bluuebunny/crossref_metadata_2025 huggingface dataset:
Human Pulmonary Dirofilariasis: One More Case in Greece Suggests That Dirofilaria is a Rather Common Cause of Coin Lesions in the Lungs in Endemic Areas of Europe
Authors: Miliaras D. , Meditskou S. , Kelekis A. , Papachristos I.
Published: January 2017

Herein we describe a case of a 52 year-old male from Greece who presented with a coin lesion in the right lung, which proved to be an infection from Dirofilaria immitis. A careful review of the literature shows that, contrary to the common perception, humans may be frequently infected by Dirofilaria species. For this reason the authors suggest that in every case which presents with a coin lesion in the lung in endemic areas, dirofilariasis should always be considered, and excluded before any other intervention is decided.
CD4+CD25+Foxp3+ T Regulatory Cells are not Involved in Oral Desensitization
Authors: Mori F. , Bianchi L. , Pucci N. , Azzari C. , De Martino M. , Novembre E.
Published: January 2017

Oral tolerance has been related to generation of T regulatory cells (Treg) or clonal anergy/deletion, respectively by administering low and high doses of fed antigens. CD4+CD25+ regulatory T cell clones can be induced by the antigen in Peyer's patches of animal models. We selected ten subjects (mean age: 89.4 ± 36.21 months; group A) with severe cow's milk allergy. They underwent oral desensitization (OD) according to the current protocols. In six months they reached a tolerance of 50 ml of cow's milk. CD4+CD25+Foxp3+ T(reg) blood levels were measured at the beginning of OD (A) and after 6 months (A'), but almost the same values were obtained: A = 0.36 ± 0.11%; A'= 0.59 ± 0.15%. These results were compared with a control group (C) of non-atopic children. Naturally outgrowing cow's milk allergy can be related to high blood levels of CD4+CD25+Foxp3+ T(reg), as previously reported in children. On the other hand, a forced oral desensitization through a progressive intake of the antigenic food seems not to be related to an enhancement of CD4+CD25+Foxp3+ T(reg) levels in peripheral blood, making the role of long-lasting systemic immunologic changes unlikely.
Combination Therapy of Lamivudine and Interferon-Alpha in Pediatric Patients with Chronic Hepatitis B in Bangladesh: A Safe and Effective Therapeutic Approach for Pediatric CHB Patients in Developing Countries
Authors: Al-Mahtab M. , Rahman S. , Akbar S.M. , Khan S.I. , Uddin H. , Karim M.F. , Ahmed F.
Published: January 2017

Hepatitis B virus (HBV) is mainly transmitted during birth or perinatal period, however, treatment is not usually recommended for pediatric patients with chronic hepatitis B (CHB). Twelve pediatric patients with CHB in Bangladesh were treated with both lamivudine and interferon. Lamivudine was given at a dose of 3 mg/kg, daily for 12 months. Two months after commencement of lamivudine therapy, all patents were given interferon-α (3 million IU/square meter of body surface area) three times weekly, subcutaneously for 10 months. Combination therapy was safe for all pediatric CHB patients. The levels of serum HBV DNA became undetectable (<500 copies/ml) in 8 patients and reduced in 4 patients after the end of therapy. Anti-HBe was detected in 10 of 12 patients at this time point. The levels of serum alanine aminotransferase (ALT) were significantly reduced in these patients (p<0.05) due to therapy. Neither flare of HBV DNA nor elevation of serum ALT were detected during follow-up. In conclusion, combination therapy with lamivudine and interferon-α represents a new and novel therapeutic option for treatment of pediatric CHB patients.
Zoledronic Acid Enhances Vδ2 T-Lymphocyte Antitumor Response to Human Glioma Cell Lines
Authors: Cimini E. , Piacentini P. , Sacchi A. , Gioia C. , Leone S. , Lauro G.M. , Martini F. , Agrati C.
Published: January 2017

Glioblastoma multiforme (GBM), the most frequent and aggressive primary brain tumor in humans, responds modestly to treatment: most patients survive less than one year after diagnosis, despite both classical and innovative treatment approaches. A recent paper focused on γδ T-cell response in GBM patients, suggesting the application of an immunomodulating strategy based on γδ T-cells which is already in clinical trials for other tumors. Human Vδ2 T-cells recognize changes in the mevalonate metabolic pathway of transformed cells by activating cytotoxic response, and by cytokine and chemokine release. Interestingly, this activation may also be induced in vivo by drugs, such as zoledronic acid, that induce the accumulation of Vδ2 T-cell ligand Isopentenyl-pyrophosphate by blocking the farnesyl pyrophosphate synthase enzyme. The aim of our work is to confirm whether bisphosphonate treatment would make glioma cell lines more susceptible to lysis by in vitro expanded γδ T-cells, improving their antitumor activity. We expanded in vitro human Vδ2 T-cells by phosphoantigen stimulation and tested their activity against glioma cell lines. Co-culture with glioma cells induced Vδ2 T-cell differentiation in effector/memory cells, killing glioma cells by the release of perforin. Interestingly, glioma cells were directly affected by zoledronic acid; moreover, treatment increased their activating ability on Vδ2 T-cells, inducing an effective antitumor cytotoxic response. Taken together, our results show that aminobisphosphonate drugs may play a dual role against GBM, by directly affecting tumor cells, and by enhancing the antitumor response of Vδ2 T-cells. Our results confirm the practicability of this approach as a new immunotherapeutic strategy for GBM treatment.
Natural Killer Cell Deficiencies in a Consecutive Series of Children with Herpetic Encephalitis
Authors: Almerigogna F. , Fassio F. , Giudizi M.G. , Biagiotti R. , Manuelli C. , Chiappini E. , Galli L. , Romagnani S. , De Martino M.
Published: January 2017

Natural killer (NK) cells play a fundamental role in innate and early phases of adaptive immunity against viral infections, both in humans and in animal models. To date, NK cell deficiencies in patients with severe herpetic infections have been reported in single cases, and their role as predisposing factor is still controversial. Five children affected by herpetic encephalitis were consecutively admitted to the Anna Meyer Children's Hospital in Florence (Italy) between 2003 and 2005. We therefore investigated the presence of NK cell deficiencies in a consecutive series of children with herpetic encephalitis. Five healthy children were included in the study as controls. Differential WBC counts, main Ig and IgE class serum analysis, cytofluorimetric analysis of circulating T, B and NK cells were performed on our study population. Sequencing of a selected region of CD16A gene transcript was carried out in two patients. All patients resulted to be affected by deficiencies related to NK cells in respect to controls. One patient was also affected by lymphopenia, while no other significant deficits of immunity were detected in the study population. To date, this is the first survey that demonstrates isolated NK cell deficiencies in a cohort of consecutive patients affected by severe herpes simplex infections. These findings suggest a role for NK cell deficiencies as a predisposing factor for increased susceptibility and severe course of disease in these patients.
Novel Strategies for the Development of a Vaccine for Parietaria Allergy
Authors: Bonura A. , Colombo P.
Published: January 2017

Specific immunotherapy is a well established and clinically proved strategy to cure allergic reactions. The impressive boost of knowledge derived from DNA recombinant technology applied to this field allowed the identification, cloning and expression of several clinically relevant allergens. Recombinant allergens can be easily produced in a pure and reproducible way with immunological properties comparable to natural allergens and matching the requirements of pharmaceutical companies. Parietaria pollinosis is a major health problem in the Mediterranean basin with prolonged symptoms. In this review we will discuss the rational approaches to design hypoallergenic derivatives of the major allergens of this pollen, their immunological properties and possible clinical future implications.
Circulating Regulatory T Cells in “Clinical” Monoclonal B-Cell Lymphocytosis
Authors: D'Arena G. , Rossi G. , Minervini M.M. , Savino L. , D'Auria F. , Laurenti L. , Del Principe M.I. , Deaglio S. , Biagi A. , De Martino L. , De Feo V. , Statuto T. , Musto P. , Del Poeta G.
Published: January 2017

Regulatory T-cells (Tregs) constitute a small subset of cells involved in antitumour immunity and are generally increased in patients with chronic lymphocytic leukemia (CLL). No data is available on Tregs in monoclonal B-cell lymphocytosis (MBL), a disease entity characterized by less than 5000/μL circulating clonal B-cells in absence of other features of lymphoproliferative disorders. We used multicolour flow cytometry to evaluate the number of circulating Tregs in 56 patients with “clinical” MBL, 74 patients with previously untreated CLL and 40 healthy subjects. MBL patients showed a lower absolute number of Tregs, compared to CLL patients, but slightly higher than controls. Moreover, the absolute cell number of Tregs directly correlated both with more advanced Rai/Binet clinical stages and peripheral blood B-cell lymphocytosis. Of note, the absolute number of Tregs was found lower in MBL patients than in CLL patients staged as 0/A Rai/Binet. The study showed that Tregs increase gradually from normal subjects to “clinical” MBL patients and are significantly higher in CLL patients as compared to MBL patients. Moreover, a significant direct relationship was found between higher Treg values and a higher tumor burden expressed by B-lymphocytosis or more advanced clinical stages. In light of this data, MBL seems to be a preliminary phase preceding CLL. The progressive increase of Treg numbers might contribute both to the clinical evolution of MBL to overt CLL and to CLL progression.
Rheumatoid Arthritis: A Complication of Aromatase Inhibitor Therapy?
Authors: Bruzzese V. , Hassan C. , Zullo A. , Zampa G.
Published: January 2017

We report the case of a 56-year-old woman treated with aromatase inhibitors for a breast cancer. Following one year of such therapy, the patient presented with widespread osteoarthrealgia. The clinical picture worsened 3 years later when the pain became more severe with swelling and stiffness involving several joints in a symmetric fashion. Biochemical analysis showed an increase of ESR, CRP and rheumatoid factor, as well as of anti-CCP antibodies. The x-ray was compatible with a diagnosis of rheumatoid arthritis (RA). Therapy with methotrexate, prednisol one, bisphosphonates and vitamin D was started, achieving a quick clinical remission. Aromatase inhibitors have been shown to alter the distribution of Th1/Th2 lymphocytes and increase the level of RANKL. A possible role of aromatase inhibitors in RA development has been further addressed.
IL-36 Receptor Antagonist with Special Emphasis on IL-38
Authors: Shaik Y. , Sabatino G. , Maccauro G. , Varvara G. , Murmura G. , Saggini A. , Rosati M. , Conti F. , Cianchetti E. , Caraffa A. , Antinolfi P. , Pandolfi F. , Potalivo G. , Galzio R. , Conti P. , Theoharides T.C.
Published: January 2017

IL-36 is another family member of IL-1 and induces the production of proinflammatory cytokines and activates MAPK and NFκB pathways. IL-36 is a common mediator of innate and adaptive immune response and is inhibited by IL-36 receptor antagonist (RA). IL-36RA acts on IL-36 receptor ligand which exerts proinflammatory effect in vivo and in vitro. IL-38 binds to IL-36 receptor as does IL-36RA and has similar biological effects on immune cells. IL-38 is also a member of IL-1 cytokine and shares some characteristics of IL-1RA, binding the same IL-1 receptor type I. IL-38 plays a role in the pathogenesis of inflammatory diseases, exerting protective effect in some autoimmune diseases. Both IL-38 and IL-36RA have an anti-inflammatory biological effect, however in some cases have contrary effects.
Kinetics and Interplay of Mediators of Inflammation-Induced Bone Damage in the Course of Adjuvant Arthritis
Authors: Nanjundaiah S.M. , Stains J.P. , Moudgil K.D.
Published: January 2017

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, bone erosion, and cartilage destruction in the joints. It is increasingly being realized that inflammation might play an important role in inducing bone damage in arthritis. However, there is limited validation of this concept in vivo in well-controlled experimental conditions. We addressed this issue using the adjuvant arthritis (AA) model of RA. In AA, the draining lymph nodes are the main sites of activation of pathogenic leukocytes, which then migrate into the joints leading to the induction of arthritis. We tested the temporal kinetics of mediators of bone damage [e.g., receptor activator of nuclear factor kappa-B ligand (RANKL), osteoprotegerin (OPG) and osteopontin (OPN)] and inflammation (pro-inflammatory cytokines and chemokines) in the draining lymph node cells (LNC) at different phases of AA, and then examined their inter-relationships. Our study revealed that, together with cytokines/chemokines, some of the mediators of bone remodeling are also produced in LNC. Various cytokines/chemokines showed distinct kinetics of expression as well as patterns of correlation with mediators of bone remodeling at different phases of the disease. Pro-inflammatory cytokines such as TNF-α are known to play an important role in bone damage. Interestingly, there was a positive correlation between TNF-α and RANKL, between RANKL and each of the 3 chemokines tested (RANTES, MIP-1α, and GRO/KC), and between TNF-α and RANTES. Our results in the AA model lend support to the concept of osteo-immune crosstalk during the course of autoimmune arthritis.
High Circulating Chemokines (C-X-C Motif) Ligand 9, and (C-X-C Motif) Ligand 11, in Hepatitis C-Associated Cryoglobulinemia
Authors: Antonelli A. , Fallahi P. , Ferrari S.M. , Frascerra S. , Mancusi C. , Colaci M. , Manfredi A. , Sansonno D. , Zignego A.L. , Ferri C.
Published: January 2017

(C-X-C motif) ligand 9 and (C-X-C motif) ligand 11 (CXCL9 and CXCL11), are potent chemoattractants for activated T cells, and play an important role in T helper 1 (Th) 1 cell recruitment in chronic hepatitis C. No study has evaluated CXCL9, together with CXCL11, circulating levels in patients with mixed cryoglobulinemia and hepatitis C (MC+HCV-p). The aim of the present study therefore was to measure serum CXCL9, and CXCL11 levels, in MC+HCV-p, and to relate the findings to the clinical phenotype. Serum CXCL9 and CXCL11 were measured in 71 MC+HCV-p and in matched controls. MC+HCV-p showed significantly higher mean CXCL9 and CXCL11 levels than controls (P < 0.001, for both), in particular, in 32 patients with active vasculitis (P < 0.001). By defining high CXCL9 or CXCL11 level as a value of at least 2 SD above the mean value of the control group (> 100 pg/mL): 89% MC+HCV-p and 5% controls had high CXCL9 (P < 0.0001, chi-square); 90% MC+HCV-p and 6% controls had high CXCL11 (P < 0.0001, chi-square). In a multiple linear regression model of CXCL9 vs age, ALT, CXCL11, only CXCL11 was significantly (r = 0.452, P < 0.0001) and independently related to CXCL9. Our study demonstrates in MC+HCV-p vs controls: (i) high serum CXCL9, and CXCL11, significantly associated with the presence of active vasculitis; (ii) a strong relationship between circulating CXCL9 and CXCL11. Future studies on a larger cohort of patients are needed to evaluate the relevance of serum CXCL9 and CXCL11 determination as clinico-prognostic marker of MC+HCV.
No Donor KMUP-1 Improves Hepatic Ischemia-Reperfusion and Hypoxic Cell Injury by Inhibiting Oxidative Stress and Pro-Inflammatory Signaling
Authors: Kuo K.K. , Wu B.N. , Chiu E.Y. , Tseng C.J. , Yeh J.L. , Liu C.P. , Chai C.Y. , Chen I.J.
Published: January 2017

This study investigates whether KMUP-1 improves hepatic ischemia-reperfusion (I/R) and hypoxic cell injury via inhibiting Nox2- and reactive oxygen species (ROS)-mediated pro-inflammation. Rats underwent ischemia by occlusion of the portal vein and hepatic artery for 45 minutes. Reperfusion was allowed for 4 h. Serum was used for analysis of aspartate aminotransferase (AST) and alanine aminotransferase (ALT). DNA extracted from liver homogenate was analyzed by electrophoresis to observe the fragmentation. Lipid peroxidation (LPO) was evaluated by measuring thiobarbituric acid-reactive substances (TBARS). NO and ROS contents were measured using Griess reagent and 2î-7î-dichlorofluorescein, respectively. Proteins levels were visualized by Western blotting. Liver damage was observed under a microscope. Intravenous KMUP-1 (0.25, 0.5 and 1 mg/kg) reduced I/R-induced ALT and AST levels, DNA fragmentation, ROS and malondialdehyde (MDA) and restored the NO levels of I/R rats. KMUP-1 protected the liver architecture from worsening of damage and focal sinusoid congestion, increased endothelium NO synthase (eNOS), guanosine 3î, 5î cyclic monophosphate (cGMP), protein kinase G (PKG) and the B-cell lymphoma 2/Bcl-2-associated X protein (Bcl-2/Bax) ratio, attenuated phosphodiesterase 5A (PDE-5A) and cleaved caspase-3 expression in I/R-liver. In hypoxic HepG2 cells, KMUP-1 increased cGMP/PKG, restored peroxisome proliferator-activated receptor-γ (PPAR-γ) and decreased matrix metalloproteinases-9 (MMP-9), Rho kinase II (ROCK II), hypoxia-inducible factor-1α (HIF-1α) and vascular endothelium growth factor (VEGF). KMUP-1 protects liver from I/R-injury and hypoxic hepatocytes from apoptosis-associated free radical generation and proinflammation by restoring/increasing NO/cGMP/PPAR-γ, reducing ROS/Nox2 and inhibiting ROCKII/MMP-9.
Knockdown of AXL Receptor Tyrosine Kinase in Osteosarcoma Cells Leads to Decreased Proliferation and Increased Apoptosis
Authors: Zhang Y. , Tang Y-J. , Man Y. , Pan F. , Li Z-H. , Jia L-S.
Published: January 2017

Dysregulation of the Axl receptor tyrosine kinase (RTK) has been implicated in the development and progression of a variety of malignancies. Axl is known to activate strong anti-apoptotic signaling pathways that promote oncogenesis. However, the role of Axl plays in osteosarcoma (OS) remains elusive. The present study aimed to investigate the clinical significance and function of Axl in human OS. Forty cases of OS and corresponding adjacent non-cancerous tissues (ANCT) were collected. The expression of Axl was assessed using immunohistochemical assay through tissue microarray procedure. A loss-of-function experiment was performed to investigate the effects of small hairpin RNA (shRNA)-mediated knockdown of Axl on the expression of p-AKT, poly ADP-ribose polymerase (PARP) and Ki-67, the proliferative activities, indicated by MTT assay, and the apoptotic index in OS MG-63 cells. As a result, the expression of Axl was found in OS tissues with higher strong reactivity rate, compared with the ANCT (75.0% vs 20.0%, P=0.000), but it did not associate with the age, gender, tumor size, TNM staging and distant metastases (each P>0.05). Furthermore, knockdown of Axl inhibited the proliferative activities and induced apoptosis in MG-63 cells with decreased expression of p-AKT, and Ki-67 and increased expression of PARP. In conclusion, our findings suggest that Axl is highly expressed in most of the OS tissues compared with the ANCT, and knockdown of Axl inhibits proliferation and induces apoptosis of OS cells possibly through downregulation of the AKT pathway, suggesting that our findings may provide new insights into the potential therapeutic target for cancer.
Performances of an Improved Device for Skin Prick Tests
Authors: Caimmi D. , Masse M.S. , Chiriac A.M. , Demoly P.
Published: January 2017

Every day allergists deal with skin prick testing. Following a recent paper showing that the intrevenous needle and the metal lancets are superior to the Stallerpoint® plastic lancet, the manufacturer has improved the device to reach better standards in terms of sensitivity, intra-patient reproducibility and inter-patient reproducibility, as demonstrated on 10 adult patients, comparing the results with skin tests performed with the intravenous needle. We evaluated the sensitivity of the device by calculating the ratio between the number of true-positive tests and the sum of true-positive and false-negative tests. To assess the reproducibility of the test, we calculated the interpatient and the intrapatient coefficient of variation between the mean diameters of the papules induced by the different techniques. The improved device shows performances similar to those obtained with the intravenous needle.
A Case of Cephalic Tetanus in a Developed Country
Authors: Fusetti S. , Ghirotto C. , Ferronato G.
Published: January 2017

Tetanus is a potentially life-threatening infection that results from contamination of skin wound by Clostridium Tetani spores. Although, it remains an important health problem in developing countries without strict national immunization programs, this condition is rare in the developed world. The most frequent presenting symptoms are trismus and dysphagia, due to the spasmodic contraction of the masticatory muscles. Then the disease usually diffuses with a descending pattern inducing a generalized contraction of the agonist and antagonistic muscles, which characterize a tetanic spasm. Mortality usually results from respiratory failure, cardiovascular collapse, or autonomic dysfunctions. Treatment usually requires the prompt admission to the intensive care unit to avoid the development of potential life-threatening complications. We report the case of a 78-year-old farmer, who was referred to us with progressive onset of lock-jaw and muscular stiffness of the facial region, that had occurred after he had scratched himself with a rose. The recognition of the presenting signs of cephalic tetanus allowed the prompt management of the infection. However, because of the rarity of this condition, the clinicians may be unfamiliar with the clinical presentation, and be unsuspecting of the diagnosis.
Homeless Shelter Users in the Postdeinstitutionalization Era
Authors: Stuart HL , Arboleda-Flórez J
Published: January 2017

Objective:

To describe the psychiatric symptomatology and mental health service needs of homeless shelter users in Calgary, Alberta. Data were collected as part of a broad-based community action initiative designed to reduce the problem of homelessness.

Methods:

A semistructured interview was conducted with a representative sample of 250 emergency shelter users. Mental health problems were measured through self-reports of 9 psychiatric symptoms known to be related to illnesses prevalent among homeless populations (depression, anxiety, and psychoses). The CAGE alcohol screen was also used.

Results:

Three-quarters of the sample expressed some symptomatology. About one-third were estimated to have a significant mental health problem. The lifetime prevalence of alcohol abuse was 33.6%. Higher levels of psychiatric symptomatology appeared to relate to a wide range of hardships, personal and public health risks, addictive behaviours, victimization, economic and interpersonal life events, dissatisfaction, and stress. Also, those with significant symptomatology frequently needed mental health care services but often did not know where to access them.

Conclusions:

The prevalence of mental health and substance abuse problems within homeless populations is significant and associated with considerable hardship as well as personal and public health risks.
Attachment Disorganization and Dissociative Symptoms in Clinically Treated Adolescents
Authors: West Malcolm , Adam Kenneth , Spreng Sheila , Rose Sarah
Published: January 2017

Objective:

To examine the association of unresolved and unclassifiable attachment with dissociative symptomotology in a sample of 133 adolescents in psychiatric treatment.

Method:

The study compared 69 adolescents who were unresolved and unclassifiable with 64 adolescents who were not unresolved and unclassifiable. Attachment organization was assessed using the Adult Attachment Interview (AAI). Dissociative symptomotology was assessed using a scale derived from the Youth Self Report (YSR) behaviour checklist.

Results:

A continuing unresolved and unclassifiable response to attachment-related trauma was correlated with dissociative symptomotology for both male and female adolescents.

Conclusions:

Cognitive disorganization may be an important variable mediating between the effects of earlier traumatic caregiving experiences and later dissociative symptoms.
More Than the Epidemiology of Alzheimer's Disease: Contributions of the Canadian Study of Health and Aging
Authors: Lindsay Joan , Sykes Elizabeth , McDowell Ian , Verreault René , Laurin Danielle
Published: January 2017

Objective:

To highlight contributions to knowledge made by the Canadian Study of Health and Aging (CSHA).

Method:

The CSHA began in 1991, with follow-ups in 1996 and 2001. It was national in scope, with 18 study centres and a coordinating centre. It included 10 263 participants; of these, 9008 were in the community, and 1255 were in institutions. In each phase, community participants were screened for cognitive impairment, and where appropriate, cognitive status was determined by a detailed clinical examination. Data on possible risk factors for dementia were collected at baseline. Data on caring for people with dementia were collected in each phase.

Results:

The prevalence of dementia was established at 8% of those aged 65 years and over; incidence (new cases each year) was about 2%. Cognitive impairment not dementia (CIND) was more than twice as common as dementia. Factors affecting the risk of institutionalization, mortality, and the health of caregivers were examined. The costs of dementia were conservatively estimated at $3.9 billion in 1991. Risk factors for Alzheimer's disease (AD) and vascular dementia are presented; it is noteworthy that physical activity appeared to protect against all forms of cognitive decline, particularly for women. Clinical contributions include the development of norms for several neuropsychological tests. Other topics include the health of those with CIND, predicting dementia, medication use, frailty and healthy aging, and urinary incontinence.

Conclusion:

The CSHA has contributed substantially to knowledge of the epidemiology of dementia, including AD, and to many other topics relevant to seniors' health.
Alzheimer's Disease, Genes, and Environment: The Value of International Studies
Authors: Hendrie Hugh C , Hall Kathleen S , Ogunniyi Adesola , Gao Sujuan
Published: January 2017

Objective:

To describe the construction of a disease model incorporating both genetic and environmental factors in the etiology of Alzheimer's disease (AD), using data generated from the Indianapolis–Ibadan dementia project (I-IDP).

Method:

The I-IDP is a longitudinal comparative study of the prevalence and incidence of dementia in 2 communities: elderly African Americans living in Indianapolis, Indiana, and Yoruba living in Ibadan, Nigeria.

Results:

African Americans are more than twice as likely as Yoruba to develop AD. Possible explanations for this finding include genetic factors: the possession of the apolipoprotein E ɛ4 allele does not increase risk for AD among Yoruba but confers a slight increase in AD risk for African Americans. As well, environmental factors may play a role: African Americans have a higher risk of vascular risk factors than do Yoruba.

Conclusions:

International comparative studies, particularly those involving populations from developing and developed countries, offer a unique opportunity for applying new information regarding population genetics to traditional AD risk factor research.
The Course of Depressive Illness in General Practice
Authors: Limosin Frédéric , Loze Jean-Yves , Zylberman-Bouhassira Myriam , Schmidt Mark E , Perrin Eléna , Rouillon Frédéric
Published: January 2017

Objective:

Depression is reported to be common in primary care settings and to have a high likelihood of relapse during the 4- to 6-month period following initial symptomatic improvement. However, most prospective studies of long-term treatment of depression have been conducted with patients selected for participation in placebo-controlled drug protocols or psychiatric clinics associated with tertiary referral centres.

Method:

We examined the treatment course and outcome of outpatients with major depressive episode treated in a primary care setting. The general practitioners were free to choose the treatment and its duration. Their only obligation was to assess the therapeutic outcome in terms of efficacy and safety and to perform a final evaluation at the end of the 6-month observation period or, if the patient was treated for a shorter period, at the end of the treatment.

Results:

Of the 476 patients involved, 308 (64.7%) responded to treatment and remained well, 117 (24.6%) showed no response, and 51 (10.7%) had an early relapse after initial improvement. Among the studied demographic, clinical, and therapeutic factors, the history of recurrent depression was the only variable with a significant effect size in predicting the course of the illness.

Conclusion:

Patients with recurrent depression were at higher risk of relapse or nonresponse.
Non-Alzheimer's Disease Dementias: Anatomic, Clinical, and Molecular Correlates
Authors: Hou Craig E , Carlin Danielle , Miller Bruce L
Published: January 2017

Objective:

To review the clinical and molecular features of non-Alzheimer's disease (non-AD) dementias, focusing on disorders associated with tau pathology (that is, frontotemporal lobar degeneration [FTLD], corticobasal ganglionic degeneration [CBD], and progressive supranuclear palsy [PSP]) or on disorders with synuclein pathology (that is, dementia with Lewy bodies [DLB] and multisystem atrophy [MSA]). We also discuss the pharmacologic treatment of these disorders.

Methods:

We report a selective review of the literature on FTLD, CBD, PSP, DLB, and MSA.

Results:

The non-AD dementias can present with a wide variety of cognitive and behavioural symptoms. Through common clinical features and shared molecular etiologies, neurodegenerative disorders previously thought to be distinct are now classified into tauopathies and synucleinopathies.

Conclusions:

The unique cognitive and behavioural manifestations of the non-AD dementias can be mistaken for psychiatric disorders. Improved detection of tauopathies and synucleinopathies and their differentiation from AD is possible.
Psychotropic Medication Use in Canada
Authors: Beck Cynthia A , Williams Jeanne VA , Wang Jian Li , Kassam Aliya , El-Guebaly Nady , Currie Shawn R , Maxwell Colleen J , Patten Scott B
Published: January 2017

Background:

Psychotropic medication use can be employed as an indicator of appropriate treatment for mental disorders. The Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) offers the first opportunity to characterize Canadian psychotropic medication use on a national level within diagnostic groups as assessed by a full version of the Composite International Diagnostic Interview (CIDI).

Method:

We assessed the prevalence of antidepressant, sedative-hypnotic, mood stabilizer, psychostimulant, and antipsychotic use over 2 days overall and in subgroups defined by CIDI-diagnosed disorders and demographics. We employed sampling weights and bootstrap methods.

Results:

Overall psychotropic drug utilization was 7.2%. Utilization was higher for women and with increasing age. With any lifetime CIDI-diagnosed disorder assessed in the CCHS 1.2, utilization was 19.3%, whereas without such disorders, it was 4.1%. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants for those with a past-year major depressive episode (17.8%), followed by venlafaxine (7.4%). Among people aged 15 to 19 years, antidepressant use was 1.8% overall and 11.7% among those with past-year depression; SSRIs made up the majority of use. Sedative-hypnotics were used by 3.1% overall, increasing with age to 11.1% over 75 years.

Conclusions:

International comparison is difficult because of different evaluation methods, but antidepressant use may be higher and antipsychotic use lower in Canada than in recent European and American reports. In light of the relative lack of contemporary evidence for antidepressant efficacy in adolescents, it is likely that antidepressant use among those aged 15 to 19 years will continue to decline. The increased use of sedative-hypnotics with age is of concern, given the associated risk of adverse effects among seniors.
Determinants of Service Use among Young Canadians with Mental Disorders
Authors: Bergeron Emilie , Poirier Léo-Roch , Fournier Louise , Roberge Pasquale , Barrette Geneviève
Published: January 2017

Objective:

To identify the determinants of service use by young Canadians with mental health problems.

Methods:

Data were drawn from a recent large Canadian mental health survey. The analyses were conducted on a subsample of 1092 Canadians aged 15 to 24 years and identified as presenting a mood disorder, an anxiety disorder, or a substance-related disorder in the 12 months preceding the survey. We classified variables potentially associated with any type of service use for a mental health problem over a 12-month period according to predisposing, enabling, and need factors. We conducted weighted multivariate logistic regressions to determine the association of each factor with service use.

Results:

In the final model, being female and living alone were the predisposing factors associated with service use. None of the enabling factors predicted help seeking. In regard to the perceived need factors, those who had difficulties with social situations were more likely to use services. Having a mood disorder and (or) having a diagnosed chronic illness were the evaluated need factors associated with service use.

Conclusion:

Certain groups of young Canadians are less likely to seek help for mental health problems and could be the target of interventions aimed at increasing service use.
Help-Seeking Behaviours of Individuals with Mood Disorders
Authors: Wang JianLi , Patten Scott B , Williams Jeanne VA , Currie Shawn , Beck Cynthia A , Maxwell Colleen J , El-Guebaly Nady
Published: January 2017

Objectives:

This study had the following objectives: 1) to estimate the 12-month prevalence of conventional and unconventional mental health service use by individuals with major depressive disorder (MDD) or mania in the past year, and 2) to identify factors associated with the use of conventional mental health services by individuals with MDD or mania in the past year.

Methods:

We examined data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Respondents with MDD ( n = 1563) or manic episodes ( n = 393) in the past 12 months were included in this analysis.

Results:

An estimated 63.9% of respondents with MDD and 59.0% of those with manic episodes reported having used some type of help in the past 12 months; 52.9% of those with MDD and 49.0% of those with manic episodes used conventional mental health services. Approximately 21% of respondents with either MDD or manic episodes used natural health products specifically for emotional, mental health, and drug or alcohol use problems. Respondents who reported comorbid anxiety disorders and long-term medical conditions were more likely to have used conventional mental health services.

Conclusions:

Relative to previous Canadian literature, our analysis suggests that the frequency of conventional mental health service use among persons with MDD has not increased significantly in the past decade. Further, the rate of conventional mental health service use by persons with manic episodes is unexpectedly low. These findings may reflect the lack of national initiatives targeting mood disorders in Canada. They have important implications for planning future education, promotion, and research efforts.
The Psychological Treatment of Obsessive—Compulsive Disorder
Authors: Abramowitz Jonathan S
Published: January 2017

The psychological treatment of obsessive–compulsive disorder (OCD) with exposure and response prevention (ERP) methods is one of the great success stories within the field of mental health. Within the span of about 20 years, the prognosis for individuals with OCD has changed from poor to very good as a result of the development of ERP. This success not withstanding, the procedures are far from perfect because a substantial minority of patients still either refuse treatment, drop out prematurely, or fail to benefit. I begin this article with a review of the development of ERP from early animal research on avoidance learning conducted during the 1950s. Next, I discuss the mechanisms of ERP. The bulk of the article reviews the treatment-outcome literature on ERP for OCD and includes comparisons with cognitive therapy—the “new kid on the block” with respect to psychological treatments for OCD.
Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy Study of Deficits in Hippocampal Structure in Fire Victims with Recent-Onset Posttraumatic Stress Disorder
Authors: Li Lingjiang , Chen Shulin , Liu Jun , Zhang Jinli , He Zhong , Lin Xu
Published: January 2017

Objective:

To explore hippocampal structural abnormalities in fire victims with recent-onset posttraumatic stress disorder (PTSD).

Method:

We compared 12 patients with recent-onset PTSD diagnosed according to DSM-IV criteria 6 to 8 months after a major fire with 12 individuals without PTSD who were victims of the same fire accident. Voxel-based morphometry (VBM) and magnetic resonance spectroscopy (MRS) were combined to examine hippocampal structural abnormalities in patients with recent-onset PTSD.

Results:

Results of VBM showed that the grey matter density of the left hippocampus was lower in the group with PTSD than it was in the group without PTSD. Results of MRS showed that the ratio of N-acetyl asparate and creatine in the left hippocampus was significantly lower in patients with PTSD than in control subjects.

Conclusion:

Patients with recent-onset PTSD had hippocampal structural abnormalities.
Psychiatrists' Documentation of Informed Consent: A Representative Survey
Authors: Schachter Debbie , Kleinman Irwin
Published: January 2017

Objective:

To review psychiatrists' documentation of informed consent and present data on Canadian psychiatrists' attitudes and practices regarding documentation of the informed consent process.

Method:

We surveyed a stratified random sample of psychiatrists practising in Ontario, using a mailed self-report questionnaire.

Results:

The response rate was 72%. Among respondents, 63% routinely documented the consent process, with younger respondents reporting more documentation than older ones. Although most respondents (77%) favoured recording the consent process, only 11% felt signed consent forms were necessary.

Conclusion:

There are differences in the self-reported documentation behaviour of younger and older psychiatrists. Psychiatrists should document the consent process in the clinical record.
Combined Treatment of Major Depression in Patients with Borderline Personality Disorder: A Comparison with Pharmacotherapy
Authors: Bellino Silvio , Zizza Monica , Rinaldi Camilla , Bogetto Filippo
Published: January 2017

Objective:

Combined treatment with psychotherapy and antidepressants is more effective than monotherapies. Recent data show that combined therapy has better results in patients with depression and Axis II codiagnosis. The aim of this study was to compare combined treatment using interpersonal psychotherapy (IPT) with pharmacotherapy alone in patients with depression and borderline personality disorder (BPD).

Methods:

There were 39 consecutive outpatients diagnosed with BPD who presented with a major depressive episode enrolled in this study. They were randomly assigned to 1 of 2 treatment groups: fluoxetine 20 mg to 40 mg daily or fluoxetine 20 mg to 40 mg daily plus IPT 1 session weekly. Owing to noncompliance, 7 patients dropped out. We assessed the 32 patients who completed the 24 weeks of treatment at baseline, Week 12, and Week 24, using a semistructured interview for clinical characteristics, the Clinical Global Impression Scale (CGI), the Hamilton Depression Rating Scale (HDRS), and the Hamilton Anxiety Rating Scale (HARS), and 2 self-report questionnaires, that is, the Satisfaction Profile (SAT-P) for quality of life and the 64-item Inventory for Interpersonal Problems (IIP-64). We performed statistical analysis, using univariate general linear models with 2 factors: duration and type of treatment.

Results:

Changes in remission rates, CGI, and HARS score did not differ between treatments. According to changes in the HDRS scores; changes in psychological functioning and social functioning scores on the SAT-P; and changes in vindictive or self-centred, cold or distant, intrusive or needy, and socially inhibited scores on the IIP-64, combined therapy was superior to fluoxetine alone.

Conclusions:

Combined therapy with IPT is more effective than antidepressant therapy alone, both in treating symptoms of major depression and in improving dimensions of quality of life and interpersonal functioning.
Genetics and Alcoholism: How Close are We to Potential Clinical Applications?
Authors: Quickfall Jeremy , el-Guebaly Nady
Published: January 2017

Rapid advancement of genetic knowledge has provided a wealth of data demonstrating a significant contribution of genes to the development of alcoholism but has suggested little in the way of clinical applicability. Twin and adoption studies suggest that 50% to 60% of the development of alcoholism is due to heritable factors, and linkage and association studies have identified chromosomal regions and individual genes that likely contribute to the development of this condition. Most of these genes are related to neurotransmitter systems and to alcohol metabolizing enzymes. We briefly review the evidence for this before discussing intermediate phenotypes of alcoholism under genetic control, pharmacogenetic aspects of alcoholism treatment, and the possibility of future clinical applications based on these areas.
Survey of Atypical Antipsychotic Prescribing by Canadian Child Psychiatrists and Developmental Pediatricians for Patients Aged under 18 Years
Authors: Doey Tamison , Handelman Kenneth , Seabrook Jamie A , Steele Margaret
Published: January 2017

Objective:

To describe self-reported patterns of prescribing atypical antipsychotics (ATAs) and monitoring practices of child psychiatrists and developmental pediatricians in Canada.

Method:

We surveyed members of the Canadian Academy of Child and Adolescent Psychiatry and members of the Developmental Paediatrics Section of the Canadian Paediatric Society regarding the types and frequencies of ATAs they prescribed, the ages and diagnoses of patients for whom they prescribed these medications, and the types and frequencies of monitoring used.

Results:

Ninety-four percent of the child psychiatrists (95%CI, 90% to 97%) and 89% of the developmental pediatricians (95%CI, 75% to 96%) prescribed ATAs, most commonly risperidone (69%). Diagnoses included psychotic, mood, anxiety, externalizing, and pervasive developmental disorders. Prescribing for symptoms such as aggression, low frustration tolerance, and affect dysregulation was also common. Twelve percent of all prescriptions were for children under age 9 years. Most clinicians monitored patients, but there were wide variations in the type and frequency of tests performed.

Conclusions:

Despite the lack of formal indications, ATAs were prescribed by this group of clinicians for many off-label indications in youth under age 18 years, including very young children. Neither evidence-based guidelines nor a consensus on monitoring exist for this age group.
A Shortcut to Rejection: How Not to Write the Results Section of a Paper
Authors: Streiner David L
Published: January 2017

This article discusses common errors in writing up the results of papers. It covers the following: 1) giving details about irrelevant topics, such as what program was used to enter the data, while ignoring important ones (for example, which options were chosen for various statistical tests); 2) reporting P levels of 0.0000 and negative values for t tests; 3) giving the P levels but not the actual values of the statistical tests; 4) not including confidence intervals and measures of the magnitude of an effect; 5) testing irrelevant hypotheses, such as whether reliability or validity coefficients are significantly different from zero; 6) attributing reliability and validity to tests rather than to the circumstances under which they are given; and 7) reporting levels of accuracy that cannot be supported by the data. Suggestions are made regarding the proper way to report findings.
Gender Differences in Risk Factors for Suicide: Findings from a Swedish National Cohort Study
Authors: von Borczyskowski Annika , Lindblad Frank , Vinnerljung Bo , Hjern Anders
Published: January 2017

Objective:

To investigate whether childhood sociodemographic factors and parental psychopathology affect suicide risk differently in men and women.

Method:

Cox regressions were used to calculate interaction effects of gender for childhood and parental risk factors for 8815 suicides (27% women) in a national cohort of 2.47 million people born between 1946 and 1968.

Results:

Low parental socioeconomic status increased suicide risk only for men, hazard ratio (HR) = 1.22 ( P = 0.003 for gender interaction), while living in a metropolitan area increased the risk only for women, HR = 1.42 ( P < 0.001 for gender interaction). Parental psychotic or affective disorder increased suicide risk more strongly for women (HR = 2.08), than for men (HR = 1.52) ( P = 0.004 for gender interaction).

Conclusion:

Growing up in an urban environment and parental psychotic or affective disorder are significant gender-related risk factors for suicide, both conveying higher risks in women. The mechanisms linking childhood urbanicity to increased risk of suicide in adult women stand out as an important research area for the future.
Do the Health of the Nation Outcome Scales Measure Outcome?
Authors: Kisely Stephen , Campbell Leslie Anne , Cartwright Jennifer , Cox Martha , Campbell John
Published: January 2017

Objective:

Among mental health outcome measures that have been developed for routine use, most of the information concerns the Health of the Nation Outcome Scales (HoNOS). This instrument is widely used in Europe, Australia, and New Zealand, but not in Canada. We tested its sensitivity and predictive validity under conditions that would resemble, as closely as possible, routine use.

Method:

Treating clinicians were asked to assess patients of all ages referred to outpatient mental health facilities of 2 district health authorities in Nova Scotia using either the HoNOS for adults or the HoNOS for Children and Adolescents (HoNOSCA). Data were entered using the existing routine administrative data system.

Results:

We obtained at least 1 rating on 4620 patients, giving a completion rate of 82%. On follow-up, ratings for the global score and most of the individual items were sensitive to change ( n = 808). After adjusting for confounders, a baseline HoNOS score was significantly associated with subsequent in and outpatient service use including admissions, bed days, and psychiatric contacts ( n = 1359).

Conclusions:

HoNOS has satisfactory sensitivity and predictive validity for routine use. We could introduce the adult version and HoNOSCA simultaneously and collect data using routine databases. Given the widespread routine use of HoNOS internationally, using the same outcome measure in Canada would enable comparisons of illness severity and outcomes between jurisdictions.