bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevation of plasma interleukin-18 concentration is associated with insulin levels in patients with systemic lupus erythematosus
Authors: Tso T K , Huang W-N , Huang H-Y , Chang C-K
Published: April 2006

We previously reported that systemic lupus erythematosus (SLE) patients have a higher risk of insulin resistance and abnormal insulin secretion. Recent studies demonstrated that interleukin (IL)-18, a novel pro-inflammatory cytokine, may be involved in triggering the inflammatory processes in SLE and the concentrations of circulating IL-18 in SLE patients were significantly higher than those in healthy subjects. IL-12 has a synergistic effect with IL-18, and both cytokines are inducers of interferon γ. The objective of this study was to identify the effect of fasting insulin levels on circulating concentrations of IL-18, IL-12 and IFN-γ in patients with SLE. Plasma levels of proinflammatory Th-1 cytokines were determined by enzyme-linked immunosorbent assay in a total of 70 female SLE patients and 34 age-matched healthy females. Insulin resistance (IR) and secretion were evaluated by homeostasis model assessment (HOMA). All patients were further classified into subgroups based on the quartiles of fasting insulin levels. SLE patients with fasting insulin levels in the top quartile compared with other quartiles had significantly higher plasma levels of IL-18. The presence of insulin auto-antibodies (IAA) in SLE patients had no influence on plasma levels of IL-18. In addition, fasting insulin levels and HOMA IR were positively correlated with IL-18 in all SLE patients, respectively. In conclusion, elevated circulating IL-18 concentrations corresponded with increases in fasting insulin levels and the status of insulin resistance in patients with SLE.
A case of minimal-change nephrotic syndrome in pediatric lupus erythematosus: just a coincidence?
Authors: Wang Y-T , Chou H-H , Chen F-F , Chen M-J , Chiou Y-Y
Published: April 2006

A 14-year old girl with lupus erythematosus (LE) who initially showed as discoid lupus and followed with nephrotic syndrome one year later. Concomitant piroxicam and indomethacin were prescribed for her arthritis, which preceded two months before the onset of nephrotic syndrome. Histology from renal biopsy showed minimal-change nephrotic syndrome (MCNS). After continuous treatment for six months, nephrotic syndrome resolved completely and no signs of relapse were noted over 14 years of follow-up. For the children, it is rare to have both LE and MCNS simultaneously; sequela of nonsteroidal anti-inflammatory drugs also seldom results in nephrotic syndrome. Though their relationship is still not defined, the possibility of LE combined with MCNS must be differentiated in patients with lupus and severe proteinuria.
Infections in infancy and the presence of antinuclear antibodies in adult life
Authors: Edwards C J , Syddall H , Goswami R , Goswami P , Dennison E M , Cooper C
Published: April 2006

There has been limited success defining environmental factors important to the development of connective tissue diseases such as systemic lupus erythematosus (SLE). Recent work has suggested that the perinatal environment may be important. To investigate this we measured antinuclear antibodies (ANA) in a general population with well-defined early lives to see whether fetal and infant growth and infections were associated with ANA positivity in adult life. Included in our investigation were 1334 individuals (668 men, 666 women) from the Hertfordshire cohort study. ANA was measured using an ANA ELISA and confirmed using immunofluorescence. We investigated associations between the presence of ANA and early growth and infectious exposure in infancy in men and women combined, but with adjustment for gender throughout. A positive ANA was present in 73 (10.9%) of men and 81 (12.2%) women. Of these, 26 women and 14 men were positive using IF on HEP2 cells. Sharing a bedroom during childhood was associated with a higher risk of being ANA positive (odds ratio (OR), 1.42, 95% confidence interval (CI) 1.00-2.01, P = 0.05). A record of diarrhoeal illness (OR 2.12 95% CI 1.07, 4.23, P = 0.03) and rubella or mumps during the first year of life (OR 16.12, 95% CI 2.92, 88.94, P = 0.001) was also significantly associated with ANA in adult life. Higher ANA titres by Inova ELISA were associated with infections in the first year of life from mumps (2.74-fold higher, 95% CI 0.98, 7.64, P = 0.05) and rubella (3.90-fold higher, 95% CI 1.89, 8.04, P < 0.001). In addition, higher ANA titres were also associated with mumps (1.26-fold higher, 95% CI 1.02, 1.56, P = 0.03) between one and five years of age. Our results suggest that a developing immune system exposed to increased infection is more likely to produce ANA in adult life and perhaps begin the pathological process that leads to SLE.
Valine/Leucine247 polymorphism of β2-glycoprotein I in patients with antiphospholipid syndrome: lack of association with anti-β2-glycoprotein I antibodies
Authors: Swadzba J , Sanak M , Iwaniec T , Dziedzina S , Musiał J
Published: April 2006

In antiphospholipid syndrome (APS) the presence of anti-β2-glycoprotein I (β2GPI) antibodies is strongly associated with thromboembolic complications. It has been suggested that the common β2GPI Valine/Leucine247 (Val/Leu247)polymorphism could be found more commonly in APS and might influence the generation of anti-β2GPI antibodies. Therefore we studied β2GPI Val/Leu247single-nucleotide polymorphism (SNP) by PCR in 338 patients with various autoimmune diseases (46 with secondary and 84 with primary APS) and 147 sex and age-matched healthy controls. In all patients lupus anticoagulant, anticardiolipin and anti-β2GPI antibodies (both IgG and IgM) were also determined. All patients and controls were Caucasians. Frequencies of the SNP genotypes in patients did not depart from genetic equilibrum and did not differ from those found in controls. There was also no association between the presence of β2GPI Val/Leu247genotypes and the presence or absence of lupus anticoagulant, anticardiolipin antibodies, anti-β2GPI antibodies or clinical APS symptoms in all patients studied. In conclusion, among the exclusively Caucasian, Polish population of autoimmune patients β2GPI Val/Leu247SNP has the same distribution as in healthy subjects and does not influence the production of anti-β2GPI antibodies.
High risk of tuberculosis in systemic lupus erythematosus?
Authors: Erdozain J-G , Ruiz-Irastorza G , Egurbide M-V , Martinez-Berriotxoa A , Aguirre C
Published: April 2006

The incidence and severity of tuberculosis (TB) in patients with systemic lupus erythematosus (SLE) varies greatly among different series. In addition, prospective data are scarce. The aim of this study is to analyse the frequency and severity of TB in our cohort of lupus patients. We analysed data from a prospective database of a single center cohort of 232 patients with SLE (ACR criteria). Prophylaxis with isoniazid was not regularly administered. We identified all cases of TB diagnosed during 10 years (January 1994 to December 2003). The following variables were analysed: annual incidence of TB, location of infection and response to therapy. Data from published series reporting on the incidence of TB among SLE patients were extracted.

Three patients (1.3%) suffered clinically manifest TB in 1603 patient-years of follow-up, resulting in an incidence of 187 cases/100 000 patient-years (95% CI 39-547). The pooled annual incidence of TB infection in our area during this period was 30/100 000 individuals. We recorded two cases of pulmonary TB and one case of tuberculous pleurisy. All patients had good response to therapy. The annual incidence of TB among SLE patients in other series, most of them from developing countries, varied between 150/100 000 patients in Turkey and 2450/100 000 patients in India. Of note, high prevalence of extrapulmonary forms as well as elevated TB-associated mortality was reported in most series.

TB was more frequent in SLE patients than expected in the general population. We did not see any cases of disseminated infection and all patients had good response to treatment. Our data compare favourably in terms of incidence, severity and outcome with those from highly endemic areas.
Disease outcomes and ovarian function of childhood-onset systemic lupus erythematosus
Authors: Brunner H I , Bishnoi A , Barron A C , Houk L J , Ware A , Farhey Y , Mongey A B , Strife C F , Graham T B , Passo M H
Published: April 2006

The objective of this study was to determine the medical outcomes including the ovarian function childhood-onset SLE (cSLE). The medical records of all patients diagnosed with cSLE in the Greater Cincinnati area between 1981 and 2002 were reviewed. Patient interviews were performed to obtain additional information on current medication regimens, disease activity [SLE Disease Activity Index (SLEDAI-2k)], and damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)]. The occurence of premature ovarian failure (POF) and reduction of the ovarian reserve was assessed by timed gonadotropin levels. There were 77 patients (F: M = 70: 7, 53% Caucasian, 45% African-American and 2% Asian) with a mean age at diagnosis of 14.6 years. Nine patients died (88.3% survival) during the mean follow-up of 7.1 years (standard deviation [SD] 5.6) and 88% of the patients continued to have active disease (SLEDAI-2k mean/SD: 6.6/6.7), with 42% of them having disease damage (SDI mean/SD: 1.62/2.1); Non-Caucasian patients had higher disease activity (mean SLEDAI-2k: 10 versus 3.4; P < 0.0001) and more disease damage (mean SDI: 2.1 versus 1.2; P < 0.02) than Caucasian patients. Cyclophosphamide was given to 47% of the patients during the course of their disease and associated with the presence of significantly reduced ovarian reserve (RR = 2.8; 95% CI: 1.7-4.8; P = 0.026). Patient mortality and disease damage with cSLE continue to be high. Although overt POF with cyclophosphamide exposure is rare, it is a risk factor for significantly decreased ovarian reserve cSLE.
Treatment of isolated severe immune hemolytic anaemia associated with systemic lupus erythematosus: 26 cases
Authors: Gomard-Mennesson E , Ruivard M , Koenig M , Woods A , Magy N , Ninet J , Rousset H , Salles G , Broussolle C , Sève P
Published: April 2006

The aim of this study was to evaluate the response to treatment and the long-term outcome in a cohort of patients in whom severe autoimmune hemolytic anaemia (AHA) was the leading manifestation of systemic lupus erythematosus (SLE). Twenty-six women with severe isolated AHA were included. Corticosteroids were used as the initial treatment for all patients in our study. An initial response was obtained in all but one patient (96%). The overall recurrence rate was three per 100 person-years, with an expected recurrence-free proportion of 73% with a 180 months median follow-up. Seven patients (27%) experienced a relapse of AHA. We found a higher proportion of pleuritis in relapsing patients. Only three patients experienced multiple relapses despite splenectomy and several immunosuppressants. Steroid-sparing effect of hydroxychloroquine and azathioprine could not be assessed because most of the patients received these treatments for other reasons than AHA. Intravenous immunoglobulins induced transient response in three cases. Splenectomy was efficient to definitively control AHA in one patient but two patients quickly experienced relapses while one patient did not benefit. Five patients received immunosuppressants that induced only transient responses. Rituximab was long-term efficient in one case. In conclusion, severe AHA is a serious complication of SLE that warrants appropriate management. On the basis of our experience, the ideal treatment of isolated AHA should be oral corticosteroids in first-line treatment. Our study does not support an important role for splenectomy. Patients refractory to conventional therapy should be treated either with few toxic immunosuppressive drugs, danazol or rituximab.
ICF Core Sets: how to specify impairment and function in systemic lupus erythematosus
Authors: Aringer M , Stamm T A , Pisetsky D S , Yarboro C H , Cieza A , Smolen J S , Stucki G
Published: April 2006

The World Health Organization’s International Classification of Function (ICF) is a tool to characterize and illuminate better the full of array of problems a patient faces when affected by disease. Specifying these problems is a particular challenge in a disease like systemic lupus erythematosus (SLE) because of the wide variety in organ systems involved, its variable activity and severity, and considerable ethnic and local differences. The authors of this manuscript believe, however, that a broader understanding will prove essential for optimal patient care, and that there is sufficient experience now in defining ICF Core Sets to successfully complete core sets for SLE. Therefore, we will embark on an international project for developing ICF Core Sets for SLE, which we here delineate. This development will include two versions: 1) The Brief ICF Core Set for SLE will be a very focused list of categories essential for SLE clinical trials; and 2) The Comprehensive ICF Core Set will be much broader and useful for guiding multidisciplinary assessment in patients with SLE. Both Core Sets will be developed in a formal decision-making and consensus process of health professionals integrating evidence gathered from preliminary studies. The final definition of the Core Sets will occur at a consensus conference which will integrate: i) a systematic review of the literature regarding the outcome measures used in clinical trials and selected observational studies; ii) focus groups or semi-structured interviews with SLE patients; iii) a Delphi exercise with world wide involvement of experts; and iv) the evidence from empirical studies. The development of these SLE ICF Core Sets is designed to be an inclusive, open, worldwide process. We therefore invite both SLE clinical experts and SLE patients to participate actively.
Cognitive impairment in patients with multiple sclerosis using the Brief Repeatable Battery-Neuropsychology test
Authors: Sepulcre J , Vanotti S , Hernández R , Sandoval G , Cáceres F , Garcea O , Villoslada P
Published: April 2006

Aims To assess the cognitive impairment of multiple sclerosis (MS) patients using the Brief Repeatable Battery-Neuropsychology (BRB-N) test.

Methods The performance of 59 patients with MS in the BRB-N test was assessed and compared with 152 matched healthy controls (HC).

Results In most tests, MS patients performed worse than controls. Age and educational level strongly influenced the performance of the subjects. The Symbol Digit Modality Test (SDMT) best correlated with the other individual tests and contributed most to the general BRB-N factor. Furthermore, a correlation between physical disability and performance in some BRB-N tests was observed. Indeed, patients with progressive MS and greater physical disability performed worse in some tests than less disabled patients with relapsing MS. By creating a global BRB-N Z score, we found that patients generally performed 0.7 standard deviation (SD) below the level of controls. We obtained cut-off values stratified by age and education to determinate cognitive impairment in MS patients.

Conclusions Our data show that cognitive impairment is prevalent amongst MS patients, and that a single cognitive measurement might be useful for monitoring patients during the progression of this illness.
Differential effects of Th1, monocyte/macrophage and Th2 cytokine mixtures on early gene expression for immune-related molecules by central nervous system mixed glial cell cultures
Authors: Lisak R P , Benjamins J A , Bealmear B , Yao B , Land S , Nedelkoska L , Skundric D
Published: April 2006

Cytokines secreted within the central nervous system (CNS) are important in the development of multiple sclerosis (MS) lesions. The balance between Th1, monocyte/macrophage (M/M) and Th2 cytokines in the CNS may be pivotal in determining the outcome of lesion development. We examined the effects of mixtures of cytokines on gene expression by CNS glial cells, as mixtures of cytokines are present in MS lesions, which in turn contain mixtures of glial cells. In this initial analysis by gene array, we examined changes at 6 hours to identify early changes in gene expression that represent primary responses to the cytokines. Rat glial cells were incubated with mixtures of Th1, M/M and Th2 cytokines for 6 hours and examined for changes in early gene expression employing microarray gene chip technology. A minimum of 814 genes were differentially regulated by one or more of the cytokine mixtures in comparison to controls, including changes in expression in a large number of genes for immune system-related proteins. Expression of the proteins for these genes likely influences development and inhibition of MS lesions as well as protective and regenerative processes. Analysing gene expression for the effects of various combinations of exogenous cytokines on glial cells in the absence of the confounding effects of inflammatory cells themselves should increase our understanding of cytokine-induced pathways in the CNS.
Treatment of depression for patients with multiple sclerosis in neurology clinics
Authors: Mohr D C , Hart S L , Fonareva I , Tasch E S
Published: April 2006

The objective of this study was to examine the adequacy of antidepressant pharmacotherapy in a sample of patients with multiple sclerosis (MS) treated by neurologists.

Methods MS patients under the care of neurologists were recruited from a large health maintenance organization. Major depressive disorder (MDD) was diagnosed using a structured telephone interview. Antidepressant treatment data were obtained from the HMO pharmacy database.

Results Study participants included 260 patients with MS treated by 35 neurologists. A total of 67 (25.8%) patients met the criteria for MDD. Among the patients with MDD, 65.6% received no antidepressant medication, 4.7% received subthreshold doses from their neurologists, 26.6% received doses at threshold, and 3.1% received doses exceeding threshold.

Discussion Depression was undertreated by the neurologists treating this sample of patients with comorbid MS and MDD. Potential solutions are discussed.
The norepinephrine level is decreased in the lymphocytes of long-term interferon-beta-treated multiple sclerosis patients
Authors: Rajda C , Bencsik K , Füvesi J , Seres E , Vécsei L , Bergquist J
Published: April 2006

The mutual involvement of dopamine and its metabolites in the nervous and immune systems has the potential to provide information on the interaction of these two systems. During a 24-hour period, we used capillary electrophoresis with electrochemical detection to repeatedly measure the intracellular catecholamine concentrations in the peripheral blood lymphocytes of relapsing-remitting multiple sclerosis (RRMS) patients receiving interferon (IFN)-beta-1b ( n = 13), and those of IFN-naïve RRMS patients receiving their first IFN-beta-1a injection ( n = 19) during this study, and compared them with the levels in healthy controls ( n = 12). At baseline, the norepinephrine level was significantly decreased ( P = 0.003) in the long-term IFN MS patients compared with the controls. The Time × Group interactions for dopamine ( P= 0.5854) and norepinephrine ( P = 0.6192) were not significant. The group effects for the individual drugs were P = 0.3529 and 0.1282, respectively. The lower norepinephrine level at baseline in the long-term IFN MS group suggests an immunologically stable phase, in line with our previous findings. This is the first report of the effects of IFN-beta administration on intracellular catecholamines in MS patients. Further studies are necessary to elucidate the immune reactions affected by the catecholamines in MS and to evaluate the roles of these potential immunotransmitters.
Change in clinician-assessed measures of multiple sclerosis and subject-reported quality of life: results from the IMPACT study
Authors: Miller D M , Cohen J A , Kooijmans M , Tsao E , Cutter G , Baier M ,   IMPACT Investigators
Published: April 2006

Background The IMPACT study demonstrated the benefit of interferon beta-1a (IFNβ-1a, Avonex®) two-year change in disability measured by the Multiple Sclerosis Functional Composite (MSFC) in secondary progressive multiple sclerosis (SP-MS) and health-related quality of life (HRQoL) measured by the Multiple Sclerosis Quality of Life Inventory (MSQLI). The IMPACT data permit a detailed assessment of the relation between clinical and self-reported measures.

Methods IMPACT was an international randomized, double-blind, placebo-controlled trial of SP-MS patients. As the MSQLI is only in English, this report includes US and Canadian subjects. Subjects were randomized to weekly intramuscular (im) injections of INb-1a (60 mg) or placebo for 24 months.

Results At baseline and follow-up, MSQLI correlations were generally stronger with the EDSS than with the MSQLI, MSFC but comparable with MSFC components. Combining the two groups, MSQLI changes for those in the best and worst MSFC change quartiles demonstrated a statistical difference for six of the 11 MSQLI scales. Linear regression demonstrated that EDSS change from baseline to month-24 scores was correlated with change in two MSQLI components.

Conclusion These data support the appropriateness of using the MSQLI with individuals who have SP-MS.
Psychiatric drug promotion and the politics of neoliberalism
Authors: Moncrieff Joanna
Published: April 2006

The pharmaceutical industry has popularised the idea that many problems are caused by imbalances in brain chemicals. This message helps to further the aims of neoliberal economic and social policies by breeding feelings of inadequacy and anxiety. These feelings in turn drive increasing consumption, encourage people to accept more pressured working conditions and inhibit social and political responses.
Cognitive–behavioural therapy for severe and recurrent bipolar disorders
Authors: Scott Jan , Paykel Eugene , Morriss Richard , Bentall Richard , Kinderman Peter , Johnson Tony , Abbott Rosemary , Hayhurst Hazel
Published: April 2006

Background

Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders.

Aims

To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT).

Method

We undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months.

Results

More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes.

Conclusions

People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.
What can we conclude from studies on psychotherapy in bipolar disorder?
Authors: Lam Dominic
Published: April 2006

The study by Scott et al in this issue of the Journal is at odds with other published studies. Their design of a mixed group of relatively well or acutely ill bipolar patients who may or may not be on medication leads to difficulties in interpreting the results. Important clinical decisions should not be based on a post hoc analysis with a retrospective variable.
Cost-effectiveness of preventing depression in primary care patients
Authors: Smit Filip , Willemse Godelief , Koopmanschap Marc , Onrust Simone , Cuijpers Pim , Beekman Aartjan
Published: April 2006

Background

Little is known about the cost-effectiveness of preventing mental disorders.

Aims

To study the cost-effectiveness of care as usual plus minimal contact psychotherapy relative to usual care alone in preventing depressive disorder.

Method

An economic evaluation was conducted alongside a randomised clinical trial. Primary care patients with sub-threshold depression were assigned to minimal contact psychotherapy plus usual care (n=107) or to usual care alone (n=109).

Results

Primary care patients with sub-threshold depression benefited from minimal contact psychotherapy as it reduced the risk of developing a full-blown depressive disorder from 18% to 12%. In addition, this intervention had a 70% probability of being more cost-effective than usual care alone. A sensitivity analysis indicated the robustness of these results.

Conclusions

Over 1 year adjunctive minimal contact psychotherapy improved outcomes and generated lower costs. This intervention is therefore superior to usual care alone in terms of cost-effectiveness.
Cost-effectiveness and cost-utility of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine
Authors: Kendrick Tony , Peveler Robert , Longworth Louise , Baldwin David , Moore Michael , Chatwin Judy , Thornett Andrew , Goddard Jonathan , Campbell Michael , Smith Helen , Buxton Martin , Thompson Christopher
Published: April 2006

Background

The cost-effectiveness of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) has not been compared in a prospective study in primary care.

Aims

To determine the relative cost-effectiveness of TCAs, SSRIs and lofepramine in UK primary care.

Method

An open-label, three-arm randomised trial with a preference arm. Practitioners referred 327 patients with incident depression.

Results

No significant differences were found in effectiveness or cost-effectiveness. The numbers of depression-free weeks over 12 months (on the Hospital Anxiety and Depression Scale) were 25.3 (95% CI 21.3–29.0) for TCAs, 28.3 (95% CI 24.3–32.2) for SSRIs and 24.6 (95% CI 20.6–28.9) for lofepramine. Mean health service costs per patient were $762 (95% CI 553–1059) for TCAs, $875 (95% CI 675–1355) for SSRIs and $867 (95% CI 634–1521) for lofepramine. Cost-effectiveness acceptability curves suggested SSRIs were most cost-effective (with a probability of up to 0.6).

Conclusions

The findings support a policy of recommending SSRIs as first-choice antidepressants in primary care.
Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries
Authors: Reseland Svein , Bray Isabelle , Gunnell David
Published: April 2006

Background

The effect of recent increases in antidepressant prescribing on population suicide rates is uncertain.

Aims

To investigate the relationship between antidepressant sales and trends in suicide rates.

Method

Graphical and quantitative assessment of trends in suicide and antidepressant sales in Norway, Sweden, Denmark and Finland.

Results

Suicide rates declined in all four countries during the 1990s, whereas antidepressant sales increased by 3- to 4-fold. Decreasing suicide rates in Sweden and Denmark preceded the rise in anti-depressant sales by over 10 years, although the reductions accelerated between 1988 and 1990. In Norway, a modest but short-lived decline in suicide rates began around the time of the increase in antidepressant sales. In Finland, decreases in male suicide rates and to a lesser extent in female suicide rates began around the time of increased antidepressant sales. In all four countries decreases in suicide rates appeared to precede the widespread use of SSRIs.

Conclusions

We found mixed evidence that increases in antidepressant sales have coincided with a reduction in the number of suicides in Nordic countries.
Depressive symptoms in urban population samples in Russia, Poland and the Czech Republic
Authors: Bobak Martin , Pikhart Hynek , Pajak Andrzej , Kubinova Ruzena , Malyutina Sofia , Sebakova Helena , Topor-Madry Roman , Nikitin Yuri , Marmot Michael
Published: April 2006

Background

Relatively little is known about depression in countries that were formerly part of the Soviet Union, especially Russia.

Aims

To investigate the rates and distribution of depressive symptoms in urban population samples in Russia, Poland and the Czech Republic.

Method

A cross-sectional study was conducted in randomly selected men and women aged 45–64 years (n=2151 intotal, response rate 69%) in Novosibirsk (Russia), Krakow (Poland) and Karvina (Czech Republic). The point prevalence of depressive symptoms in the past week was defined as a score of at least 16 on the Center for Epidemiological Studies Depression scale.

Results

In men the prevalence of depressive symptoms was 23% in Russia, 21% in Poland and 19% in the Czech Republic; in women the rates were 44%, 40% and 34% respectively. Depressive symptoms were positively associated with material deprivation, being unmarried and binge drinking. The association between education and depression was inverse in Poland and the Czech Republic but positive in Russia.

Conclusions

The prevalence of depressive symptoms in these eastern European urban populations was relatively high; as in other countries, it was associated with alcohol and several sociodemographic factors.
Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder
Authors: Goswami Utpal , Sharma Aditya , Khastigir Udayan , Ferrier Ian Nicol , Young Allan H. , Gallagher Peter , Thompson Jill M. , Moore P. Brian
Published: April 2006

Background

Neurocognitive deficits exist in euthymic patients with bipolar disorder, but relationships between symptoms, psychosocial and neurological factors remain uncertain.

Aims

To measure neurocognitive function in bipolar disorder and explore links to sub-syndromal mood symptoms, soft neurological signs and psychosocial impairment.

Method

Attention, memory and executive function were tested in 37 euthymic patients with bipolar disorder and 37 controls. Psychosocial functioning, soft neurological signs and residual mood symptoms were assessed.

Results

Performances on tests reflecting executive function and verbal memory (but not attention) were significantly poorer in the bipolar disorder group. Sub-syndromal mood symptoms produced small cognitive effects, predominantly on verbal memory. Soft neurological signs, especially frontal signs, were marked; some patients showed marked social disability which correlated strongly with soft neurological signs but weakly with executive dysfunction, which was linked to illness episodes.

Conclusions

Cognitive dysfunction, social dysfunction and soft signs occur in euthymic patients with bipolar disorder and may represent trait deficits.
Personality and substance use disorders in young adults
Authors: Moran Paul , Coffey Carolyn , Mann Anthony , Carlin John B. , Patton George C.
Published: April 2006

Background

There have been no studies of the co-occurrence of personality and substance use disorders in young community-dwelling adults.

Aims

To examine the association between DSM–IV personality disorders and substance use disorders in a large representative sample of young community-dwelling participants.

Method

Young Australian adults (n=1520, mean age=24.1 years) were interviewed to determine the prevalence of substance use disorders; 1145 also had an assessment for personality disorder.

Results

The prevalence of personality disorder was 18.6% (95% CI 16.5–20.7). Personality disorder was associated with indices of social disadvantage and the likely presence of common mental disorders. Independent associations were found between cluster B personality disorders and substance use disorders. There was little evidence for strong confounding or mediating effects of these associations.

Conclusions

In young adults, there are independent associations between cluster B personality disorders and substance use disorders.
Reforming forensic psychiatry and prison mental health in the former Soviet Union
Authors: van Voren Robert
Published: April 2006

Over the past 2 years the Global Initiative on Psychiatry has developed a wide range of initiatives in the fields of prison mental health and forensic psychiatry in Eastern Europe and the former Soviet Union. Both areas, until recently, were either ignored or deliberately avoided. This is not coincidental. The prison systems in the former Eastern bloc are in essence military organisations with a strict hierarchy and a rather tarnished past. Although some reform programmes in this field were implemented or started during the past decade (e.g. by Prison Reform International and the London Institute for Prison Studies), none of these projects has involved mental health services within the penitentiary system. A society that often limits itself to locking away those who have committed crimes or are suspected of having committed them, and pays only little attention to the physical and emotional well-being of those imprisoned, does not see the mental health of these persons as a priority. Equally unimportant seems to be the mental health of those who guard the prisoners and who are under constant stress.
Treatment for the initial acute phase of first-episode psychosis in a real-world setting
Authors: Wade Darryl , Harrigan Susy , Harris Meredith G. , Edwards Jane , McGorry Patrick D.
Published: April 2006

Aims and Method

The aim of the study was to examine treatment for the initial acute phase of first-episode psychosis at the Early Psychosis Prevention and Intervention Centre. Information regarding treatment was collected from file notes for all patients (n=112). For a subsample of patients (n=68), remission of positive psychotic symptoms was assessed using standardised ratings at 3-month follow-up.

Results

Treatment provided was largely in accordance with recommended treatment strategies. The majority (72%) of patients achieved rapid remission of positive symptoms.

Clinical Implications

Restrictive practices other than in-patient admission, such as in-patient seclusion, police transport or a community treatment order, can be minimised. The use of low-dose antipsychotic medication is an effective treatment strategy for the initial acute phase of first-episode psychosis.
Endoscopic Endonasal Approaches For Repair Of Cerebrospinal Fluid Leaks: Nine-Year Experience
Authors: Locatelli Davide , Rampa Federico , Acchiardi Ilaria , Bignami Maurizio , Bernardi Francesca De , Castelnuovo Paolo
Published: April 2006

Objective:

To describe surgical endoscopic experience in the repair of cerebrospinal fluid leaks treated by transnasal approaches.

Methods:

Different surgical approaches and techniques in the repair of cranial base defects are reviewed in a series of 135 patients.

Results:

Success rate at first attempt was 93.3%. Only 9 patients (6.7%) needed a second surgical repair, and in one patient, a coronal approach with frontal craniotomy was necessary. In the other eight cases, an endoscopic procedure was chosen. Two patients needed a third endonasal endoscopic surgical repair, with successful outcome.

Conclusion:

The target of endoscopic endonasal technique in the repair of cerebrospinal fluid leaks is to ensure a stable duraplasty with the least invasive approach avoiding craniotomy. A correct diagnosis surely allows the choice of the best treatment, surgical approach, graft, and technique. Our multidisciplinary approach to this pathology during these years has been essential to gain our challenging results.
Surgical Management Of Posterior Fossa Arteriovenous Malformations
Authors: Sinclair John , Kelly Michael E. , Steinberg Gary K.
Published: April 2006

Objective:

Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage.

Methods:

Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei.

Results:

Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality.

Conclusion:

Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.
Improved Technique for Harvesting the Accessory Nerve for Transfer in Brachial Plexus Injuries
Authors: Bertelli Jayme Augusto , Ghizoni Marcos Flavio
Published: April 2006

Objective:

The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle.

Methods:

Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus.

Results:

In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients.

Conclusion:

The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.
Use of Allogeneic Skin Graft for the Closure of Large Meningomyeloceles: Technical Case Report
Authors: Danish Shabbar F. , Samdani Amer F. , Storm Phillip B. , Sutton Leslie
Published: April 2006

Objective and Importance:

To describe an alternative approach to the operative management of large meningomyeloceles, in which primary closure is not possible.

Clinical Presentation:

Two full-term infants presented with very large menin-gomyeloceles for closure after an uncomplicated delivery.

Technique:

An allogeneic skin graft was used in both cases to approximate the skin defect that remained after removal of the large meningomyelocele sacs. The surgical site was treated with dressing changes only during the postoperative period.

Conclusion:

The independent use of allogeneic skin grafts can lead to a successful cosmetic result for the treatment of large meningomyeloceles without the use of complicated skin incisions or flap advancements.
Giant Eccrine Adenocarcinoma of the Scalp with Intracranial Invasion:Resection and Reconstruction Using a Vacuum-assisted Closure Device:Technical Case Report
Authors: Donovan Daniel J. , Person Donald A.
Published: April 2006

Objective and Importance:

Carcinoma of the adnexal structures of the skin is a rare malignancy, and is even more unusual in the scalp. We report an unusual case of scalp adnexal carcinoma of eccrine origin that went untreated for years, resulting in a giant tumor with extension through the cranium. The tumor resection and reconstruction of the cranium and scalp defects posed unique challenges.

Clinical Presentation:

A 54-year-old woman experienced a large recurrence of her scalp adnexal carcinoma after an incomplete wide local excision, which invaded through the cranium.

Intervention:

The entire vertex of the scalp and cranium were removed en bloc. After cranioplasty, a free vascularized muscle flap was used for soft tissue coverage, but failed owing to poor vascular inflow. A large area of dura was left open, using a vacuum-assisted wound closure device to generate granulation tissue by secondary intention. Another split thickness skin graft was used to provide a cosmetically acceptable outcome.

Conclusion:

Scalp adnexal tumors of eccrine origin rarely metastasize and can be resected for cure with complete removal. Reconstruction options for large scalp and cranial tumors may be limited, and allowing the dura to granulate by secondary intention has been very rarely described. The novel use of a vacuum-assisted wound closure device was a very useful adjunct in this situation, and may be beneficial in the reconstruction of other patients with large scalp and cranial defects after neurosurgical procedures. It should be used with caution, since it may risk injury to a major venous sinus, especially when used in the midline, or cerebrospinal fluid leakage.
Application Of Rapid-Sampling, Online Microdialysis To The Monitoring Of Brain Metabolism During Aneurysm Surgery
Authors: Bhatia Robin , Hashemi Parastoo , Razzaq Ashfaq , Parkin Mark C. , Hopwood Sarah E. , Boutelle Martyn G. , Strong Anthony J.
Published: April 2006

Objective:

To introduce rapid-sampling microdialysis for the early detection of adverse metabolic changes in tissue at risk during aneurysm surgery.

Methods:

A microdialysis catheter was inserted under direct vision into at-risk cortex at the start of surgery. This monitoring was sustained throughout the course of the operation, during which intraoperative events, for example, temporary arterial occlusion or lobe retraction, were precisely documented. A continuous online flow of dialysate was fed into a mobile bedside glucose and lactate analyser. This comprises flow-injection dual-assay enzyme-based biosensors capable of determining values of metabolites every 30 seconds.

Results:

Eight patients underwent clipping or wrapping of intracranial aneurysms and were monitored. Time between events and detection: 9 minutes. Mean change in metabolite value ± standard deviation: temporal lobe retraction lactate, +656 ± 562 µmol/L (n = 7, P< 0.05); glucose, -123 ± 138 µmol/L (n = 6, P = 0.08). Glucose intravenous bolus infusion glucose, +512 ± 244 µmol/L (n = 5, P< 0.01); peak at mean time after bolus, 16 minutes. Temporary proximal clip lactate, +731 ± 346 µmol/L (n = 6, P< 0.01); glucose, -139 ± 96 µmol/L (n = 5, P< 0.05); mean clip time, 8.6 minutes.

Conclusion:

The technique detects changes 9 minutes after intraoperative events occur (limited only by probe-to-sensor tubing length and dialysate flow rate). This provides reliable information to the surgeon and anesthetist promptly. It is a useful method for monitoring glucose and lactate in dialysate, particularly when rapid, transient changes in brain analyte levels need to be determined and the alternative offline methodology would be inadequate.
Solubilization of Lipid-Soluble Vitamins in Water by Forming Complexes with Poly(N-vinylpyrrolidone)
Authors: Inamura Isamu , Isshiki Masayuki , Araki Takeo
Published: April 2006

Lipid-soluble vitamins A1, E, D2, and K1, were solubilized in water by forming complexes with poly(N-vinylpyrrolidone) (PVP). The effects of ultraviolet (UV) irradiation and hydrogen peroxide on the vitamin–PVP complexes in water were examined by measuring absorption spectra, and compared with those on the vitamins in ethanol.
An Improved Method for the Preparation of Symmetrically Substituted Porphyrins via 2-Methoxymethyl-3,4-disubstituted Pyrrole Derivatives
Authors: Kinoshita Hideki , Tanaka Shingo , Inomata Katsuhiko
Published: April 2006

2-Methoxymethylpyrrole derivatives readily available from 2-methylthiomethylpyrroles were found to be readily cyclized to porphyrinogens with formic acid, and subsequent oxidation with O2 affords the corresponding porphyrins in excellent yields.
Abiotic Synthesis of Amino Acids by Proton Irradiation of a Mixture of Carbon Monoxide, Nitrogen, and Water
Authors: Kobayashi Kensei , Oshima Tairo , Yanagawa Hiroshi
Published: April 2006

We have shown that proton irradiation simulating the action of cosmic rays and solar flare particles formed proteinous and non-proteinous amino acids such as glycine, alanine, aspartic acid and β-alanine from a mixture of carbon monoxide, carbon dioxide, nitrogen and water. The yield of amino acids per unit energy was the highest obtained among various prebiotic energy sources used. This result suggests the possibility of the formation of amino acids from mildly reduced primitive atmospheres on the earth.
Photoinduced Electron Transfer Oxygenation of Triphenylcarbenium Ion
Authors: Futamura Shigeru , Kamiya Yoshio
Published: April 2006

Photooxidation of triphenylcarbenium ion in the presence of an electron donor affords bis(triphenylmethyl) peroxide via one electron transfer from the electron donor to the excited singlet state of triphenylcarbenium ion.
Separation of Al(III), Cu(II), Ga(III), and Fe(III) as 8-Hydroxyquinoline-5-sulfonic Acid Complexes by High-performance Liquid Chromatography
Authors: Shijo Yoshio , Saitoh Atsuko , Suzuki Kazuyoshi
Published: April 2006

High-performance reversed-phase liquid chromatography with UV detection of 8-hydroxyquinoline-5-sulfonic acid (8-HQS) complexes is studied for the determination of Al(III), Cu(II), Ga(III), and Fe(III). After complexation with 8-HQS, these metals can be determined by direct aqueous injection onto a C18 column in the range of 0.05–2 μg ml−1, with a precision of 3.2–6.5%.
Isolation and Characterization of Some Oxygen-deficient Reduced Forms of Dodecamolybdophosphate Anion Salts
Authors: Kawafune Isao
Published: April 2006

By a reaction of [n-Bu4N]3[PMo(VI)12O40] with PPh3 in acetonitrile, reduced forms, [n-Bu4N]3[PMo(VI)12−2xMo(V)2xO40−x] (x = 1, 2, 3), were isolated and characterized by X-ray diffractiometry, IR, and X-ray photoelectron spectroscopies. No decomposition took place on the anion structure of the reduced compounds, although three of the bridging oxygen atoms in the Mo–O–Mo bonds were eliminated.
Photoreaction of 3-Azido-5,7-di-t-butyl-2,1-benzisothiazole. Spectroscopic Detection of a Thionitroso Intermediate
Authors: Okazaki Renji , Takahashi Masaki , Inamoto Naoki , Sugawara Tadashi , Iwamura Hiizu
Published: April 2006

Photoreaction of the title compound at cryogenic temperatures produced a highly reactive 2,4-di-t-butyl-6-cyanothionitrosobenzene which showed a visible absorption around 470 nm.
The Control of Molecular Transport Rate through Liquid Membrane Containing Ferromagnetic Powder under Rotating Magnetic Field
Authors: Sakai Yasuzo , Kumakura Hiroyuki , Takahashi Fujio
Published: April 2006

A novel method with using liquid membrane containing ferromagnetic powder (LM-FP) under rotating magnetic field was proposed for the control of molecular transport rate through the liquid membrane. The rate of phenylglyoxylic acid transport through the LM-FP, (toluene-chloroform mixture containing magnetite powder) increased more than 10 times as compared with the transport rate under non-magnetic field.