow-up did not differ between the groups. After risk adjustment, the primary outcome was less frequent among patients treated with DES (adjusted HR = 0.48, 95% CI = 0.27–0.84, P < 0.01) with similar relative benefits across the individual endpoints. Conclusions Among patients undergoing SVG PCI in a “real world” registry analyzed using propensity score stratification, treatment with DES compared with BMS was associated with reduced MACE at 1 year following PCI. © 2012 Wiley Periodicals, Inc.

Abstract 15573: In-Hospital Switching of ADP Receptor Inhibitors in Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention: Insights from the TRANSLATE-ACS Study

Abstract: Background: While several ADP receptor inhibitors are now available, little is known regarding patterns of drug switching and associated patient selection factors. Methods: We studied ADP receptor ...