Patterns of disease and severity in bipolar disorder: Retrospective data from a large multinational longitudinal study (WAVE-bd)

Introduction

The Wide AmbispectiVE study of the clinical management and burden of bipolar disorder (BD) (WAVE-bd; NCT01062607) is ongoing to address limitations of longitudinal BD studies to-date focused on single disease phases or treatment.

Aim/Objective

To describe baseline bipolar mood state and severity in a cohort of patients with BD.

Methods

Multinational, multicentre, non-interventional, longitudinal study of patients diagnosed with BD-I or BD-II with ≥1 mood event in the preceding 12 months (retrospective data collection from index mood event to enrolment, followed by 9-14 months’ prospective follow-up). Site and patient selection provided a sample representative of bipolar populations. The study includes descriptive analyses of demographics, diagnosis and medical history.

Results

2880 patients (mean age 46.5 years [SD: 13.3]; 62.0% female) were recruited March to September 2010: 1989 (69.1%) BD-I and 891 (30.9%) BD-II. Time (years) from first symptoms to diagnosis was 2.9 [SD: 6.6] (BD-I) and 4.4 [SD: 8.0] (BD-II). Of the total population, 20.8% lived alone (13.9% BD-I, 6.9% BD-II), 36.7% were employed (24.0% BD-I, 12.7% BD-II) and 13.3% unemployed (9.5% BD-I, 3.8% BD-II). Disease status at inclusion (BD-I, BD-II, respectively [mild, moderate, severe]) included hypomania (7.9% [67.7%, 31.0%, 1.3%], 6.5% [70.7%, 29.3%, 0%]), mania (7.1% [26.1%, 47.2%, 26.8%], 0%), euthymia (58.6%, 60.3%), depression (19.7% [38.8%, 47.7%, 13.5%], 31.1% [41.2%, 46.9%, 11.9%]) and mixed (5.7% [30.1%, 46.9%, 23.0%], 0%).

Conclusions

This ongoing study provides detailed insight into a large BD population, showing the majority with euthymia and an important proportion with depression both in BD-I and BD-II patients.

Spent mushroom substrates as component of growing media for germination and growth of horticultural plants

This research work was conducted in order to investigate the possibility of using spent mushroom substrate (SMS) in the production of horticultural seedlings replacing part of the peat in the growing media. Three vegetable species with different salt sensitivities, the less sensitive being tomato (Lycopersicon esculentum var. Muchamiel), the moderately salt-sensitive being courgette (Cucurbita pepo L. var. Afrodite F1) and the most salt-sensitive being pepper (Capsicum annum L. var. Lamuyo F1) were grown in 12 media containing SMS of two types of mushroom (Agaricus bisporus (SMS-AB) and Pleurotus ostreatus (SMS-PO)) or a mixture of both 50% (v/v) (SMS-50), as well as peat in various ratios. The proportions of each residue in the mixtures elaborated with peat were 25%, 50%, 75% and 100% v/v residue. A substrate of 100% peat was used as control. The experiment was arranged in a completely-randomised design with two replicates per treatment under greenhouse conditions. Prior to sowing, some physical, physico-chemical and chemical properties of the growing media were determined and seed germination and fresh weight of seedling were also measured. In most of the cases, the addition of SMS to the growing media produced an increase in the pH values, salt contents, macro and micronutrient concentrations and a decrease in the water holding capacity contents in comparison to peat, whereas great differences were found in the air capacity values between SMS-based substrates and peat. Up to 75% SMS can be used in mixtures with peat for seed germination of the plant species studied. Regarding the most suitable SMS-based substrates for plant growth, any substrate could be used for tomato seedling production. However, all SMS-AB-based substrates and the media containing low dose of SMS-PO and SMS-50 were adequate for growth of courgette and pepper.

Effect of sunitinib on TRAIL-induced apoptosis in preclinical colon cancer models

e14633

Background: Tumor necrosis factor related apoptosis-inducing ligand (TRAIL) is a potent inducer of apoptosis, however not all cancers respond to TRAIL, which may be due to activation of survival signals. Sunitinib is a potent inhibitor of multiple receptor tyrosine kinases, including vascular endothelial growth factor receptor (VEGFR) and platelet-derived growth factor receptor (PDGFR). These receptors and their signaling cascades promote cell survival and drug resistance. Inhibition of these pathways with sunitinib may augment TRAIL-mediated apoptosis. Aims: 1) Determine sensitivity of colon cancer cell lines to the combination of TRAIL and sunitinib, 2) identify mechanism by which sunitinib enhances TRAIL-mediated apoptosis, and 3) investigate the anticancer activity of this drug combination in xenograft models. Methods & Results: Sunitinib enhanced the anticancer activity of TRAIL in HCT116 and HCT15 colon cancer cell lines, with increased caspase cleavage and DNA fragmentation using western blot analysis and propidium iodide staining, respectively. Overexpression of Bcl-2 in HCT116 cells reduced TRAIL+sunitinib-mediated apoptosis, suggesting that sunitinib enhances TRAIL-induced apoptosis via activation of the mitochondrial apoptotic pathway. Sunitinib enhanced TRAIL-induced JNK activation, which may play a role in TRAIL+sunitinib-mediated apoptosis. Xenograft models of HCT116 and HCT15 were established in nude mice and treated with TRAIL, sunitinib, or the combination. The TRAIL+sunitinib combination significantly reduced tumor burden in both xenograft models compared to either treatment alone. The reduction in tumor volume correlated with increased apoptosis and decreased tumor proliferation and angiogenesis as determined by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay and immunohistochemistry for Proliferating Cell Nuclear Antigen and VEGF. Conclusion: These results are the first to demonstrate that simultaneous treatment with TRAIL and sunitinib reduced cell viability, induced apoptosis, inhibited tumor proliferation and angiogenesis in both in vitro and in vivo models of colon cancer, and warrants further investigation.

No significant financial relationships to disclose.

Endoscopic pneumatic balloon dilation in primary achalasia: predictive factors, complications, and long-term follow-up

Pneumatic dilation (PD) has been widely used in the treatment of idiopathic achalasia with a 70-90% response. The aim of this study was to evaluate the effectiveness of PD and its predictive factors by means of clinical assessment. In addition, we evaluated its safety and the need for subsequent surgical intervention. Fifty-six patients were treated with a Witzel dilator. The response was evaluated at medium (1-5 years) and long term (>5 years). Diverse possible predictive factors to response were analyzed. After the first PD, 85.7% of the 56 patients improved and passed from clinical stage II-III to clinical stage 0-I (P < 0.005). After the second dilation, 84.6% of the patients (13) passed to clinical stage 0-I (P < 0.05). Only patients who were not young (>40 years) avoided a second dilation and/or surgery (P < 0.001). During the first 5 years of follow-up, 80% of patients maintained their response; this percentage decreased to 58% after 10 years. PD therapy of achalasia is a safe technique, with few adverse effects (4% perforations and 10% gastroesophageal reflux). It offers a medium-term response of 80% and long-term response of around 60%. Age was the only predictive response factor.

Multiple Factor Analysis of the Autonomous Nervous System during PTCA

This study describes the Autonomic Nervous System (ANS) response before, during and after a percutaneous transluminal coronary angioplasty (PTCA). The study population consisted of 37 patients undergoing PTCA from Staff-3 Database. Classical Heart rate variability (HRV) parameters: RR mean, SD, rMSSD, LF, HF, LF/HF and LF/(HF+LF) were extracted and a multiple factorial analysis (MFA) was carried out. Preliminary results show that sympathetic activity increases during and after PTCA, and global HRV decreases during PTCA and increases after PTCA. These findings suggest that MFA provides a powerful tool allowing assessment of ANS's response during PTCA.

[Complications of endoscopic retrograde cholangiopancreatography in patients aged more than 90 years old]

INTRODUCTION

To evaluate the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) and the complication rates of this procedure in patients aged 90 years and older.

PATIENTS AND METHOD

A descriptive, prospective study including 42 endoscopic procedures performed from first January 2001 until first June 2004 in 36 patients (7 males and 29 females) was performed. The mean age was 91 years (range 90-96 years). All patients underwent the following: a) clinical evaluation before and after endoscopic exploration; b) evaluation of the success or failure of the endoscopic procedure and c) assessment of complications (perforation, hemorrhage, pancreatitis and infection). Concurrent associated illnesses, as well as the existence of anatomical alterations in Vaters papilla (duodenal diverticula), were also evaluated.

RESULTS

ERCP was successful in 85.7% of all explorations performed. Twenty-three patients (63.8%) had one or more major associated diseases. In 15 patients (33.3%) Vaters papilla was associated with duodenal diverticula. The complication rates were as follows: 1) acute pancreatitis in 2 explorations (4.7%), one mild (2.35%) and the other moderate (2.35%); 2) hemorrhage after endoscopic sphincterotomy in 2.8% of patients (1/35); 3) bacteriemia in one patient (2.3%) and cholangitis in one patient (2.3%), with no cases of secondary cholecystitis; 4) hypoxemia in one patient. There were no perforations or deaths related to the procedure.

CONCLUSION

ERCP is a safe and effective technique with a low complication rate in patients aged 90 years or older.

Quilotórax bilateral masivo en postoperatorio de gastrectomía subtotal

Chylothorax is a lymphatic effusion of chylous in the pleural space due to thoracic duct obstruction or injury. The most frequent aetiology is cancer; it is also related to chest trauma and iatrogenic. We describe the case of bilateral chylothorax in a 76-year-old woman, right predominant, during the post-operational phase of gastric surgery. This presented itself with respiratory insufficiency and tachycardia without initial haemodynamic compromise. It presented a favourable evolution after conservative treatment, cessation of oral intake and TPN and chest tube during 10 to 14 days.

Intranasal vaccination with streptococcal fibronectin binding protein Sfb1 fails to prevent growth and dissemination of Streptococcus pyogenes in a murine skin infection model

Fibronectin binding protein F1 (Sfb1) of Streptococcus pyogenes (group A streptococcus [GAS]) is a well-characterized adhesin that has been shown to induce protection in mice against a lethal intranasal GAS challenge after intranasal immunization with cholera toxin B subunit (CTB) as adjuvant. With a murine skin infection model, we have shown that Sfb1/CTB vaccination neither elicits opsonizing antibodies nor prevents systemic bacterial growth and dissemination to internal organs after a subcutaneous GAS challenge. These results indicate that an Sfb1-based vaccine should be complemented with additional protective antigens in order to be used in areas such as the tropical north of Australia, where the skin is the primary route of entry for invasive streptococcal diseases.

Ionic shell and subshell structures in aluminum and gold nanocontacts

Conductance histograms of aluminum and gold nanocontact rupture are studied experimentally and simulated using embedded atom potentials to assess the interplay between electronic and structural properties at room temperature. Our results reveal a crossover from quantized conductance structures to crystalline faceting or geometric shell/subshell structures at 300 K. The absence of electronic shell structure in gold and aluminum is in stark contrast with the behavior of alkaline metal nanowires which emulate their cluster counterparts. Semiclassical arguments suggest why rapid dominance of ionic structures takes place, and possible nanowire architectures are proposed in consistency with both the experimental and simulated nanocontact data.

[Trihalomethanes in the drinking water of Carabobo State, Venezuela]

OBJECTIVE

Disinfection of water with chlorine in water treatment plants leads to the formation of trihalomethanes (THMs). These compounds are associated with adverse health effects. The aim of this study was to analyze THM concentrations in the water provided for human consumption in the two main water treatment systems of Carabobo State: the Alejo Zuloaga plant and the Pao-Cachinche reservoir, which form the Central Regional System I (CRS I), and the Lucio Baldo Soules plant and the Pao-La Balsa reservoir, which form the Central Regional System II (CRS II).

METHODS

We analyzed 144 water samples collected in 6 samplings carried out in 2000 and 2001. THM concentrations were determined by gas chromatography using the headspace technique. The concentrations of the following THMs were measured: chloroform (CHCl3), bromoform (CHBr3), chlorodibromomethane (CHBr2Cl) and bromodichloromethane (CHCl2Br).

RESULTS

The concentration of total THMs was between 47.84 g/l and 94.23 g/l. CHCl3 was the most commonly formed compound representing 83% of all THMs in the CRS I and 82% in the CRS II. The concentrations of total THMs in the CRS I, specifically in the Baja and San Diego networks, were significantly higher (p < 0.05) than permissible levels set by the American Environmental Protection Agency (80 g/l) for the sum of all four THMs.

CONCLUSIONS

The results show that in the area studied there is a risk of adverse health effects due to THMs in drinking water, especially in the Baja and San Diego networks.

Prospective evaluation of magnetic resonance cholangiopancreatography in patients with biliary disease: comparative study with conventional ultrasonography and endoscopic retrograde cholangiopancreatography diagnostic algorithm

BACKGROUND

Magnetic resonance cholangiopancreatography is an accurate technique that can replace invasive diagnostic methods of the biliary and pancreatic duct.

AIMS

Our aim was to assess sensitivity and specificity of magnetic resonance cholangiopancreatography and ultrasonography using the results of endoscopic retrograde cholangiopancreatography as reference, and to establish a diagnostic algorithm under which circumstances magnetic resonance cholangiopancreatography can replace endoscopic retrograde cholangiopancreatography.

PATIENTS

Eighty-three patients with suspicion of biliary disease based on clinical, biochemical and ultrasonography findings were studied.

METHODS

Ultrasonography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were performed, comparing the results of the techniques for the determination of their sensitivity and specificity.

RESULTS

Sensitivity and specificity results obtained by magnetic resonance cholangiopancreatography were: 100 and 92.8% when dilated ducts were detected (n=61); 97.4 and 97.2% in the diagnosis of choledocholithiasis (n=38); 100 and 96.7% in malignant lesions (n=14) and 81.8 and 98.4% when biliary ducts were normal. The percentage of images of diagnostic quality was 97.6%. Sensitivity and specificity achieved by ultrasonography was: 100 and 57.1% in detection of dilatation, 71 and 97.2% in choledocholithiasis, 92.8 and 96.7% in malignancy and 66.6 and 96.8% in normal ducts.

CONCLUSIONS

Magnetic resonance cholangiopancreatography is a technique with high sensitivity and specificity in the evaluation of biliary ducts. Thus, magnetic resonance cholangiopancreatography may replace diagnostic endoscopic retrograde cholangiopancreatography for purely diagnostic purposes, following an initial clinical and ultrasonographic exam.

Identificación de las variables de influencia en los tiempos de espera en atención especializada

OBJECTIVE

To identify the variables influencing waiting time for specialized care (waiting lists) through multiple regression analysis and to analyze the health districts with long waiting times according to these variables.

DESIGN

Descriptive, cross sectional and retrospective study of waiting times for access to specialized care between 1997 and 1998.

SETTING

Area 20 of the Health Department of the Autonomous Community of Valencia (Spain) consisting of 12 health districts with 204,424 inhabitants.

INTERVENTIONS

The following variables were gathered: variables influencing demand: type of municipality, aging and indexes of dependent population, and percentage of pensioners; variables influencing supply: age, sex, training and professional stability of the doctor, and size of the patient list; variables influencing resource consumption: percentage of referrals to specialized care per thousand inhabitants, mean WT for access to specialized care (in natural days) by district and year, number of consultations, and workload. A multiple regression model was constructed through (backward) elimination, taking the mean WT as the dependent variable and the remaining variables as independent variables. The resulting equation enabled calculation of the expected WT per health district and the deviation of the real WT from the expected WT. A district was considered to have a high WT when its deviation was above the mean plus one standard deviation of the distribution.

RESULTS

The mean WT for access to specialized care was 37 days in 1997 and 34 days in 1998. A significant correlation (p < 0.005) was found between WT and the percentage of the population aged less than 14 years (r = 0.693), the percentage of the population aged between 14-65 years (r = 0.517), the number of consultations (r = 0.689), and coastal population (r = 0.470). Our final model included: percentage of the population aged less than 14 years, number of consultations, and coastal population (F = 41.803; p < 0.000; r = 0.945; r2 = 0.893). Three districts (37.5%) with high WTs were identified.

CONCLUSIONS

The number of consultations, the percentage of the pediatric population, and proximity to the coast were closely correlated with WT for specialized care, with a consequent influence on waiting lists.

Viscosity minimum in bimodal concentrated suspensions under shear

We study a model of concentrated suspensions under shear in two dimensions. Interactions between suspended particles are dominated by direct-contact viscoelastic forces and the particles are neutrally bouyant. The bimodal suspensions consist of a variable proportion between large and small droplets, with a fixed global suspended fraction. Going beyond the assumptions of the classical theory of Farris (R.J. Farris, Trans. Soc. Rheol. 12, 281 (1968)), we discuss a shear viscosity minimum, as a function of the small-to-large-particle ratio, in shear geometries imposed by external body forces and boundaries. Within a linear-response scheme, we find the dependence of the viscosity minimum on the imposed shear and the microscopic drop friction parameters. We also discuss the viscosity minimum under dynamically imposed shear applied by boundaries. We find a reduction of macroscopic viscosity with the increase of the microscopic friction parameters that is understood using a simple two-drop model. Our simulation results are qualitatively consistent with recent experiments in concentrated bimodal emulsions with a highly viscous or rigid suspended component.