In the guinea pig, experimental allergic contact dermatitis (ACD) and primary irritant contact dermatitis (PICD) were induced with different concentrations of dinitrochlorobenzene (DNCB). The epidermal Langerhans' cells (LCs) were observed sequentially by both adenosine triphosphatase (ATPase) and electron microscopy. Light microscopically, in ACD, the density and dendritic processes of LC decreased markedly within 12 h after antigen challenge. Almost no recognization LCs could be seen within 2 to 5 days. Later, LCs began to repopulate in the epidermis. Within 14 days, the density and shape of the LCs returned to normal. On the contrary, LCs changed more rapidly in PICD. The dendritic processes of LC decreased within 2 h and cell density decreased dramatically within 6 h after DNCB application. LCs also repopulated more rapidly in the epidermis. Electron microscopically, in ACD, we observed that lymphocyte-like cells apposed to LCs; LCs were activated and damaged; however, in PICD, we found neither the apposition of lymphocyte-like cells to LCs, nor the activation of LCs. LCs play an important role in the convalescence phase as well as in the early and later phases of contact allergic reaction.

Proposed for the ICD-11 is a dimensional model of personality disorder that, if approved, would be a paradigm shift in the conceptualization of personality disorder. The proposal consists of a general severity rating, 5 maladaptive personality trait domains, and a borderline pattern qualifier. The general severity rating can be assessed by the Standardized Assessment of Severity of Personality Disorder (SASPD), the trait domains by the Personality Inventory for ICD-11 (PiCD), and the borderline pattern by the Borderline Pattern Scale (BPS), which is developed in the present study. To date, no study has examined the relations among all 3 components, due in part to the absence of direct measures for each component (until recently). The current study develops and provides initial validation evidence for the BPS, and examines the relations among the BPS, SASPD, and PiCD. Also considered is their relationship with the 5-factor model of general personality as well as with 2 other measures of personality disorder severity (including the DSM-5 Level of Personality Functioning Scale [LPFS]). Further, an alternative trait-based coding of the DSM-5 LPFS is examined (modeled after the ICD-11 SASPD), suggesting that its coverage of diverse maladaptivity may not be because it assesses the core of personality disorder, but rather because it has items specific to the different domains of personality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neutrophils are essential for the innate immune response against bacterial pathogens and play a key role during the early phases of infection, including mastitis and endometritis in cows. When directly challenged with bacteria, neutrophils undergo phagocytosis induced cell death (PICD). The molecular mechanisms of this cell death modality are poorly understood, especially for bovine neutrophils. Therefore, this study aimed to determine the mechanisms and hallmarks of PICD in bovine neutrophils after in vitro challenge with Escherichia coli (E. coli). Our data show that various apoptotic hallmarks such as blebbing, chromatin condensation and executioner caspase (C)-3/-7 activity are only observed during constitutive bovine neutrophil apoptosis. In contrast, bovine neutrophil PICD is characterized by production of reactive oxygen species (ROS), pro-inflammatory C-1 activation, nuclear factor (NF)-κB activation, and interleukin (IL)-1β and IL-6 secretion. Nevertheless, under both conditions these phagocytes undergo cell death with the exposure of phosphatidylserine (PS). Although PS exposure is generally attributed to the anti-inflammatory features of executioner caspase-dependent apoptosis, it surprisingly preceded plasma membrane rupture during bovine neutrophil PICD. Moreover, C-1 inhibition strongly affected IL-1β production but not the PICD kinetics. This indicates that the secretion of the latter pro-inflammatory cytokine is a bystander effect rather than a regulator of PICD in bovine neutrophils, in marked contrast to the IL-1β-dependent pyroptosis reported for macrophages.

To assess the psychometric properties of the Personality Inventory for ICD-11 (PiCD, where ICD-11 is the International Classification of Diseases, 11th Revision), a sample of Italian community-dwelling adult participants (N = 1,122) was administered the PiCD, the Five-Factor Model Rating Form, the Big Five Inventory, the Personality Inventory for DSM-5 Short Form (where DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders, fifth edition), and the Measure of Disordered Personality Functioning. Our findings supported the unidimensionality hypothesis for the PiCD Negative Affectivity, Detachment, and Dissocial scale items, whereas adequate fit indices were observed for the bifactor model of the PiCD Disinhibition and Anankastic item joint polychoric correlation matrix. The PiCD scales showed adequate internal consistency, test-retest reliability (n = 262), and meaningful relationships with five-factor model domains and their maladaptive variants. A four-factor model of the joint correlation matrix of the PiCD, Personality Inventory for DSM-5 Short Form, and the five-factor model composite score was provided with adequate fit. All PiCD scales were significantly associated with the impairment in personality functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The International Classification of Diseases-11th Edition (ICD-11) Classification of Personality Disorders provides the option of coding 5 trait domain qualifiers that contribute to the individual expression of personality dysfunction (i.e., Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia). Previous investigations of these trait domains are based on self-reported data, and so is much of the research literature from which the ICD-11 trait model has evolved. However, the ICD-11 itself involves judgments made by clinicians about their patients. Thus, it is important to examine whether the trait domains identified in self-report studies can also be obtained from clinician-reported data. A sample of 238 mental health patients were characterized by clinicians using an informant-report form of the Personality Inventory for ICD-11 (PiCD-IRF). As expected, exploratory factor analysis (EFA) indicated that clinician-reported ICD-11 trait domains could be captured by both 4- and 5-factor structures, of which the 5-factor solution seemed less conceptually sound relative to the 4-factor solution. The 4-factor model captured the unipolar domains of Negative Affectivity, Detachment, Dissociality, along with a bipolar domain of Disinhibition versus Anankastia, whereas the 5-factor model furthermore captured features of Disinhibition and Anankastia as 2 separate factors. The hierarchical structure from 1 to 5 factors partially resembled previously reported trait structures and models of psychopathology. These findings overall support the multimethod robustness of ICD-11 trait domain qualifiers and the potential for their valid ratings by mental health clinicians. The PiCD-IRF is provided in the online supplementary material - for clinical or research purposes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

BACKGROUND

Immunoglobulins (IVIG) have been shown to be useful in adults suffering from sepsis. In contrast, prophylactic and curative IVIG trials failed to show beneficial effects in neonates. We tested the hypothesis that IVIG, have different effects on monocytes from cord blood (CBMO) and peripheral blood monocytes from adults (PBMO) with respect to survival, phenotype, and function.

METHODS

Mononuclear cells, or purified monocytes, were cultured in 5% human serum, incubated with polyvalent IVIG (1 mg/ml), stimulated with green fluorescent protein (GFP)-labeled Escherichia coli (E. Coli-GFP), Interferon-γ (IFN-γ, 50 U/ml), or the T cell mitogen anti-CD3 monoclonal antibody, αCD3-mAb, (5 μg/ml). Phagocytosis, phenotype, T cell proliferation, and apoptosis were assessed by flow cytometry.

RESULTS

IVIG enhanced phagocytosis in PBMO or CBMO when infected directly after isolation, while IVIG had no effect on monocytes cultured 48 h prior to infection. In contrast to PBMO, IVIG inhibited the IFN-γ mediated up-regulation of CD80, CD86, and HLA-DR on CBMO. In the presence of IVIG, stimulation with αCD3 in cord blood enhanced deletion, inhibited blast formation and CD28 up-regulation of T cells (P < 0.05 vs. T cells from adults). IVIG induced monocyte apoptosis, associated with up-regulation of Annexin V and loss of nuclear DNA, which was more pronounced in CBMO. Although phagocytosis induced cell death (PICD) was lower in CBMO (P < 0.05 vs. PBMO), the addition of IVIG enhanced PICD levels of CBMO to the extent of PBMO.

CONCLUSIONS

IVIG inhibits co-stimulatory receptors and functions of CBMO and induces apoptosis. These findings may be of clinical relevance for the failure of IVIG benefit in neonatal sepsis.

The majority of deaths in Australia occur in general hospital wards and most are neither sudden nor unexpected. The Pathway for Improving the Care of the Dying (PICD) is an adaptation of the Liverpool Care Pathway to the Australian healthcare setting (or 'to Australian conditions') and is designed to help ensure a 'good death' for patients dying outside the palliative care system. PICD consists of a series of prompts, guidelines, revised medical and nursing care plans and a number of medication algorithms.

BACKGROUND

A percutaneous intravascular cardioverter-defibrillator (PICD) has been developed with a right ventricular (RV) single-coil lead and titanium electrodes in the superior vena cava (SVC)-brachiocephalic vein (BCV) region and the inferior vena cava (IVC).

OBJECTIVE

To compare defibrillation thresholds (DFTs) of the PICD with those of a conventional ICD in humans.

METHODS

Ten patients with ischemic cardiomyopathy and ejection fraction ≤35% were randomized to initial testing with either PICD or conventional ICD. A standard dual-coil lead was positioned in the RV apex. If randomized to PICD, the device was placed into the vasculature such that 1 titanium electrode was positioned in the SVC-BCV region and the second in the IVC. For PICD DFTs, the RV coil of the conventional ICD lead was connected to the PICD mandrel [shock vector: RV (+) to SVC-BCV (-) + IVC (-)]. When testing the conventional ICD, a subcutaneous pocket was formed in the left pectoralis region and the ICD was connected to the lead system and positioned in the pocket [shock vector: RV (+) to SVC (-) + active can (-)]. Each device was removed before testing with the other. A step-down binary search protocol determined the DFT, with the initial shock being 9 J.

RESULTS

The mean PICD DFT was 7.6 ± 3.3 J, and the conventional ICD system demonstrated a mean DFT of 9.5 ± 4.7 J (N = 10; paired t test, P = .28).

CONCLUSIONS

The intravascular defibrillator has DFTs similar to those of commercially available ICDs.

BACKGROUND

Postinterventional cognitive dysfunction (PICD) is a known complication of coronary artery bypass grafting (CABG). However, it is largely unknown whether PICD occurs after coronary catheterization.

METHODS

Neuropsychologic data were obtained from 37 patients who received coronary catheterization and 47 patients who underwent elective CABG at baseline and 3 months after the interventions. The outcomes were contrasted to 33 healthy volunteers, using analysis of covariance with baseline scores as covariates. Cerebral magnetic resonance imaging with diffusion-weighted imaging (DWI) sequences was performed in 30 catheter and 39 CABG patients 2 to 4 days after the procedures.

RESULTS

The rate of acute ischemic lesions amounted to 3.3% in the catheter group and to 17.9% in the CABG group. Postinterventional cognitive dysfunction was detected in 2 (of 10) tests in the catheter group as compared with the healthy controls (verbal memory: total recall, t = -2.61 (P = .005) and nonverbal memory, t = -2.60 [P = .005]). The CABG group showed PICD in 7 of 10 tests as compared with the healthy controls (statistics ranging from t = -1.95 [P = .027] to t = -5.14 [P < .001]). Scores of depression/anxiety and health-related quality of life were not associated with PICD (P>> .05).

CONCLUSIONS

As compared with CABG, PICD and cerebral lesions appear to be substantially milder after coronary catheter intervention, but not negligible.

The 11th edition of the International Classification of Diseases and Related Health Problems (ICD-11), recently approved by the World Health Organization, contains a new diagnostic approach for personality disorders. This approach partly involves the consideration of 5 dimensional trait domain qualifiers-Negative Affectivity, Detachment, Dissocial, Disinhibition, and Anankastia. Oltmanns and Widiger (2018) recently developed a self-report measure, the Personality Inventory for ICD-11 (PiCD), to assess the 5 domains; however, further examination of the psychometric properties of the PiCD is warranted due to its limited research base. The present study aimed to further examine the reliability, structural and concurrent validity, and method variance of the PiCD in an ethnically diverse undergraduate sample (N = 518), who were also administered the Minnesota Multiphasic Personality Inventory-2-Restructured Form. First, results suggested that the PiCD domain scales exhibited adequate internal consistency reliability via coefficient categorical omega (range = .77-.87). Next, exploratory structural equation modeling results suggested support for a 4-factor solution, with the 4th factor thought to represent a bipolar continuum of Anankastia to Disinhibition severity. Random-intercept factor analysis results suggested a small amount of variance in items (4.88%) attributable to idiosyncratic scale usage. Lastly, relations between PiCD domains and Minnesota Multiphasic Personality Inventory-2-Restructured Form scales (Personality Psychopathology-5 and Higher Order scales) provided support for the validity of the Negative Affectivity, Detachment, and Dissocial domains, though relatively less support for the Disinhibition and Anankastia domains. Further examination of other psychometric properties and the nomological network of the PiCD is recommended. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

BACKGROUND

Neonates show sustained inflammation after a bacterial infection, which is associated with inflammatory diseases like bronchopulmonary dysplasia or periventricular leucomalacia. Physiologically, inflammation is terminated early after the removal of the invading pathogens by phagocytosis-induced cell death (PICD) of immune effector cells. Earlier results showed reduced PICD in neonatal monocytes. The underlying molecular mechanisms are unknown. We hypothesize that the reduced PICD in neonatal monocytes is regulated through the proteins of the B-cell lymphoma 2 (Bcl-2) protein family.

METHODS

mRNA and protein expression of Bcl-2 family proteins in cord blood and adult peripheral blood monocytes infected with Escherichia coli were analyzed by quantitative real-time PCR and flow cytometry and cytochrome c release by fluorescence microscopy.

RESULTS

mRNA expression of antiapopototic Bcl-xL was upregulated in cord blood monocytes (CBMO), whereas proapoptotic Bim tended to be higher in peripheral blood monocytes (PBMO). Upon infection, Bax was more strongly expressed in PBMO compared with CBMO. The pro/antiapoptotic balance was skewed toward survival in CBMO and apoptosis in PBMO. Cytochome c release into the cytosol was enhanced in PBMO compared with CBMO.

CONCLUSIONS

Bcl-2 proteins are involved in reduced PICD in neonatal monocytes. These findings are another step toward the understanding of sustained inflammation in neonates.

Up to date 6 patients with initial presenile idiopathic cognitive decline (PICD) and 5 suffering from a presenile Alzheimer-type dementia (PAD) with a mean age of 59.5 were admitted to the trial. The 6 PICD patients were assigned to a double-blind nicergoline/placebo 6-month course with an oral dose of 30 mg twice a day. PAD patients were treated in an open design (nicergoline oral dose 30 mg twice a day) for at least 6 months. Until now only 4 PICD and 3 PAD patients have been treated regularly for 6 months. Two of 4 PICD patients showed a progressive enhancement of contingent negative variation (CNV), shorter reaction time (RT) and an improvement of clinical status. The other 2 PICD patients, on the contrary, showed a progressive mild worsening of CNV-RT and clinical patterns. The double-blind trial is not yet completed. CNV activity, RTs and clinical patterns progressively improved also in 2 PAD patients while in the 3rd they remained nearly unchanged or minimally worse during the 6-month treatment. The positive nicergoline effect on CNV-RT and clinical status noted in our patients appeared similar to that observed by other authors with DHEMT in patients with senile dementia of Alzheimer type. No adverse drug-related reactions were seen.

OBJECTIVE

In this pilot study, we compared midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction (PICD).

BACKGROUND

PICD with pronounced arterial vasodilatation in cirrhotics with tense ascites can be prevented by the infusion of albumin, which is an expensive treatment modality. Various vasoconstrictors have also been used to prevent PICD, but there are few studies about the usage of midodrine.

METHODS

Fifty patients with cirrhosis and tense refractory ascites were randomly assigned to be treated with either midodrine (n=25) (12.5 mg 3 times/d; over 3 d) or albumin (n=25) (8 g/L of removed ascites) after a large-volume paracentesis. Effective arterial blood volume was assessed indirectly by measuring serum creatinine, serum sodium, plasma renin activity, and aldosterone concentration before and 6 days after paracentesis.

RESULTS

Midodrine therapy was cheaper compared with albumin therapy, but serum creatinine, serum sodium, plasma renin activity, and plasma aldosterone concentration values after treatment [0.99±0.19 to 3.02±2.58 mg/dL (P=0.001), 132.36±3.2 to 130.2±4.1 mEq/L (P<0.001), 3.03±0.33 to 4.2±0.76 ng/mL/h (P<0.001), and 166.72±64.26 to 298.64±130 pg/mL (P<0.001), respectively] significantly differed in the midodrine group from that in the albumin group [1.10±0.22 to 1.11±0.161 mg/dL (P=0.885), 132.2±3.524 to 131.88±3.09 mEq/L (P=0.246), 4±0.91 to 4.11±0.74 ng/mL/h (P=0.440), and 204.88±115.9 to 177.08±100.5 pg/mL (P<0.001), respectively]. Seven patients, among whom 6 were hepatocellular carcinoma (HCC) positive, in the midodrine group of our study died as a consequence of liver failure complicated by acute renal failure, followed by hepatic encephalopathy. Whereas in the albumin group, even among the 7 patients with HCC, no patient died or developed hepatorenal syndrome or developed hepatic encephalopathy.

CONCLUSIONS

This pilot study suggests that midodrine is not as effective as intravenous albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with cirrhosis and tense ascites, especially with HCC-positive patients.

Phagocytosis-induced cell death (PICD) is diminished in cord blood monocytes (CBMO) as compared to cells from adults (PBMO) due to differences in the CD95-pathway. This may support a prolonged pro-inflammatory response with sequels of sustained inflammation as seen in neonatal sepsis. Here we hypothesized that TNF-α mediated induction of apoptosis is impaired in CBMO due to differences in the TNFR1-dependent internalization. Monocytes were infected with Escherichia coli-GFP (E. coli-GFP). Monocyte phenotype, phagocytic activity, induction of apoptosis, and TNF-α/TNF-receptor (TNFR) -expression were analysed. In the course of infection TNF-α-secretion of CBMO was reduced to 40% as compared to PBMO (p<0.05). Neutralization of TNF-α by an αTNF-α antibody reduced apoptotic PICD in PBMO four-fold (p < 0.05 vs. infection with E. coli). PICD in CBMO was reduced 5-fold compared to PBMO and showed less responsiveness to αTNF-α antibody. CBMO expressed less pro-apoptotic TNFR1, which, after administration of TNF-α or infection with E. coli was internalized to a lesser extent. With similar phagocytic capacity, reduced TNFR1 internalization in CBMO was accompanied by lower activation of caspase-8 (p < 0.05 vs. PBMO). Stronger caspase-8 activation in PBMO caused more activation of effector caspase-3 and apoptosis (all p < 0.05 vs. PBMO). Our results demonstrate that TNFR1 internalization is critical in mediating PICD in monocytes after infection with E.coli and is reduced in CBMO.

The CNV complex evoked with a standard paradigm (S1-2 sec-S2-motor response) and reaction time (RT) to the imperative signal (S2) were recorded and measured in 12 patients with initial presenile idiopathic cognitive decline (PICD), 12 with presenile Alzheimer-type dementia (PAD) and 10 healthy age-matched controls. Significant group differences were obtained for measures of some CNV components, particularly of the late pre-S2 CNV. No significant CNV activity, very prolonged RTs and sometimes characteristic post-imperative negative variations (PINV) were observed in the majority of patients with PAD. These results suggest that similar CNV complex and RT changes to those observed in our patients may constitute a valuable clue in the study of pathophysiological brain functioning in the early stages of presenile idiopathic mental deterioration.

OBJECTIVE

Ascites is a dreadful complication of liver cirrhosis associated with short survival. Large volume paracentesis (LVP) is used to treat tense or refractory ascites. Paracentesis induced circulatory dysfunction (PICD) develops if no plasma expanders are given with ominous complications. To study the effect of ascites flow rate on PICD development.

METHODS

Sixty patients with cirrhosis and tense ascites underwent LVP of 8 L were randomized into 3 equal groups of different flow rate extraction; group I (80 mL/minute), group II (180 mL/minute) and group III (270 mL/minute). Plasma renin activity (PRA) was measured baseline and on day six. PICD was defined as increase in PRA >50% of the pretreatment value.

RESULTS

In group I through 3; the mean age was (52.5±9.4 vs. 56.4±8.5 vs. 55.8±7.1 years; P>0.05), mean arterial pressure (81.4±5.6 vs. 81.5±7 vs. 79.5±7.2 mmHg; P>0.05), MELD (17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5). Baseline PRA was comparable (1,366.0±1244.9 vs. 1,151.3±1,444.8 vs. 951.9±1,088 pg/mL; P>0.05). There was no statistically significant (P>0.05) flow mediated changes (Δ) of creatinine (0.23±0.27 vs. 0.38±0.33 vs. 0.26±0.18 mg/dL), MELD (1.25±5.72 vs. 1.70±2.18 vs. 1.45±2.21) or PRA (450.93±614.10 vs. 394.61±954.64 vs. 629.51±1,116.46 pg/mL). PICD was detected in a similar frequency in the three groups (P>0.05). On univariate logistic analysis only female sex was a fairly significant PICD predictor (Wald 3.85, odds ratio 3.14; P=0.05).

CONCLUSIONS

The ascites flow rate does not correlate with PICD development.

Large volume paracentesis may cause paracentesis induced circulatory dysfunction (PICD). Albumin is recommended to prevent this abnormality. Meanwhile, the price of albumin is too expensive and there should be another alternative that may prevent PICD. This report aimed to compare albumin to colloids in preventing PICD. Search strategy was done using PubMed, Scopus, Proquest, dan Academic Health Complete from EBSCO with keywords of "ascites", "albumin", "colloid", "dextran", "hydroxyethyl starch", "gelatin", and "paracentesis induced circulatory dysfunction". Articles was limited to randomized clinical trial and meta-analysis with clinical question of "In hepatic cirrhotic patient undergone large volume paracentesis, whether colloids were similar to albumin to prevent PICD". We found one meta-analysis and four randomized clinical trials (RCT). A meta analysis showed that albumin was still superior of which odds ratio 0.34 (0.23-0.51). Three RCTs showed the same results and one RCT showed albumin was not superior than colloids. We conclude that colloids could not constitute albumin to prevent PICD, but colloids still have a role in patient who undergone paracentesis less than five liters.

Photocontact dermatitis is not a common condition, but neither is it rare. Both photo-irritant contact dermatitis (PICD) and photoallergic contact dermatitis (PACD) are seen by most dermatologists in general practice. PICD is diagnosed on clinical grounds and is usually caused by furocoumarins in plants like limes and celery. PACD is caused primarily by sunscreens but can also be the result of fragrances and antibacterial agents. PACD can only be diagnosed by photo-patch testing that most dermatologists, even those who patch test and give phototherapy in their office, do not perform. The procedure as outlined in this manuscript is relatively simple and can easily be accomplished in the dermatologist's office.

The predominant maladaptive trait models are now provided by Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) Section III, assessed by the Personality Inventory for DSM-5 (PID-5; Krueger, Derringer, Markon, Watson, & Skodol, 2012), and the International Classification of Diseases-11th Revision (ICD-11; assessed by the Personality Inventory for ICD-11 (PiCD; Oltmanns & Widiger, 2018). However, 2 historical precedents are the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ; Livesley & Jackson, 2009) and the Schedule for Nonadaptive and Adaptive Personality (SNAP; Clark, 1993). The current study administered the DAPP-BQ, SNAP, PiCD, and PID-5 to a sample of 323 persons with a history of mental health treatment. The results provided support for the historical precedence of the DAPP-BQ and SNAP, although also suggest that additional traits should perhaps be included in current models. The results also bear on additional ongoing issues, including (but not limited to) the bipolarity of maladaptive personality structure, the conceptualization of identity problems as a trait, and the discriminant validity of maladaptive trait models and their assessment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Personality Inventory for ICD-11 (PiCD) was recently developed to assess the ICD-11 model of personality disorders. The purpose of this study was to examine the construct validity of the PiCD using the Minnesota Multiphasic Personality Inventory (MMPI)-2-Restructured Form (MMPI-2-RF) and the Computerized Adaptive Test of Personality Disorders Static Form (CAT-PD-SF). We administered these tests to 328 college students (150 males, 178 females). We found that the PiCD had adequate internal consistency reliability. Correlations between scores from the PiCD scales and the criterion measures generally indicated adequate discriminant validity. Along the same lines, convergent validity was adequate for the PiCD Negative Affective, Disinhibition, and Dissocial scales. However, the evidence was more mixed for the PiCD Detachment and Anankastic domains, which may be due to limitations with the content domains for these scales. Consistent with other research and theoretical expectations, a conjoint exploratory factor analysis utilizing the PiCD and MMPI-2-RF PSY-5 scales also indicated that anankastic and disinhibition may be more appropriately conceptualized as measuring opposite poles of one construct. Implications of these findings for the PiCD and the ICD-11 model are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The International Classification of Diseases-11th Edition (ICD-11) includes a dimensional trait model of personality disorder. The Personality Inventory for ICD-11 (PiCD) was the first self-report measure developed for its assessment. The present study examines the validity of an informant-report version of the PiCD, the Informant-Personality Inventory for ICD-11 (the IPiC), and is the first study to test self-other agreement, ratings from close others, and the criterion validity of both the IPiC and the PiCD for several popular and well-validated measures of life functioning: Life and romantic relationship satisfaction, social support, physical and mental health, depressive symptoms, insomnia symptoms, and cognitive decline. The present study is also the first to examine the IPiC and PiCD in a sample of older adults in the community. Results suggest that the IPiC and the PiCD show moderate self-other agreement, are associated significantly with several important life functioning areas, and have structural validity even at the item level. Further replication and validation are necessary for these instruments, but the IPiC and the PiCD have shown strong validation evidence to date, now including evidence of consensual and criterion validity, in addition to structural validity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Before participation in medical research an informed consent must be obtained. This study investigates whether the readability of patient information and consent documents (PICDs) corresponds to the average educational level of participants in rheumatological studies in the Netherlands, Denmark, and Norway.

24 PICDs from studies were collected and readability was assessed independently using the Gunning's Fog Index (FOG) and Simple Measure of Gobbledygook (SMOG) grading.

The mean score for the FOG and SMOG grades were 14.2 (9.0-19.0) and 14.2 (12-17) respectively. The mean FOG and SMOG grades were 12.7 and 13.3 in the Dutch studies, 15.0 and 14.9 in the Danish studies, and 14.6 and 14.3 in the Norwegian studies, respectively. Out of the 2865 participants, more than 57 % had a lower educational level than the highest readability score calculated in the individual study.

As the readability level of the PICDs did not match the participants' educational level, consent may not have been valid, as the participants may have had a limited understanding of what they agreed to participate in. There should be more focus on the readability of PICDs. National guidelines for how to write clear and unambiguous PICDs in simple and easily understandable language could increase the focus on the readability of PICD.

BACKGROUND

Invasive fungal infections with Candida albicans (C. albicans) occur frequently in extremely low birthweight (ELBW) infants and are associated with poor outcome. Phagocytosis of C.albicans initializes apoptosis in monocytes (phagocytosis induced cell death, PICD). PICD is reduced in neonatal cord blood monocytes (CBMO).

OBJECTIVE

Phagocytosis of C. albicans causes PICD which differs between neonatal monocytes (CBMO) and adult peripheral blood monocytes (PBMO) due to lower stimulation of TLR-mediated immune responses.

METHODS

The ability to phagocytose C. albicans, expression of TLRs, the induction of apoptosis (assessment of sub-G1 and nick-strand breaks) were analyzed by FACS. TLR signalling was induced by agonists such as lipopolysaccharide (LPS), Pam3Cys, FSL-1 and Zymosan and blocked (neutralizing TLR2 antibodies and MYD88 inhibitor).

RESULTS

Phagocytic indices of PBMO and CBMO were similar. Following stimulation with agonists and C. albicans induced up-regulation of TLR2 and consecutive phosphorylation of MAP kinase P38 and expression of TNF-α, which were stronger on PBMO compared to CBMO (p < 0.005). Downstream, TLR2 signalling initiated caspase-3-dependent PICD which was found reduced in CBMO (p < 0.05 vs PBMO).

CONCLUSIONS

Our data suggest direct involvement of TLR2-signalling in C. albicans-induced PICD in monocytes and an alteration of this pathway in CBMO.

Paracentesis-induced circulatory dysfunction (PICD) is a serious complication of large-volume (>5 L) paracentesis in cirrhosis and is reduced with albumin infusion. There is a lack of data on PICD in acute-on-chronic liver failure (ACLF). Because ACLF patients have greater hemodynamic derangements than patients with decompensated cirrhosis, we investigated whether PICD could develop with modest-volume paracentesis (MVP) and the role of albumin infusion. A total of 80 ACLF patients undergoing <5 L paracentesis were randomized to receive albumin (8-10 g/L of ascitic fluid; n = 40) or no albumin (n = 40) and were serially followed to detect PICD. Baseline characteristics were comparable between groups, including volume of ascitic tap (4.16 ± 0.23 vs. 4.14 ± 0.27 L; P = 0.72) and plasma renin activity (PRA) (20.5 ± 7.03 vs. 23.2 ± 8.24 ng/mL/hour; P = 0.12). PICD was more frequent in the no-albumin group than the albumin group (70% vs. 30%; P = 0.001), with higher incidence of hepatic encephalopathy (50% vs. 27.5%; P = 0.04), hyponatremia (67.5% vs. 22.5%; P < 0.001), acute kidney injury (62.5% vs. 30%; P = 0.001), and in-house mortality (62.5% vs. 27.5%; P = 0.003). PRA of 25.15 ng/mL at day 3 had sensitivity and specificity of 71% and 68% for development of PICD at day 6. Albumin infusion decreased the incidence of PICD at day six (odds ratio, 0.068; 95% confidence interval, 0.011-0.43; P = 0.005). Conclusion: PICD is common and develops even with MVP in ACLF patients. Albumin infusion decreases the incidence of PICD and mortality in ACLF patients.