Assessing the quality of care for patients with first-episode psychosis

INTRODUCTION

This study evaluated the quality of care in an early psychosis intervention programme (EPIP), as compared to standard treatment received by patients prior to the inception of the programme.

METHODS

The medical records of 50 patients with first-episode psychosis (FEP) who received psychiatric treatment in the calendar year of 2000, i.e. prior to the implementation of EPIP, and 87 FEP patients who were accepted in the EPIP, were reviewed for a period of one year. These patients were aged between 18 and 40 years. Each medical record was reviewed for a list of process indicators, which were identified from the published literature and other treatment guidelines, and covered different domains.

RESULTS

None of the pre-EPIP patients met all the 13 process indicators, whereas 48 percent of EPIP patients met all the indicators (p-value is less than 0.001). Using the default rate as a proxy of outcome, we found that 19 percent of EPIP patients had defaulted at the end of one year, whereas the default rate was 52 percent for the pre-EPIP patients (p-value is less than 0.001).

CONCLUSION

It is possible to improve the quality of care in patients with FEP through the use of treatment guidelines, regular monitoring of symptoms and side effects, and periodic audits.

The LRRK2 Gly2385Arg variant is associated with Parkinson’s disease: genetic and functional evidence

Evidence of LRRK2 haplotypes associated with Parkinson's disease (PD) risk was recently found in the Chinese population from Singapore, and a common LRRK2 missense variant, Gly2385Arg, was independently detected as a putative risk factor for PD in the Chinese population from Taiwan. To test the association between the Gly2385Arg variant in a large case-control sample of Chinese ethnicity from Singapore, and to perform functional studies of the wild type and Gly2385Arg LRRK2 protein in human cell lines. In a case-control study involving 989 Chinese subjects, the frequency of the heterozygous Gly2385Arg genotype was higher in PD compared to controls (7.3 vs. 3.6%, odds ratio = 2.1, 95% CI: 1.1-3.9, P = 0.014); these values yield an estimated population attributable risk (PAR) of approximately 4%. In a multivariate logistic regression analysis with the disease group (PD vs. controls) as the dependent variable and the genotype as an independent factor with adjustments made for the effect of age and gender, the heterozygous Gly2385Arg genotype remained associated with an increased risk of PD compared to wild type genotype (odds ratio = 2.67, 95% CI: 1.43-4.99, P = 0.002). The glycine at position 2385 is a candidate site for N-myristoylation, and the Gly2385Arg variant replaces the hydrophobic glycine with the hydrophilic arginine, and increases the net positive charge of the LRRK2 WD40 domain. In transfection studies, we demonstrated that both the wild type and Gly2385Arg variant LRRK2 protein localize to the cytoplasm and form aggregates. However, under condition of oxidative stress, the Gly2385Arg variant was more toxic and associated with a higher rate of apoptosis. Our study lends support to the contention that the Gly2385Arg is a common risk factor for PD in the Chinese population. Our bioinformatics and in-vitro studies also suggest that the Gly2385Arg variant is biologically relevant and it might act through pro-apoptotic mechanisms.

An assessment of the efficiency of fungal DNA extraction methods for maximizing the detection of medically important fungi using PCR

To date, no single reported DNA extraction method is suitable for the efficient extraction of DNA from all fungal species. The efficiency of extraction is of particular importance in PCR-based medical diagnostic applications where the quantity of fungus in a tissue biopsy may be limited. We subjected 16 medically relevant fungi to physical, chemical and enzymatic cell wall disruption methods which constitutes the first step in extracting DNA. Examination by light microscopy showed that grinding with mortar and pestle was the most efficient means of disrupting the rigid fungal cell walls of hyphae and conidia. We then trialled several published DNA isolation protocols to ascertain the most efficient method of extraction. Optimal extraction was achieved by incorporating a lyticase and proteinase K enzymatic digestion step and adapting a DNA extraction procedure from a commercial kit (MO BIO) to generate high yields of high quality DNA from all 16 species. DNA quality was confirmed by the successful PCR amplification of the conserved region of the fungal 18S small-subunit rRNA multicopy gene.

Are national quality standards for traditional Chinese herbal medicine sufficient? Current governmental regulations for traditional Chinese herbal medicine in certain Western countries and China as the Eastern origin country

Traditional Chinese herbal Medicine (TCHM) has been gaining interest and acceptance world wide. TCHM provides on the one side promising perspective of scientific interest and on the other side possible health risks if TCHM drugs are not controlled with respect to quality standards or if practitioners for TCHM are not well trained. This paper outlines an introduction to the scientific aspects and potential risks of TCHM therapy followed by a brief, exploratory overview of the current status of TCHM regulations in certain Western countries like the USA, United Kingdom, Germany, Australia and in China as the Eastern origin country of TCHM. Legal foundations to establish quality and safety standards for TCHM crude drugs and ready-made formulas exist in some countries on a local basis but in practice are poorly enforced, where this products have no drug status. In addition practitioners treating patients with TCHM should be well versed in the pharmacology, side effects, and interactions of these substances with Western medicines and should be certified on a regular basis.

Cathodal current-induced vasodilation to single application and the amplified response to repeated application in humans rely on aspirin-sensitive mechanisms

Assumed to rely on an axon reflex, the current-induced vasodilation (CIV) interferes with the microvascular response to iontophoretic drug delivery. Mechanisms resulting in CIV are likely different at the anode and at the cathode. While studies have been conducted to understand anodal CIV, little information is available on cathodal CIV. The present study investigates CIV observed following 0.1-mA cathodal applications on forearms of healthy volunteers and the possible mechanisms involved. Results are expressed in percentage of the cutaneous heat-induced maximal vascular conductance [%MVC (means ± SE)]. 1) The amplitude of CIV was proportional to the duration of cathodal currents for periods of <1 min: r = 0.99. 2) Two current applications of 10 s, with 10-min interstimulation interval, induced a higher peak value of CIV (79.1 ± 8.6% MVC) than the one obtained with all-at-once 20-s current application (39.5 ± 4.3% MVC, P < 0.05). This amplified vascular response due to segmental application was observed for all tested interstimulation intervals (up to 40 min). 3) Two hours and 3 days following pretreatment with 1-g oral aspirin, the CIV observed following cathodal application, as well as the difference of cathodal CIV amplitude between all-at-once and segmented applications, were reduced. These findings suggest a role of prostaglandins, not only released from endothelial or smooth muscle cells, as direct vasodilator and/or as a sensitizer. Thus aspirin pretreatment could be used to decrease CIV resulting from all-at-once and repeated cathodal application and facilitate the study of the specific vascular effect induced by the drug delivered.

Polyunsaturated eicosapentaenoic acid changes lipid composition in lipid rafts

BACKGROUND

Polyunsaturated fatty acids (PUFAs) modulate immune responses particularly by affecting T cell function and are applied clinically as adjuvant immunosuppressants in the treatment of various inflammatory diseases. However, the molecular mechanisms of PUFA-induced immunosuppressive effects are not yet elucidated. Membrane lipid rafts are functional plasma membrane microdomains characterized by a unique lipid environment. Since lipid interactions are crucial for the formation of lipid rafts, the immunomodulatory effects of PUFAs may be due to changes of fatty acid composition in lipid rafts.

AIM OF THE STUDY

We investigated the effects of eicosapentaenoic acid (EPA, 20:5 n - 3) supplementation on modulating lipid composition and fatty acyl substitution in their cytoplasmic and exoplasmic lipid leaflet in lipid rafts.

METHODS

The human Jurkat E6-1 T cells were cultured in EPA-supplemented medium and the cells treated with stearic acid served as a control. Lipid rafts were isolated by discontinuous sucrose density gradient ultracentrifugation. The lipids in raft and soluble fractions from EPA-treated and control T cells were extracted and separated by gas chromatography. Raft phospholipids were analyzed by mass spectrometry.

RESULTS

Our results showed that EPA treatment could alter lipid composition resulting in a considerable increase of unsaturated fatty acyl chains in lipid rafts from EPA-treated T cells compared with control cells. Effective incorporation of EPA to rafts was not only in the exoplasmic but also in the cytoplasmic membrane lipid leaflet. EPA treatment altered the lipid environment in lipid rafts. EPA presented an inhibiting effect on Jurkat T cells proliferation and inhibited IL-2Ralpha expression on the surface of T cells.

CONCLUSIONS

Our data provided evidence for an important modification in lipid composition of membrane lipid rafts and T cell function by EPA supplementation.

Chairside sensor for rapid monitoring of Enterococcus faecalis activity

In this study, optical spectroscopy was used to monitor a chromogenic, enzyme-substrate reaction for the rapid identification of Enterococcus faecalis. The detection system, comprising a miniature spectrophotometer and an accompanying data acquisition system, was placed in an incubator. During testing, a 3-ml test sample was placed in a cuvette within the spectrophotometer. This permitted online, real-time, and remote analysis of spectral signature needed to monitor the bacteria. It was observed that the absorption peak intensity increased conspicuously 3.5 h after inoculation and through the entire period of testing. A linear-regression analysis demonstrated a significant correlation between the increase in absorption peak intensity at 610 nm (r = 0.9389) and 653 nm (r = 0.9387) with the formation of colony-forming units. Optical spectroscopy-based sensing systems can pave the way for rapid, nonlaboratory-based approaches to monitor microbial status quantitatively and qualitatively from clinical samples.

Telopeptides as markers of bone turnover in rheumatoid arthritis and osteoarthritis

AIMS

The aim of the present study was to determine if urinary excretion of type I collagen N-terminal telopeptides (UrNTx) and deoxypyridinoline (UrDPD) and serum levels of type I collagen C-terminal telopeptides (SeCTx) differed in patients with rheumatoid arthritis (RA) compared with populations matched for age and gender with and without osteoarthritis (OA). The correlation of markers of bone turnover with disease activity in patients with RA or radiographic severity in patients with OA was also examined.

METHODS

Patients with RA aged >50 years (men) and >60 years (women) were identified from computer databases at two tertiary referral centres for rheumatology. Strict exclusion criteria were applied to avoid the effects of factors known to influence markers of bone turnover. Patients with RA and OA were matched for age and sex with a control population free of known arthritic disease and a population with OA. Bone markers were assayed in serum and urine. Urine markers were measured on three consecutive days and mean values used to minimize day-to-day variability of these analytes.

RESULTS

The level of UrNTx was elevated in patients with RA compared with normal controls and patients with OA. UrNTx and UrDPD correlated with markers of disease activity in patients with RA (erythrocyte -sedimentation rate and C-reactive protein), but not with -clinical signs of inflammation (swollen and tender joint counts). Patients with OA failed to show any correlation between markers of bone turnover and radiographic severity.

CONCLUSIONS

These data support a role for the use of UrNTx and UrDPD in further studies of the patho-physiology of RA and in longitudinal studies designed to modify the course of clinical disease.

Corrosion and wear-corrosion behavior of NiTi modified by plasma source ion implantation

The understanding of corrosion behavior in NiTi is critical for the devices using this shape-memory alloy. In order to improve the surface properties of NiTi such as corrosion resistance, plasma source ion implantation (PSII) technique was employed with oxygen as incident ions at three levels of implantation dose (5x10(16), 1x10(17) and 3x10(17) ions/cm(-2)). Pitting corrosion and wear-corrosion behavior of control and PSII-modified Ti-50.7at% Ni alloy were evaluated by cyclic potentiodynamic polarization and wear-corrosion measurements. Surface characterization was used to interpret the different corrosion behavior observed between control and oxygen-implanted samples. Results showed that corrosion behavior was influenced by both heat treatment and surface modification. The best pitting corrosion resistance was observed for samples with Af=21 degrees C modified by oxygen implantation at a dose of 1x10(17) ions/cm(-2). Better wear-corrosion resistance was observed for oxygen-implanted samples.

Parasitism of molluscs by nematodes: types of associations and evolutionary trends

Although there are no confirmed fossil records of mollusc parasitic nematodes, diverse associations of more than 108 described nematode species with slugs and snails provide a fertile ground for speculation of how mollusc parasitism evolved in nematodes. Current phylogenic resolution suggests that molluscs have been independently acquired as hosts on a number of occasions. However, molluscs are significant as hosts for only two major groups of nematodes: as intermediate hosts for metastrongyloids and as definitive hosts for a number of rhabditids. Of the 61 species of nematodes known to use molluscs as intermediate hosts, 49 belong to Metastrongyloidea (Order Strongylida); of the 47 species of nematodes that use molluscs as definitive hosts, 33 belong to the Order Rhabditida. Recent phylogenetic hypotheses have been unable to resolve whether metastrongyloids are sister taxa to those rhabditids that use molluscs as definitive hosts. Although most rhabditid nematodes have been reported not to kill their mollusc hosts prior to their reproduction, some species are pathogenic. In fact, infective juveniles of Phasmarhabditis hermaphrodita vector a lethal bacterium into the slug host in which they reproduce. This life cycle is remarkably similar to the entomopathogenic nematodes in the families Steinernematidae and Heterorhabditidae. Also, the discoveries of Alloionema and Pellioditis in slugs are interesting, as these species have been speculated to represent the ancestral forms of the entomopathogenic nematodes. Development of the infective stage appears to be an important step toward the acquisition of molluscs as definitive hosts, and the association with specific bacteria may have arisen in conjunction with the evolution of necromeny.

Predicting the HER2 status of breast cancer from basic histopathology data: an analysis of 1500 breast cancers as part of the HER2000 International Study

The tests that are currently available for the measurement of overexpression of the human epidermal growth factor-2 (HER2) in breast cancer have shown considerable problems in accuracy and interlaboratory reproducibility. Although these problems are partly alleviated by the use of validated, standardised 'kits', there may be considerable cost involved in their use. Prior to testing it may therefore be an advantage to be able to predict from basic pathology data whether a cancer is likely to overexpress HER2. In this study, we have correlated pathology features of cancers with the frequency of HER2 overexpression assessed by immunohistochemistry (IHC) using HercepTest (Dako). In addition, fluorescence in situ hybridisation (FISH) has been used to re-test the equivocal cancers and interobserver variation in assessing HER2 overexpression has been examined by a slide circulation scheme. Of the 1536 cancers, 1144 (74.5%) did not overexpress HER2. Unequivocal overexpression (3+ by IHC) was seen in 186 cancers (12%) and an equivocal result (2+ by IHC ) was seen in 206 cancers (13%). Of the 156 IHC 3+ cancers for which complete data was available, 149 (95.5%) were ductal NST and 152 (97%) were histological grade 2 or 3. Only 1 of 124 infiltrating lobular carcinomas (0.8%) showed HER2 overexpression. None of the 49 'special types' of carcinoma showed HER2 overexpression. Re-testing by FISH of a proportion of the IHC 2+ cancers showed that only 25 (23%) of those assessable exhibited HER2 gene amplification, but 46 of the 47 IHC 3+ cancers (98%) were confirmed as showing gene amplification. Circulating slides for the assessment of HER2 score showed a moderate level of agreement between pathologists (kappa 0.4). As a result of this study we would advocate consideration of a triage approach to HER2 testing. Infiltrating lobular and special types of carcinoma may not need to be routinely tested at presentation nor may grade 1 NST carcinomas in which only 1.4% have been shown to overexpress HER2. Testing of these carcinomas may be performed when HER2 status is required to assist in therapeutic or other clinical/prognostic decision-making. The highest yield of HER2 overexpressing carcinomas is seen in the grade 3 NST subgroup in which 24% are positive by IHC.

[Survey of jugular bulb with MRA in sudden sensorineural hearing loss]

To evaluate the correlation between the size and position of the jugular bulb and the sudden sensorineural hearing loss(SSHL), the diameter and height of all jugular bulbs were measured with magnetic resonance angiography and analysed with statistics in 15 cases with SSHL and 35 cases without SSHL(as control). The ipsilateral and the contralateral bulbs of the SSHL were more asymmetrical than that of the control. The mean diameter and height of the ipsilateral bulbs of SSHL were larger than that of the dominant side bulbs of the control. It indicates that the heteroplasia of jugular bulbs which were greatly enlarged and bulgy upward might be related to SSHL.

[Influence of nitric oxide upon cerebral infarction in 15 cases]

To study the role of the nitric oxide(NO) in patients with cerebral infarction, NO in cerebrospinal fluid was determined in cerebral infarction group(15 cases) and control group(10 cases). Infarct volume was determined by CT between the second and the 7th day after the onset of symptoms. The severity of neurological deficits was assessed with the stroke scale of Ministry of Public Healthy(China). The results showed that NO was higher in cerebral infarction group (3.12 +/- 1.60) than that in control group(1.19 +/- 1.01) (P < 0.01). The concentration of NO was positively correlated with infarction volume(r = 0.57, P < 0.05) and severity of neurological of deficits(r = 0.54, P < 0.05), respectively. The results support the conclusion that NO produced in large amounts in the postischemic tissue contributes to the progression of the brain damage, which was demonstrated in animal models of focal cerebral ischemia.

Arthroscopic mediopatellar plicaectomy and lateral retinacular release in mechanical patellofemoral disorders

Arthroscopy was performed on 168 knees of 164 patients with anterior knee pain by a single arthroscopic surgeon between April 1993 and March 2000, with a mean follow-up of29 months. There were 168 mediopatellar plicae, 16 infrapatellar plicae, 8 suprapatellar plicae, and 30 lateral plicae, and all plicae were excised. Lateral retinacular release was performed in 74 patients with patellar lateral compression syndrome, patellar lateralization, and patellar lateral subluxation through anterolateral portal without using a third portal with the help of a hook knife. Débridement and drilling were performed in type 3 and 4 chondropathies (Outerbridge classification), and cartilage débridement was performed in type 2 chondropathies. We examined the effect on morbidity and prognosis of the arthroscopic lateral retinacular release through the standard anterolateral portal; the results of condylar chondropathies and débridement and drilling applied to the chondropathies were also evaluated. Mediopatellar plica was seen to play a mechanical role in the development of medial femoral chondropathy, which confirms that excision of plica is a prophylactic procedure. A further successful method is lateral retinacular release applied through the standard anterolateral portal with conventional methods without using a third portal at the cases with patellar lateral compression syndrome, patellar lateralization, and patellar lateral subluxation. Classical débridement and drilling methods are cheap and easy for the treatment of chondropathy. We consider these methods still to be useful methods of treatment.

Fretting wear study of surface modified Ni-Ti shape memory alloy

A combination of shape memory characteristics, pseudoelasticity, and good damping properties make near-equiatomic nickel-titanium (Ni-Ti) alloy a desirable candidate material for certain biomedical device applications. The alloy has moderately good wear resistance, however, further improvements in this regard would be beneficial from the perspective of reducing wear debris generation, improving biocompatibility, and preventing failure during service. Fretting wear tests of Ni-Ti in both austenitic and martensitic microstructural conditions were performed with the goal of simulating wear which medical devices such as stents may experience during surgical implantation or service. The tests were performed using a stainless steel stylus counter-wearing surface under dry conditions and also with artificial plasma containing 80 g/L albumen protein as lubricant. Additionally, the research explores the feasibility of surface modification by sequential ion implantation with argon and oxygen to enhance the wear characteristics of the Ni-Ti alloy. Each of these implantations was performed to a dose of 3 x 10(17) atom/cm(2) and an energy of 50 kV, using the plasma source ion implantation process. Improvements in wear resistance were observed for the austenitic samples implanted with argon and oxygen. Ion implantation with argon also reduced the surface Ni content with respect to Ti due to differential sputtering rates of the two elements, an effect that points toward improved biocompatibility.

Evaluation of somnolence in Parkinson's disease: comparison with age- and sex-matched controls

The authors found a significantly higher prevalence of daytime somnolence in 201 patients with PD compared with 214 age- and sex-matched healthy control subjects (Epworth Sleepiness Scale score 5.6 vs 4.6). The prevalence of "sleep attacks" (SA) was about seven times higher in patients with PD than in control subjects (13.9% vs 1.9%; p < 0.0005). Multivariate analysis demonstrated that a higher dose of levodopa and longer duration of disease significantly predicted for SA in patients with PD. Epworth Sleepiness Scale scores of > or =10 had 71.4% sensitivity and 88.4% specificity for SA.