Measurement error – the missing link?

Measurement error – the missing link?

Fitness and body composition profiling of elite junior South African rugby players

Objective. The aim of this study was to describe the body composition, strength and speed characteristics of elite junior South African rugby players. Design. Cross-sectional. Setting. Field study. Subjects. Rugby players (16 and 18 years old, N = 174) selected for the South African Rugby Union National Green Squad. Outcome measures. Body composition, 10 m and 40 m speed, agility, 1RM bench press, underhand pull-ups, push-ups, multistage shuttle run. Results. The under-16 players were on average shorter (175.6 ± 5.7 v. 179.2 ± 6.7 cm), weighed less (76.5 ± 8.2 v. 84.8 ± 8.3 kg) had less upper body absolute strength (77.1 ± 11.8 kg v. 95.3 ± 16.7 kg) and muscular endurance (41 ± 12 v. 52 ± 15 push-ups) and aerobic fitness (87.1 ± 19.4 v. 93.5 ± 15.3 shuttles) than the under-18 players. There were no differences in body fat, sprinting speed (10 m and 40 m) or agility between the two age groups. There were differences between playing positions, with the props having the most body fat, strongest upper bodies, slowest sprinting speed, least agility and lowest aerobic capacity compared with players in the other positions. Conclusion. This study provides data for elite junior rugby players and can be used to monitor the progression of players after intervention while also assisting with talent identification for the different playing positions. South African Journal of Sports Medicine Vol. 18 (2) 2006: pp. 38-45

Comparison of four diagnostic tests for the identification of serum antibodies in small ruminants infected withMycoplasma agalactiae

AIM

To determine the diagnostic capability of a newly developed Western blot (WB) assay for the detection of serum antibodies against Mycoplasma agalactiae compared with conventional serological tests, and to identify the best test for routine diagnostic use.

METHODS

The serological test methods used were: two commercial indirect enzyme-linked immunosorbent assays (ELISA), viz ELISA-1, using a bacterial antigen preparation, and ELISA-2, using a recombinant protein (lipoprotein p48) antigen; the complement fixation test (CFT); and a newly developed WB assay, the latter both using a bacterial antigen preparation. Thirty sera from goats infected with M. agalactiae and 97 sera from non-infected sheep were tested using all four methods.

RESULTS

Staining patterns in the WB were quite variable. An immuno-dominant band of 41 kDa was detected in 63% of sera from infected animals. The same band also appeared, although mostly very weakly, in 10% of sera from non-infected animals. When suspicious or very weak reactors were omitted, the diagnostic sensitivity (DSE) and diagnostic specificity (DSP), respectively, for the four assays were: WB=56.7%, 97.9%; ELISA-1=76.7%, 99.0%; ELISA-2=56.7%, 100%; and CFT=40.0%, 94.8%.

CONCLUSIONS

ELISA-1 performed best in this comparison. While the WB can be used, it did not have a technical advantage over the ELISA. The CFT should be discouraged as the primary screening method for contagious agalactia and should be replaced by ELISA-1. Results from this study confirm that serological test methods for contagious agalactia are useful for the detection of infected flocks but will not detect every individual infected animal.

Failure monitoring in water distribution networks

An algorithm for the burst detection and location in water distribution networks based on the continuous monitoring of the flow rate at the entry point of the network and the pressure at a number of points within the network is presented. The approach is designed for medium to large bursts with opening times in the order of a few minutes and is suitable for networks of relatively small size, such as district metered areas (DMAs). The burst-induced increase in the inlet flow rate is detected using the modified cumulative sum (CUSUM) change detection test. Based on parameters obtained from the CUSUM test, the burst is simulated at a number of burst candidate locations. The calculated changes in pressure at the pressure monitoring points are then compared to the measured values and the location resulting in the best fit is selected as the burst location. The EPANET steady-state hydraulic solver is utilised to simulate the flows and pressures in the network. A sensitivity-based sampling design procedure is introduced to find the optimal positions for pressure monitoring points. The proposed algorithm is tested on a case study example network and shows potential for burst detection and location in real water distribution systems.

[Endomyocardial fibrosis: a rare case of restrictive cardiomyopathy in a Caucasian female]

The authors report the case of endomyocardial fibrosis diagnosed in a young Caucasian female presenting with progressive congestive cardiac failure. The diagnosis was suspected on the echocardiographic, magnetic resonance imaging and cardiac catheterisation findings in association with the clinical presentation. After a short course of symptomatic medical therapy, the patient underwent the only curative treatment of this pathology, surgical endocardectomy and combined valvular surgery. The confirmation of the diagnosis was obtained a posteriori by histopathological examination of the operative findings which showed appearances of endomyocardial fibrosis similar to those observed in tropical regions. The patient was discharged on the eighth postoperative day, much improved clinically, and follow-up at one year was very satisfactory.

Regulation of N-cadherin dynamics at neuronal contacts by ligand binding and cytoskeletal coupling

N-cadherin plays a key role in axonal outgrowth and synaptogenesis, but how neurons initiate and remodel N-cadherin-based adhesions remains unclear. We addressed this issue with a semiartificial system consisting of N-cadherin coated microspheres adhering to cultured neurons transfected for N-cadherin-GFP. Using optical tweezers, we show that growth cones are particularly reactive to N-cadherin coated microspheres, which they capture in a few seconds and drag rearward. Such strong coupling requires an intact connection between N-cadherin receptors and catenins. As they move to the basis of growth cones, microspheres slow down while gradually accumulating N-cadherin-GFP, demonstrating a clear delay between bead coupling to the actin flow and receptor recruitment. Using FRAP and photoactivation, N-cadherin receptors at bead-to-cell contacts were found to continuously recycle, consistently with a model of ligand-receptor reaction not limited by membrane diffusion. The use of N-cadherin-GFP receptors truncated or mutated in specific cytoplasmic regions show that N-cadherin turnover is exquisitely regulated by catenin partners. Turnover rates are considerably lower than those obtained previously in single molecule studies, demonstrating an active regulation of cadherin bond kinetics in intact cells. Finally, spontaneous neuronal contacts enriched in N-cadherin exhibited similar turnover rates, suggesting that such dynamics of N-cadherin may represent an intrinsic mechanism underlying the plasticity of neuronal adhesions.

PANSS syndromes and quality of life in schizophrenia

BACKGROUND

Results from factor analysis studies have suggested that a five-dimensional structure appears to be a better representation of the psychopathological data of the PANSS. The purpose of this study was the detailed investigation of the association of schizophrenia syndromes and single symptoms with quality of life (QOL) in acute and remitted patients. The leading hypotheses were: (1) affective symptoms, especially depression and anxiety, are mostly associated with QOL longitudinally and (2) in the acute phase, QOL is also associated with positive schizophrenia symptoms.

METHODS

For the present study, schizophrenia and schizophreniform patients were studied on admission, at the end of the acute phase and 6 months after hospitalization. Psychopathology was measured using the PANSS syndromes, QOL was assessed using disease-specific (SWN) and generic (MLDL, EDLQ) scales.

RESULTS

Eighty-four patients entered the study and were assessed during the acute phase taking into account their history and actual treatment. Results revealed anxiety as the most important symptom and depression as the most important syndrome associated with different areas of QOL during and after hospitalization. Also cognitive and negative symptoms were associated with different QOL domains, but both positive symptom clusters showed no substantial association with QOL.

CONCLUSIONS

Results of this longitudinal study investigating psychopathology and QOL in schizophrenia provide further support for the need to consider the psychopathological state and treatment setting when measuring QOL in schizophrenia and the need for a differential analysis of schizophrenia symptoms and QOL in the acute, mid-term and long-term phase. Anxiety reduction should be a critical goal of treatment in order to prevent further QOL impairment.

Comparison of Olanzapine and Risperidone in 367 First-Episode Patients with Non-Affective or Affective Psychosis: Results of an Open Retrospective Medical Record Study

INTRODUCTION

Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis.

METHODS

The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level).

RESULTS

367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms ( p = .054) and a shorter treatment duration to reach this remission in affective FEP patients ( p = .077). More extrapyramidal side effects ( p <.001) were related to RIS and more weight gain to OLZ-treatment ( p <.001).

DISCUSSION

Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.

An unusual mid term complication of coronary rupture

A 55-year-old man was admitted with a four-month history of lethargy, dyspnea and ascites. An idiopathic liver cirrhosis was suspected to be responsible for these symptoms and for elevated hepatic enzymes on blood tests. A few months before he had an angioplasty on the left anterior descending artery for an acute coronary syndrome (ACS). The intervention was complicated by coronary perforation which required the implantation of a polytetrafluoroethylene-covered (PTFE) stent to seal the rupture. On admission, pressure measurements during cardiac catheterism revealed a typical right ventricular dip-plateau consistent with the diagnosis of constrictive pericarditis (CP). Magnetic resonance imaging (RMI) showed localized pericardial thickening next to the right ventricle. We suspect hemopericardium, due to coronary perforation, is responsible for constrictive pericarditis. This mid-term complication of coronary rupture has not been reported before and should be suspected in this particular clinical setting.

Population history and its impact on medical genetics in Quebec

Knowledge of the genetic demography of Quebec is useful for gene mapping, diagnosis, treatment, community genetics and public health. The French-Canadian population of Quebec, currently about 6 million people, descends from about 8500 French settlers who arrived in Nouvelle-France between 1608 and 1759. The migrations of those settlers and their descendants led to a series of regional founder effects, reflected in the geographical distribution of genetic diseases in Quebec. This review describes elements of population history and clinical genetics pertinent to the treatment of French Canadians and other population groups from Quebec and summarizes the cardinal features of over 30 conditions reported in French Canadians. Some were discovered in French Canadians, such as autosomal recessive ataxia of the Charlevoix-Saguenay (MIM 270550), agenesis of corpus callosum and peripheral neuropathy (MIM 218000) and French-Canadian-type Leigh syndrome (MIM 220111). Other conditions are particularly frequent or have special genetic characteristics in French Canadians, including oculopharyngeal muscular dystrophy, hepatorenal tyrosinaemia, cystic fibrosis, Leber hereditary optic neuropathy and familial hypercholesterolaemia. Three genetic diseases of Quebec First Nations children are also discussed: Cree encephalitis (MIM 608505), Cree leukoencephalopathy (MIM 603896) and North American Indian childhood cirrhosis (MIM 604901).

The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis

OBJECTIVE

Studies investigating the impact of comorbid substance use disorders (SUD) in psychosis have tended to focus on cross-sectional data, with few studies examining the effects of substance use course on clinical outcome. The main aim of the present study was to assess the impact of baseline SUD and course of SUD on remission of positive symptoms.

METHOD

The Early Psychosis Prevention and Intervention Centre admitted 786 first-episode psychosis (FEP) patients between 1998 and 2000. Data on SUD and clinical outcome were collected from patients' medical records (MR) of 643 patients who met inclusion criteria.

RESULTS

Lifetime prevalence of SUD was 74%, with 62% having a SUD at baseline. This reduced to 36% in those patients who completed 18 months of treatment at the EPPIC program. A Cox regression analysis indicated that a decrease or cessation of substance use significantly increased the probability of remission, whilst persistent SUD substantially reduced the likelihood. In addition, patients who reduced use appeared to have better outcomes at 18 months than those patients who had never used substances. Baseline SUD was not found to have any significant influence on symptom remission.

CONCLUSION

Patients presenting with FEP have high rates of SUD. Effective management of psychosis within a specialized service is associated with reductions in SUD over the course of treatment, although persistent substance use is associated with non-compliance, treatment drop-out and poor remission rates. As such, young people with FEP and comorbid substance use should be offered integrated treatment that addresses both disorders.

Regression of Sweet's syndrome associated with Crohn's disease after anti-Tumour Necrosis Factor therapy

The association of inflammatory bowel disease and acute febrile neutrophilic dermatitis (Sweet's syndrome) has infrequently been reported in the literature. We describe the case of a 41-year-old Caucasian woman with ileo- anal Crohn's disease who presented simultaneously an erythema nodosum and a Sweet's syndrome. A dramatic regression of the cutaneous lesions was observed after infliximab treatment, indicating that this therapy might be useful for both Crohn's disease and Sweet's syndrome.

Subjective well-being under the neuroleptic treatment and its relevance for compliance

OBJECTIVE

To review the concept of 'subjective well-being under neuroleptic treatment', its development and clinical relevance,particularly regarding compliance.

METHOD

The manuscript includes a review of the limited literature and recent open and controlled clinical trials.

RESULTS

The patients' perspective of antipsychotic treatment was largely neglected for a long time. Scientific interest in this field of strong clinical relevance started mainly with the development of atypical antipsychotics. Recent research indicates that subjective well-being (SW) is a major determinant of medication compliance in schizophrenia. There are several self-report instruments with sufficient internal consistency and good construct validity. Effects of antipsychotic treatment on psychopathology and SW are only partly related. Most patients strongly prefer the atypical over typical antipsychotics. The assessment of SW is helpful for selecting the optimal drug for the individual patient.

CONCLUSION

SW, under antipsychotic treatment, is a valid construct; its assessment provides an independent outcome variable, which is relevant to compliance.

A novel function for cadherin-11 in the regulation of motor axon elongation and fasciculation

We previously observed that cadherin-11, a type II cadherin, is expressed in growing motor and sensory axons in the mouse embryo. Here, we assessed its functional involvement in the regulation of axon elongation and fasciculation by evaluating the activity of a specific cadherin-11 homophilic ligand, cad11-Fc (cadherin-11 extracellular region fused to Fc fragment of IgG), on the length and organization of motor axons outgrowing from embryonic ventral spinal cord explants. Cad11-Fc substrate enhanced axon growth and prevented interactions occurring between growing axons, providing evidences for a role of cadherin-11 in the control of growth cone progression. Comparison of cadherin-11 with N-cadherin, a type I cadherin concomitantly expressed by motor axons, revealed similarities in their functional properties, including the ability to reorganize the actin cytoskeleton through interactions with catenins, but differences in their axon growth-promoting activity, arguing for subtle differences in their contributions to peripheral nerve elongation.

Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence

OBJECTIVE

(1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence.

METHODS

The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment.

RESULTS

The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P < 0.001), extrapyramidal (P < 0.05) and psychic side effects (P < 0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P < 0.05), were more doubtful about their efficacy (P < 0.01) and were less likely to encourage a relative to take such a medication in case of need (P < 0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects.

CONCLUSIONS

All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

Olanzapine vs. other antipsychotics in actual out-patient settings: six months tolerability results from the European Schizophrenia Out-patient Health Outcomes study

OBJECTIVE

The European Schizophrenia Out-patient Health Outcomes study is an observational study investigating treatment in schizophrenia. We report treatment-emergent adverse events during the first 6 months of treatment.

METHOD

The rate of extrapyramidal symptoms (EPS), anticholinergic use, weight gain and sexual related dysfunctions were assessed in 8,400 out-patients.

RESULTS

Patients typical antipsychotics and risperidone experienced significantly more EPS and anticholinergic use than patients in the clozapine, olanzapine, and quetiapine cohorts. Patients treated with amisulpride, typical antipsychotics and risperidone were significantly more likely to have sexual related dysfunctions and/or amenorrhea. Increases in weight and body mass index occurred in all cohorts, but were significantly greater in the olanzapine and clozapine cohorts.

CONCLUSION

Patients treated with olanzapine, quetiapine and clozapine had better tolerability outcomes regarding EPS and sexual related dysfunctions compared with patients receiving risperidone, amisulpride and typicals. Patients treated with olanzapine and clozapine had higher weight increases than patients treated with risperidone, quetiapine and typicals.

Randomized double blind comparison of olanzapine vs. clozapine on subjective well-being and clinical outcome in patients with schizophrenia

OBJECTIVE

This randomized double-blind multicenter trial evaluated the effects of olanzapine vs. clozapine on subjective well-being, quality of life (QOL) and clinical outcome.

METHOD

The primary objective was to demonstrate non-inferiority of olanzapine, mean dosage 16.2 +/- 4.8 (5-25 mg/day) vs. clozapine, mean dosage 209 +/- 91 (100-400 mg/day) regarding improvement on the 'Subjective Well-Being under Neuroleptic Treatment' (SWN) Scale after 26 treatment weeks in 114 patients with schizophrenia. Secondary outcome parameters included: Munich QOL Dimension List (MLDL), Positive and Negative Symptom Scale (PANSS), Clinical Global Impression (CGI).

RESULTS

SWN scores improved significantly in both groups, olanzapine was non-inferior to clozapine (group difference 3.2 points in favor of olanzapine; 95% CI: 4.2;10.5). MLDL-satisfaction, PANSS and CGI-S improved similarly, olanzapine yielded a higher CGI Therapeutic Index. Individual SWN and PANSS changes correlated only moderately (r = -0.45).

CONCLUSION

Olanzapine was non-inferior to clozapine. The lack of a marked correlation between PANSS and SWN improvements indicates that patients and psychiatrists perceive treatment differently.

Cough as the presenting symptom of large vessel vasculitis

We report the case of a 57-year-old woman presenting with persistent cough, weight loss, and fever. An extensive work-up revealed laboratory signs of inflammation and a mild thickening of the aortic wall on computed tomographic scan of the thorax. These findings raised the suspicion of large vessel vasculitis that was elegantly confirmed by fluorodeoxyglucose positron emission tomography. Persistent cough as the inaugural symptom and involvement of large vessels in Horton's disease are also discussed.

[Physiopathologic approach to symptoms and complication of anorexia nervosa: concerning various adipocytokines]

Anorexia nervosa (AN) is the most typical but also the most severe of eating disorders. Its prevalence among adolescents is estimated at 1% and its incidence has doubled the last twenty years. One of the most characteristic clinical sign in the anorexic people who have markedly decreased body mass index, is the prominent loss of fat tissues. This observation is confirmed by several studies of body composition measured by dual-energy x-ray absorptiometry or bioimpedance. The recent discovery of some adipocytokines, such as leptin and adiponectin has allowed to explain various complications classically described in AN, in particular hematologic changes, immunodepression, osteopenia and several neuro-endocrine disorders.

Correlates of subjective well-being in schizophrenic patients treated with atypical antipsychotics

Objective A growing body of research indicates that a low subjective well-being (SW) may be predictive of non-adherence and less favourable outcome. This study examined baseline variables and variables in the course of treatment hypothesised to be associated with later SW. Methods Sixty-three inpatients with schizophreniform disorder or schizophrenia were randomly assigned to treatment with various atypical antipsychotics after a wash-out phase of 2 days. Subjects were evaluated with a protocol that examined psychopathology (Positive and Negative Symptom Scale, PANSS), side effects (Scandinavian Society of Pharmacology, UKU), and subjective well-being (Subjective Well-being under Neuroleptic treatment, SWN) at baseline and endpoint (mean duration of treatment 39.9 days). Two-thirds of subjects were multiple episode schizophrenic inpatients pre-treated with antipsychotics. Results Multiple regression analyses revealed that the PANSS negative score, neurological side effects, and SWN at baseline, as well as change of the PANSS positive score between baseline and endpoint, were associated independently with SW at endpoint (R(2)=0.55 after exclusion of two subjects). Conclusions Patients with low SW, severe negative symptoms, and neurological side effects, all at baseline, as well as those without improvement or deterioration of positive symptoms are at risk of low SW later in treatment and, most likely, of non-adherence.