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Major depression represents among the most frequent psychiatric disorders in the general population with an estimated lifetime prevalence of 16-17%. It is characterized by high levels of comorbidities with other psychiatric conditions or somatic diseases as well as a recurrent or chronic course in 50 to 80% of the cases leading to negative repercussions on the daily functioning, with an impaired quality of life, and to severe direct/indirect costs. Large cohort studies have supported that failure of a first-line antidepressant treatment is observed in more than 60% of patients. In this case, several treatment strategies have been proposed by classical evidence-based guidelines from internationally recognized scientific societies, referring primarily on: I) the switch to another antidepressant of the same or different class; II) the combination with another antidepressant of complementary pharmacological profile; III) the addition of a wide range of pharmacological agents intending to potentiate the therapeutic effects of the ongoing antidepressant medication; IV) the association with appropriate psychological therapies; and, V) the use of non-invasive brain stimulation techniques. However, although based on the most recently available data and rigorous methodology, standard guidelines have the significant disadvantage of not covering a large variety of clinical conditions, while currently observed in everyday clinical practice. From these considerations, formalized recommendations by a large panel of French experts in the management of depressed patients have been developed under the shared sponsorship of the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN) and the Fondation FondaMental. These French recommendations are presented in this special issue in order to provide relevant information about the treatment choices to make, depending particularly on the clinical response to previous treatment lines or the complexity of clinical situations (clinical features, specific populations, psychiatric comorbidities, etc.). Thus, the present approach will be especially helpful for the clinicians enabling to substantially facilitate and guide their clinical decision when confronted to difficult-to-treat forms of major depression in the daily clinical practice. This will be expected to significantly improve the poor prognosis of the treatment-resistant depression thereby lowering the clinical, functional and costly impact owing directly to the disease.

International audience; African dust emission and transport exhibits variability on diurnal to decadal timescales and is known to influence processes such as Amazon productivity, Atlantic climate modes, regional atmospheric composition and radiative balance and precipitation in the Sahel. To elucidate the role of African dust in the climate system, it is necessary to understand the factors governing its emission and transport. However, African dust is correlated with seemingly disparate atmospheric phenomena, including the El Niño/Southern Oscillation, the North Atlantic Oscillation, the meridional position of the intertropical convergence zone, Sahelian rainfall8 and surface temperatures over the Sahara Desert, all of which obfuscate the connection between dust and climate. Here we show that the surface wind field responsible for most of the variability in North African dust emission reflects the topography of the Sahara, owing to orographic acceleration of the surface flow. As such, the correlations between dust and various climate phenomena probably arise from the projection of the winds associated with these phenomena onto an orographically controlled pattern of wind variability. A 161-year time series of dust from 1851 to 2011, created by projecting this wind field pattern onto surface winds from a historical reanalysis, suggests that the highest concentrations of dust occurred from the 1910s to the 1940s and the 1970s to the 1980s, and that there have been three periods of persistent anomalously low dust concentrations—in the 1860s, 1950s and 2000s. Projections of the wind pattern onto climate models give a statistically significant downward trend in African dust emission and transport as greenhouse gas concentrations increase over the twenty-first century, potentially associated with a slow-down of the tropical circulation. Such a dust feedback, which is not represented in climate models, may be of benefit to human and ecosystem health in West Africa via improved air quality and increased rainfall6. This feedback may also enhance warming of the tropical North Atlantic, which would make the basin more suitable for hurricane formation and growth.

Background Public health policies aim to prevent suicide in the general population. Assessing their effectiveness is required to further guide public health policies. The present article focuses on the French paradox. The French health care system was classified as the best in the world according the World Health Organization (WHO). However, suicide rates in France remain high compared to other European countries. The aim of the present article was to analyze (i) the evolution of suicide Age-Standardized Death (ASDRs) in France during the last three decades and the associations with socio-economic parameters and (ii) to understand which populations may specifically benefit from further targeted suicide prevention policies. Methods The database of the World Health Organization (WHO), freely available, was explored in April 2015. ASDRs were calculated each year by ratio between the number of deaths by suicide and the total population (per 100,000 inhabitants). Number of deaths by gender and age were also analyzed. Results Overall, ASDR suicide has decreased since 1987 in France (−32.8% between 1987 and 2010). However, France kept the same rank (10/26) when compared to other European countries between 1987 and 2010. The relative burden of suicide in all-causes mortality increased during the same period (+28.2%) while the total number of deaths by suicide increased only slightly (+3.9%). More specifically, the number of deaths by suicide increased substantially in [35–54] years old (+40%) and 75+ years old (+27%) males, and in [35–54] (+41%) years old females. Between 2000 and 2010, suicide rates significantly decreased when yearly mean income increased, and when general and psychiatric care beds decreased. Conclusion Although ASDR suicide has decreased in France since 1987, this decline is quite modest when considering its universal access to care, the prevention of depression and suicide public policies. Suicide prevention public policies should focus on evaluation and improvement of prevention and care in the [35–54] years old population, and in the males aged 75+.

Strong vertical wind shear can prevent the formation of tropical cyclones, even when ocean temperatures are otherwise warm enough to brew them up. Amato Evan et al. now show that increased emissions of black carbon, sulphates and other aerosols have altered the atmospheric circulation in the pre-monsoon season over the Arabian Sea, leading to decreased vertical wind shear. As a result, these anthropogenic emissions seem to have caused an increase in the intensity of tropical cyclones in the pre-monsoon season. Throughout the year, average sea surface temperatures in the Arabian Sea are warm enough to support the development of tropical cyclones1, but the atmospheric monsoon circulation and associated strong vertical wind shear limits cyclone development and intensification, only permitting a pre-monsoon and post-monsoon period for cyclogenesis1,2,3,4. Thus a recent increase in the intensity of tropical cyclones over the northern Indian Ocean5 is thought to be related to the weakening of the climatological vertical wind shear3,4. At the same time, anthropogenic emissions of aerosols have increased sixfold since the 1930s, leading to a weakening of the southwesterly lower-level and easterly upper-level winds that define the monsoonal circulation over the Arabian Sea6,7,8,9. In principle, this aerosol-driven circulation modification could affect tropical cyclone intensity over the Arabian Sea, but so far no such linkage has been shown. Here we report an increase in the intensity of pre-monsoon Arabian Sea tropical cyclones during the period 1979–2010, and show that this change in storm strength is a consequence of a simultaneous upward trend in anthropogenic black carbon and sulphate emissions. We use a combination of observational, reanalysis and model data to demonstrate that the anomalous circulation, which is radiatively forced by these anthropogenic aerosols, reduces the basin-wide vertical wind shear, creating an environment more favourable for tropical cyclone intensification. Because most Arabian Sea tropical cyclones make landfall1, our results suggest an additional impact on human health from regional air pollution.

Background: In Italy, Klebsiella pneumoniae carbapenemase producing K. pneumoniae (KPC-Kp) strains are highly endemic and KPC producing CC258 is reported as the widely predominating clone. In Palermo, Italy, previous reports have confirmed this pattern. However, recent preliminary findings suggest that an epidemiological change is likely ongoing towards a polyclonal KPC-Kp spread. Here we present the results of molecular typing of 94 carbapenem non susceptible K. pneumoniae isolates detected during 2014 in the three different hospitals in Palermo, Italy. Methods and Results: Ninety-four consecutive, non replicate carbapenem non susceptible isolates were identified in the three largest acute general hospitals in Palermo, Italy, in the six-month period March-August 2014. They were characterized by PCR for β-lactam, aminoglycoside and plasmid mediated fluoroquinolone resistance genetic determinants. The mgrB gene of the colistin resistant isolates was amplified and sequenced. Clonality was assessed by pulsed field gel electrophoresis and multilocus sequence typing. Eight non-CC258 sequence types (STs) were identified accounting for 60% of isolates. In particular, ST307 and ST273 accounted for 29% and 18% of isolates. CC258 isolates were more frequently susceptible to gentamicin and non-CC258 isolates to amikacin. Colistin non susceptibility was found in 42% of isolates. Modifications of mgrB were found in 32 isolates. Conclusions: Concurrent clonal expansion of some STs and lateral transmission of genetic resistance determinants are likely producing a thorough change of the KPC-Kp epidemiology in Palermo, Italy. In our setting mgrB inactivation proved to substantially contribute to colistin resistance. Our findings suggest the need to continuously monitor the KPC-Kp epidemiology and to assess by a nationwide survey the possible shifting towards a polyclonal epidemic.

The existence of a genetic background is well admitted in schizophrenia, but some individuals at genetic risk for that disease could never manifest it at a clinical level. However, several vulnerability models could help us to identify such individuals. According to them, when similar perturbations at a given task are observed both in clinically stable patients with schizophrenia and their nonschizophrenic first degree relatives, this task could be qualify as an indicator of the vulnerability to schizophrenia. In literature, that seems the case for auditory ERP late components in oddball paradigms. Our study was undertaken to replicate literature data. For that purpose, amplitude and latencies of auditory N100, P200, N200 and P300 wave-forms were assessed among 21 clinically, stable schizophrenics, 21 of their biological full siblings and 21 unrelated control subjects matched with the two others groups for several socio-demographic factors. Comparison were performed by non parametric analyses (Kruskal-Wallis one way ANOVA, and post-hoc Mann-Whitney). Compared to controls, delayed latencies and/or reduced amplitudes were observed for several ERP components--mainly with P300--in the sibling group. ERP values from this group did not statistically differ from those of the group with schizophrenia. In conclusion, results from the sibling group suggest that ERP impairments in auditory oddball paradigms may actually represent indicators of the genetic vulnerability to schizophrenia.

Most of existing self-report measures of schizotypal personality assess only few of the nine traits of schizotypal personality disorder according to DSM III-R or DSM IV. Adrian Raine has developed a self-report scale named "Schizotypal Personality Questionnaire, [SPQ]" to evaluate all these traits. The questionnaire was found to have high sampling validity, high internal reliability [0.91] and test-retest reliability [0.82]. However, the SPQ was still not available in French. Therefore, the first purpose of this report was to offer a French translation of this tool with the agreement of A. Raine for both translated version and its back translation. The second purpose of our study was to establish French norms. The preliminary norms presented here were obtained by administering the SPQ to a sample of 134 French students of both gender (mean age: 20.11 +/- 1.53 years; mean educational level: 13.39 +/- 1.04 years). On that sample, the minimal score was 2/74 and the maximal one 54/74 (mean of the sample: 23.60 +/- 12.09). With the original English study, based on a sample of American students, the cut-offs for the top and the bottom ten percents of SPQ scores were respectively of 41/74 and 12/74. Very close preliminary cut-offs were observed in our own study i.e. respectively 40/74 and 9/74. We will confirm them in a larger sample.

The P3 component of the event-related potential (E.R.P.) is an endogenous positive wave with a latency of approximately 300 msec, which is typically elicited by rare target stimuli in a detection task. The P3 has been applied to the study of cognitive impairments. One of the most consistently replicated biologic observation in schizophrenia is the P3 amplitude reduction. More recently, a prolonged P 3 latency has been observed by some authors. Nevertheless, when the heterogeneity of the schizophrenic syndrome is taken into consideration, results reported in the literature do not show much agreement. In the present study, we attempted to explore the P 3 component in a group of schizophrenic patients with a precisely defined clinical symptomatology.Subjects. The study included 19 inpatients and 19 healthy control subjects age and sex-matched. Patients were medication-free for at least 15 days prior recording. According to the DSM III-R diagnosis criteria, 10 patients were classified as "paranoid subtype" and 9 as "disorganized subtype". Furthermore, on the day of the neurophysiological examination, the patients were interviewed using the Scale of the Assessment of Positive Symptoms (S.A. P.S.) and the Scale of the Assessment of Negative Symptoms (S.A.N.S.). The median age (SD) of the patients was 35.3 +/- 8 years, with a median duration of illness 12.5 +/- 7.2 years, a median duration of hospitalization 4.2 +/- 4.3 years and a median IQ 82.8 +/- 13.7. E.R.P. Recording. Subjects performed a two-tone auditory discrimination task: they were instructed to count silently infrequent high-pitched tones of 2000 Hz randomly presented within a serie of low-pitched tones of 1000 Hz. E.R.P. were recorded from 16 scalp electrodes (international 10-20 system) referred to nose. The P 3 was defined as the most positive wave between 250 and 500 msec after the stimulus onset. The amplitude was measured referred to the prestimulus baseline; the latency was measured at the point of maximum amplitude. Statistical analysis. The data were submited to a statistical analysis (ANOVA, Student's t-test, Fisher PLSD and Scheffe F-test, Spearman's correlation and linear regression analysis).1) The schizophrenic group (N = 19) showed both a significantly prolonged latency and a reduced amplitude, compared to the control group (p0.01). 2) In the paranoid subgroup (N = 10), P 3 response was later and smaller than in the control group (p0.05). The P 3 latency and amplitude were not significantly different between the two groups of disorganized schizophrenics and controls. 3) A significant correlation between the global score of the S.A.P.S. and the P 3 amplitude was found (r = -0.67). There was no significant correlation between the P 3 parameters and a) the global score of the S.A.N.S. and b) the different items of each evaluation scale. 4) The P 3 amplitude showed a trend toward a negative correlation with the duration of hospitalization. 5) The duration of hospitalization was more important and the global score of the S.A.P.S. was higher in the paranoid than in the disorganized subgroup. There were no significant differences concerning the global score of the S.A. N.S., age, duration of illness, duration of hospitalization, IQ and performances in the detection task between the two subgroups of patients.We confirmed the P 3 parameters modifications in schizophrenic patients. The P 3 reduced amplitude and prolonged latency only in the paranoid subgroup, while the disorganized subgroup had both values comparable to those of the controls, is the main finding in our study. Kütcher or Louza studies tend to the same results. Furthermore, we showed that task performances or clinical measures such as age, duration of illness, duration of hospitalization or IQ did not account as biases of P 3 parameters. These results could be a further indication that different subtypes of schizophrenia may have different biological substrates.

A retrospective rubella serological survey spanning a 14-year period (1973-1986) was carried out on 5,726 subjects (2,339 diseased patients and 3,387 healthy females) of various ages and mostly living in the town of Siena or in its surroundings. Rubella antibodies were assayed by a haemagglutination-inhibition technique. The infection rate, as inferred from the analysis of the seropositivity rate according to age, peaked in the 6 to 10 year age group and was apparently very low in subjects aged over 30. The overall seropositivity rate of healthy females of childbearing age was 88.4%. Notwithstanding the fact that rubella vaccination has been recommended for all school-girls since 1973, no significant difference was noticed between the seropositivity rates of healthy females aged 18-23 observed in the period 1973-78 (i.e. before the first immunized subjects reached this age group) and in the period 1981-86 (i.e. when this age group had already been included among the first vaccinees). Serological diagnosis of acute rubella infection was achieved in 44 (1.9%) of the 2,339 diseased patients. Most diagnoses occurred in spring months.

The existence of a genetic background is now a well admitted notion in schizophrenia, but some individuals at genetic risk for that disease could never manifest it at a clinical level. However, several vulnerability models could help us to identify such individuals. According to them, when similar perturbations at a given test are observed both in clinically stable schizophrenics and their nonschizophrenic first degree relatives, this test could be qualify as an indicator of the vulnerability to schizophrenia. In literature, that seems the case for several neuropsychological tasks, exploring attentional abilities (degraded version of the Continuous Performance Task [DS-CPT], and Span Of Apprehension task [SOA]) and executive functions (Wisconsin Card Sorting Test [WCST]). Our study was undertaken to replicate literature data and to further explore the relationship between these three neuropsychological markers. For that purpose, performances at DS-CPT, SOA and WCST were assessed among 18 clinically stable schizophrenics, 18 of their biological full siblings and 15 unrelated control subjects matched with the two others groups for several socio-demographic factors. Comparisons were performed by non parametric analysis (Kruskal-Wallis one way ANOVA, and Mann-Whitney). Compared to controls, the siblings group performances were significantly impaired on the three tasks, while they did not statistically differ from the schizophrenic ones. No relationship was observed between the markers, except for the "d'" index at DS-CPT and the number of successfully performed categories at the WCST. Results from the sibling group suggested that the observed impaired neuropsychological performances may actually represent indicators of the genetic vulnerability to schizophrenia. Moreover, the generally admitted relationship between WCST poor performances and an impairment of the prefrontal cortex, lead us to hypothesize some role of this brain area in schizophrenia vulnerability.

Meehl used the term "schizotype" to refer to individuals who possess an underlying vulnerability for schizophrenia. Because of the extremely varying degrees of the schizotype's clinical expression, he recommended assessing schizotypic signs through objective measures rather than clinical judgement. In this way, Chapman et al. have developed symptom-oriented scales based on Meehl's manual, such as the Social Anhedonia (SA) and Physical Anhedonia (PhA) Scales, the Magical Ideation Scale (MIS), the Perceptual Aberration Scale (PAS) and the Impulsive Nonconformity Scale (IN). Whereas Chapman's scales of psychosis proneness are the most internationally used instruments for the assessment of schizotypy, some of them, such as MIS and PAS, were still not available in French. Therefore, the first aim of this report was to offer French translations of the Magical Ideation and the Perceptual Aberration Scales; the agreement of the original authors were obtained for both translated versions and their back translations. The second aim of our study was to establish French norms for each of these scales. The preliminary norms presented here [MIS: 19/30 (for females) and 20/30 (for males); PAS: 18/35 (for both genders)] were obtained by administering both scales to a sample of 134 French students. They are very close to those found by Chapman et al. for University of Wisconsin undergraduate students. We will confirm them with a larger sample of French students.

Blood transfusion and blood management are important aspects in orthopaedic surgery. Strategies include intra-operative and post-operative blood salvage and even the use of fibrin sealant in selected case. Objectives of the study were (1) to compare the total number of transfusions and the length of hospital stay in patients undergoing complete revision hip arthroplasty (RHA) with and without the use of a fibrin sealant (EVICEL®) and (2) to evaluate the possible role in cost savings of EVICEL® in association with the blood-saving protocol. Retrospective observational study evaluating patients undergoing complete RHA (stem + cup) with a blood-saving protocol with (n = 50) and without EVICEL® (n = 60). The outcome measures were: number of patients transfused (allogeneic red blood cells—RBC—and plasma), amount of blood/plasma transfusions, quantity of re-infused recycled blood, and length of hospital stay. An economic model was developed to assess the differences in costs between the two groups. EVICEL® reduced the number of transfused red blood cells and plasma (p

PurposeTo compare post-operative recovery of prosthetic hip surgery patients with or without the implementation of iron supplementation with a new highly absorbable oral iron formulation.MethodsObservational retrospective quality improvement assessment conducted on patients who had undergone elective prosthetic hip surgery (first implant) with ferritin 100mcg/dl but C-reactive protein (CRP) >3mg/l and transferrin saturation (TSAT) 100mcg/l to two groups of patients with iron deficiency, of which only one received iron supplementation. Measurements included haemoglobin levels, length of hospital stay, and number of transfused patients/blood units.ResultsPatients with iron deficiency supplemented with Sideral (R) Forte compared to non-supplemented patients showed a smaller decline in post-operative Hb (9.71.24g/dl vs 8.4 +/- 0.6g/dl), required shorter hospital stay (4 vs 6.5days) and less blood transfusions (0 in the iron-supplemented group vs 7units in the non-iron-supplemented group), yielding an overall savings of 1763.25 Euro/patient.Conclusions p id=Par4 Pre-operative sucrosomial iron supplementation at least 4weeks prior to elective surgery in non-anaemic patients limits the drop in post-operative Hb levels, determining higher post-operative haemoglobin, quicker post-surgical recovery, shorter hospitalisation, and decreased surgery-related costs.

The origin and function of monocytoid B cells (MBCs) are poorly understood. Taking advantage of their strong expression of IRTA1 (a receptor that is also associated with MALT marginal zone B cells), we have comprehensively analysed MBCs in 25 cases of lymphadenitis of different aetiologies, shedding new light on the topographical distribution, immunophenotype and IgVH gene usage and mutational profile of this B cell subset. IRTA1+ MBCs, although predominantly located in the subcapsular and intermediary sinuses, were also observed scattered within germinal centres (GCs) in all lymphadenitis cases examined. The molecular characterization of IgVH genes revealed that IRTA1+ MBCs residing in different areas of the lymph node (subcapsular sinus, intermediary sinuses and GCs) can be clonally related (with intraclonal variation), and that those located in GCs are consistently more mutated and selected for expression of a functional antigen receptor than those located in the sinuses. Moreover, by contrast, IRTA1+ MBCs in GCs express the memory B cell marker CD27. Finally, in toxoplasmic lymphadenitis, the IRTA1+ MBC population shows a highly preferential usage of the VH genes 3-7 and 3-30 (without any obvious peculiarity in their CDR3s), possibly suggesting that a superantigen expressed by Toxoplasma gondii may be involved in the early activation of this B cell subset. Copyright © 2006 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

The normal counterpart of the neoplastic B cells in Burkitt lymphoma (BL) is still unclear. Based on immunoglobulin gene rearrangement studies, some authors suggest an origin from germinal center cells and others from memory B cells. However, most of these studies rely on cell lines or on a small series of cases. To help clarify the cell of origin of BL, semi-nested polymerase chain reaction (PCR) was performed to amplify the VDJ rearrangements of the immunoglobulin heavy chain (VH) genes, and the resultant amplificates were sequenced for comparison with known germline VH segments. The results of this approach revealed that all cases (15 endemic BL [eBL], 10 sporadic BL [sBL], and 6 AIDS-related BL) harbor mutated VH genes, with different mutation ranges among the 3 types of BL. The eBL and AIDS-related forms showed considerably higher mutation rates than the sBL form (5.1%, 5.4%, and 1.5%, respectively). The mutations in eBL and AIDS-related BL also showed signs of antigen selection, whereas no signs of antigen selection were found in sBL. Finally, after subcloning the amplificates, sequence analysis revealed no signs of ongoing mutations in any of the cases analyzed. Given that one of the main differences between eBL and AIDS-related BL on the one hand and sBL on the other hand is the association with Epstein-Barr virus (EBV), we compared EBV-positive and EBV-negative BLs independently of their geographic origin and HIV status. The differences in the number of somatic mutations and antigen selection were even more evident when this approach was used. According to our molecular results, it appears that EBV-positive and EBV-negative BL may originate from 2 distinct subsets of B cells, pointing to a particular role for the germinal-center reaction in the pathogenesis of these tumors. The different types of C-MYC translocation reported in BL may also be related to the different stages of B-cell maturation.

CDK9 is a member of the CDC2-like family of kinases. Its cyclin partners are members of the CYCLIN T family (T1, T2a, and T2b) and CYCLIN K. The CDK9/CYCLIN T1 complex is very important in the differentiation programme of several cell types, controlling specific differentiation pathways. Limited data are available regarding the expression of CDK9/CYCLIN T1 in haematopoietic and lymphoid tissues. The aim of this study was to analyse the expression of the CDK9/CYCLIN T1 complex in lymphoid tissue, in order to assess its role in B- and T-cell differentiation and lymphomagenesis. CDK9/CYCLIN T1 expression was found by immunohistochemistry in precursor B and T cells. In peripheral lymphoid tissues, germinal centre cells and scattered B- and T-cell blasts in interfollicular areas expressed CDK9/CYCLIN T1, while mantle cells, plasma cells, and small resting T-lymphocytes displayed no expression of either molecule. CDK9/CYCLIN T1 expression therefore appears to be related to particular stages of lymphoid differentiation/activation. CDK9 and CYCLIN T1 were highly expressed in lymphomas derived from precursor B and T cells, from germinal centre cells, such as follicular lymphomas, and from activated T cells (ie anaplastic large cell lymphomas). Hodgkin and Reed-Sternberg cells of classical Hodgkin's lymphoma also showed strong nuclear staining. Diffuse large B-cell, Burkitt's lymphomas, and peripheral T-cell lymphomas, among T-cell lymphoproliferative disorders, showed a wide range of values. No expression of CDK9 or CYCLIN T1 was detected in mantle cell and marginal zone lymphomas. However, at the mRNA level, an imbalance in the CDK9/CYCLIN T1 ratio was found in follicular lymphoma and diffuse large B-cell lymphomas with germinal centre phenotype, and in the cell lines of classical Hodgkin's lymphomas, Burkitt's lymphomas, and anaplastic large cell lymphoma, in comparison with reactive lymph nodes. These results suggest that the CDK9/CYCLIN T1 complex may affect the activation and differentiation programme of lymphoid cells. The molecular mechanism through which the CDK9/CYCLIN T1 complex is altered in malignant transformation needs to be elucidated.

Portal vein flow was recorded by color Doppler sonography in 31 patients with chronic heart failure and 18 control subjects. Compared with patients showing a forward flow (Group A), those with reversed portal vein flow (Group B) had higher prevalence of tricuspid regurgitation (75% vs. 43%), hepatic congestion (100% vs. 30%) and ascites (50% vs. 18%), and showed higher right atrial pressure (25.3 +/- 3.01 mmHg vs. 11.8 +/- 5.75 mmHg, p < 0.01). In controls, portal vein pulsatility ratio was 0.66 +/- 0.08, in Group A it was 0.46 +/- 0.28 (p < 0.01), in Group B -0.60 +/- 0.19 (p < 0.01). Portal vein pulsatility ratio negatively correlated with right atrial pressure (r = -0.87; p < 0.01). In Group A, hepatic congestion, ascites and tricuspid regurgitation were associated with a higher portal vein pulsatility. This study indicates that portal vein pulsatility ratio reflects the level of impairment of the right heart.