Nuclear localization of the Hermes transposase depends on basic amino acid residues at the N-terminus of the protein

For the Hermes transposable element to be mobilized in its eukaryotic host, the transposase, encoded by the element, must make contact with its DNA. After synthesis in the cytoplasm, the transposase has to be actively imported into the nucleus because its size of 70.1 kDa prevents passive diffusion through the nuclear pore. Studies in vitro using transient expression of a Hermes-EGFP fusion protein in Drosophila melanogaster Schneider 2 cells showed the transposase was located predominantly in the nucleus. In silico sequence analysis, however, did not reveal any nuclear localization signal (NLS). To identify the sequence(s) responsible for localization of Hermes transposase in the nucleus, truncated or mutated forms of the transposase were examined for their influence on sub-cellular localization of marker proteins fused to the transposase. Using the same expression system and a GFP-GUS fusion double marker, residues 1-110 were recognized as sufficient, and residues 1-32 as necessary, for nuclear localization. Amino acid K25 greatly facilitated nuclear localization, indicating that at least this basic amino acid plays a significant role in this process. This sequence overlaps the proposed DNA binding region of the Hermes transposase and is not necessarily conserved in all members of the hAT transposable element family.

In situ sensing of volatile organic compounds in groundwater: first field tests of a mid-infrared fiber-optic sensing system

A prototype mid-infrared sensor system for the determination of volatile organic pollutants in groundwater was developed and tested under real-world conditions. The sensor comprises a portable Fourier transform infrared spectrometer, coupled to the sensor head via mid-infrared transparent silver halide fiber-optic cables. A 10 cm unclad middle section of the 6-m-long fiber is coated with ethylene propylene copolymer in order to enrich the analytes within the penetration depth of the evanescent field protruding from the fiber sensor head. A mixture of tetrachloroethylene, dichlorobenzene, diethyl phthalate, and xylene isomers at concentrations in the low ppm region was investigated qualitatively and quantitatively in an artificial aquifer system filled with Munich gravel. This simulated real-world site at a pilot scale enables in situ studies of the sensor response and spreading of the pollutants injected into the system with controlled groundwater flow. The sensor head was immersed into a monitoring well of the aquifer system at a distance of 1 m downstream of the sample inlet and at a depth of 30 cm. Within one hour, the analytes were clearly identified in the fingerprint region of the IR spectrum (1300 to 700 cm(-1)). The results have been validated by head-space gas chromatography, using samples collected during the field measurement. Five out of six analytes could be discriminated simultaneously; for two of the analytes the quantitative results are in agreement with the reference analysis.

Repetition of suicidal behaviour in elderly Europeans: a prospective longitudinal study

The aim of this study was to assess any predictive factors for repeated attempted suicide and completed suicide in a 1-year follow-up on a sample of elderly European suicide attempters (60 years and over). From 1990 to 1993, 63 subjects completed the first interview and were recontacted after 1 year. At follow-up, eight subjects (12.7%) had taken their lives and seven (11.1%) had repeated at least one suicide attempt. On comparison of repeaters and non-repeaters, differences emerged in terms of death of the father in childhood and for mean Suicidal Intent Score. At the end of follow-up period, repeaters reported a more frequent desire to repeat suicidal behaviour and judged their mental health and social assistance received to be worse. Suicides and non-repeaters differed especially in relation to death of father during childhood and number of contacts with General Practitioner. Interpretation of the results must take into account the smallness of the test sample, the difficulties in obtaining complete data for the follow-up interview, the lack of a control group and a diagnosis formulated in a hospital consultation setting. The study confirms, however, the high risk of repetition of suicidal behaviour in the elderly. In old age suicidal ideation is often sustained over long periods of time and requests for help are addressed to relatives and GPs. An interesting finding is the more frequent death of the father during childhood among repeaters.

Does the proposed DSE motif form the active center in the Hermes transposase?

Donor cleavage and strand transfer are two functions performed by transposases during transposition of class II transposable elements. Within transposable elements, the only active center described, to date, facilitating both functions, is the so-called DDE motif. A second motif, R-K-H/K-R-H/W-Y, is found in the site-specific recombinases of the tyrosine recombinase family. While present in many bacterial insertion sequences as well as in the eukaryotic family of mariner/Tc1 elements, the DDE motif was considered absent in other classes of eukaryotic class II elements such as P, and hAT and piggyBac. Based on sequence alignments of a hobo-like element from the nematode Caenorhabditis elegans, to a variety of other hAT transposases and several members of the mariner/Tc1 group, Bigot et al. [Gene 174 (1996) 265] proposed the presence of a DSE motif in hAT transposases. In the present study we tested if each of these three residues is required for transposition of the Hermes element, a member of the hAT family commonly used for insect transformation. While D402N and E572Q mutations lead to knock-out of Hermes function, mutations S535A and S535D did not affect transposition frequency or the choice of integration sites. These data give the first experimental support that D402 and E572 are indeed required for transposition of Hermes. Furthermore, this study indicates that the active center of the Hermes transposase differs from the proposed DSE motif. It remains to be shown if other residues also form the active site of this transposase.

Glycine activates myenteric neurones in adult guinea-pigs

1. We studied the effects of glycine on myenteric neurones and muscle activity in the colon and stomach of adult guinea-pigs. 2. Intracellular recordings revealed that myenteric neurones responded to local microejection of glycine (1 mM) with a fast, transient membrane potential depolarisation (57 % of 191 colonic neurones and 26 % of 50 gastric neurones). Most glycine-sensitive neurones had ascending projections and were choline acetyltransferase immunoreactive. Glycine preferentially activated neurones with a late afterhyperpolarisation (AH-neurones) and tonic spiking neurones with fast synaptic inputs (tonic S-neurones) but less frequently phasic S-neurones and inexcitable (non-spiking) neurones. The depolarisation had a reversal potential at -19 +/- 13 mV, which was increased by 18 +/- 10 % upon lowering extracellular chloride concentration and decreased by 38 +/- 14 % in furosemide (frusemide, 2 mM). 3. Strychnine (300 nM) reversibly abolished the glycine-induced depolarisation and the Cl(-) channel blocker picrotoxin (100 microM) reduced the amplitude of the depolarisation by 55 +/- 5 %. The glycine effect was a postsynaptic response because it was not changed after nerve blockade with tetrodotoxin (1 microM) or blockade of synaptic transmission in reduced extracellular [Ca(2+)]. The effect was specific since the response was not changed by the nicotinic antagonists hexamethonium (200 microM) and mecamylamine (100 microM), the GABA(A) receptor antagonist bicuculline (10 microM), the NMDA antagonist MK-801 (20 microM) or the 5-HT(3) antagonist ICS 205930 (1 microM). 4. Glycine (1 mM) induced a tetrodotoxin- and strychnine-sensitive contractile response in the colon; the contractile response in the stomach was tetrodotoxin insensitive. 5. Glycine activated myenteric neurones in the adult enteric nervous system through strychnine-sensitive mechanisms. The glycine-evoked depolarisation was caused by Cl(-) efflux and the maintenance of relatively high intracellular chloride concentrations involved furosemide-sensitive cation-chloride co-transporters.

Projections of excitatory and inhibitory motor neurones to the circular and longitudinal muscle of the guinea pig colon

The aim of this study was to identify myenteric pathways to the circular and longitudinal muscle of the guinea pig proximal colon. To identify excitatory and inhibitory muscle motoneurones, we applied the neuronal retrograde tracer DiI onto the circular or longitudinal muscle layer and performed additional immunohistochemistry for nitric oxide synthase (NOS) and choline acetyltransferase (ChAT). On average 166 +/- 81 circular muscle motoneurones (CMMN) and 100 +/- 74 longitudinal muscle motoneurones (LMMN) were labelled by DiI tracing. Myenteric pathways innervating the muscle were either ascending (DiI-labelled neurones with oral projections) or descending (DiI-labelled neurones with anal projections). The circular muscle was preferentially innervated by ascending pathways (66.0 +/- 9.1%). Most ascending CMMN were ChAT-positive (87.2 +/- 8.5%), whereas descending CMMN were mainly NOS-positive (82.3 +/- 14.6%). Most ascending (62.2 +/- 11.1%) and descending (82.0 +/- 12.5%) CMMN had circumferential projection preferences (circumferential projections were longer than projections along the longitudinal gut axis). In contrast to the polarised projections to the circular muscle, the longitudinal muscle was equally innervated by ascending (46.2 +/- 15.1%) and descending (53.9 +/- 15.1%) neurones. Ascending and descending pathways to the longitudinal muscle consisted predominantly of ChAT-positive neurones (98.1 +/- 1.9% and 68.0 +/- 8.5%, respectively), and both pathways had prominent longitudinal projection preferences. Only 25.5% of the descending LMMN were NOS-positive. In conclusion, the circular muscle in the proximal colon is innervated by descending inhibitory (NOS-positive neurones) and ascending excitatory (ChAT-positive neurones) pathways. In contrast, the longitudinal muscle is primarily innervated by ascending and descending excitatory motoneurones, and only a small proportion of the descending pathway consisted of inhibitory motoneurones.

Neurotransmitter coding of enteric neurones in the submucous plexus is changed in non-inflamed rectum of patients with Crohn's disease

Knowledge of the neurochemical coding of submucosal neurones in the human gut is important to assess neuronal changes under pathological conditions. We therefore investigated transmitter colocalization patterns in rectal submucosal neurones in normal tissue (n=11) and in noninflamed tissue of Crohn's disease (CD) patients (n=17). Neurone-specific enolase (NSE), choline acetyltransferase (ChAT), vasoactive intestinal polypeptide (VIP), substance P (SP), nitric oxide synthase (NOS) and calcitonin gene-related peptide (CGRP) were detected immunohistochemically in whole-mount preparations from rectal biopsies. The neuronal marker NSE revealed no differences in the number of cells per ganglion (controls 5.0; CD 5.1). Four cell populations with distinct neurochemical codes were identified. The sizes of the populations ChAT/VIP (58% vs. 55%), ChAT/SP (8% vs. 8%), and ChAT/- (22% vs. 22%) were similar in control and CD. The population VIP/- was significantly increased in CD (12% vs. 2% in controls). Unlike in controls, all NOS neurones colocalized ChAT in CD. Thickened CGRP-fibres occurred in CD. We identified neurochemically distinct populations in the human submucous plexus. The increase in the VIP/- population, extensive colocalization of ChAT and NOS and hypertrophied CGRP fibres indicated adaptive changes in the enteric nervous system in noninflamed rectum of CD patients.

Quercetin 3,3',4'-tri-O-beta-D-glucopyranosides from leaves of Eruca sativa (Mill.)

Three new quercetin 3,3',4'-tri-O-beta-D-glucopyranosides isolated from leaves of Eruca sativa (Mill.) were identified as quercetin 3,3',4'-tri-O-beta-D-glucopyranoside, quercetin 3'-(6-sinapoyl-O-beta-D-glucopyranosyl)-3,4'-di-O-beta-D-glucopyranoside and quercetin 3-(2-sinapoyl-O-beta-D-glucopyranosyl)-3'-(6-sinapoyl-O-beta-D-glucopyranosyl)-4'-O-beta-D-glucopyranoside. The structures were established by one- and two-dimensional 1H and 13C NMR spectra as well as b

A cross-cultural study of suicide intent in parasuicide patients

As part of the WHO/EURO Multicentre Study on Parasuicide, the level of suicide intent among female and male parasuicide patients from various European regions was compared. From nine regions, a total of 1,212 parasuicide patients, 752 females and 460 males, were included in the study. Although some statistical significant differences in level of suicide intent between the regions and genders were found, the effect sizes of these relationships were so small that the differences have neither theoretical nor practical significance. As far as level of suicide intent is concerned, the WHO study has succeeded in recruiting a relatively homogeneous group of self-harming patients across borders of region, culture, and country.

Hermes-mediated germ-line transformation of the Mediterranean fruit fly Ceratitis capitata

We report the use of the Hermes transposable element for germ-line transformation of the Mediterranean fruit fly, Ceratitis capitata. Hermes was able to genetically transform this insect at an estimated frequency between 0.6 and 1.1%, which is comparable to the transformation frequencies obtained for this species when using other transposable elements. Hermes integrates into the medfly genome by a cut-and-paste mechanism and the sequences integrated into the genome are delimited by the terminal nucleotides of the Hermes inverted terminal repeats. Integration resulted in the generation of 8 bp target site duplications, the sequences of which conformed to the target site duplications generated by hAT element transposition in insects. The Hermes element is one additional genetic tool that can be deployed in manipulating and characterizing the medfly genome.

Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour

OBJECTIVE

The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989-93).

METHODS

Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres.

RESULTS

Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study.

An exercise in improving suicide reporting in print media

This study was conducted to support the publication of guidelines for media reporting on suicide. First, quantitative and qualitative aspects of suicide reporting in Swiss print media were surveyed over a time span of 8 months. The results were presented at a national press conference, and written guidelines for suicide reporting were sent out to all newspaper editors. The results of the survey and the guidelines were discussed in a personal meeting with the Editor-in-Chief of the main tabloid. After the publication of the guidelines a second, identical survey was conducted. The main variables regarding frequency, form, and content of the newspaper reports before and after the press conference were compared. The number of articles, on the one hand, increased over the 3 years between the first and second survey, but the quality of reporting clearly improved on the other. The personal contact with the editor of the tabloid was probably the most effective means of intervention.

Enteric pathways in the stomach

This report summarises the characteristics of target specific projection and neurochemical coding patterns of motor and interneuronal pathways in the gastric enteric nervous system (ENS) which are involved in the innervation of the mucosa, the circular and the longitudinal muscle. The pathways were identified by retrograde tracing and further characterised by optical and intracellular recordings of the synaptic activation of muscle motor neurones, and by recordings of pathway-specific muscle responses. All motor pathways had polarised projections consisting of ascending cholinergic and descending nitrergic populations. Thus, both muscle layers were innervated by excitatory and inhibitory motor neurones. Their projections indicated the presence of intrinsic circuits that mediate excitatory and inhibitory components of a peristaltic reflex and/or are involved in reflex mediated changes in gastric tone. Although polarised projections were also identified for interneuronal pathways, a substantial proportion of descending interneurones was cholinergic. Interneurones and longitudinal muscle motor pathways had longitudinal projection preferences whereas circular muscle motor pathways had circumferential projection preferences. Target-specific coding was primarily revealed for cholinergic populations; ChAT/ENK/+/-SP neurones projected to the muscle layers, ChAT/NPY/+/-VIP projected to the mucosa and ChAT/+/-SP/+/-5-HT/+/-Calret/+/-Calb were interneurones. Muscle strip recordings revealed the functional significance of ascending excitatory and descending inhibitory pathways to the circular muscle and the prominent influence of ascending and descending cholinergic interneurones which activated excitatory and inhibitory circular muscle motor neurones through nicotinic synapses. It is concluded that enteric pathways in the stomach have region specific features which reflect structural and functional adaptation of the gastric ENS.

Projections and neurochemistry of interneurones in the myenteric plexus of the guinea-pig gastric corpus

Recently, motor neurones of the myenteric plexus innervating the muscle layers or the mucosa have been identified in the guinea-pig stomach. We applied the neuronal tracer DiI (1,1'-didodecyl-3,3,3', 3'-tetramethylindocarbocyanine perchlorat) onto myenteric ganglia in order to identify populations of interneurones in the myenteric plexus of the guinea-pig stomach. The tracing was combined with the immunohistochemical detection of calbindinD28k (CALB), choline acetyltransferase (ChAT), neuropeptide Y (NPY) and 5-hydroxytryptamine (serotonin) (5-HT) and the results were compared to the neurochemical coding of target specific motor neurones. Long projecting ( approximately 5.4 mm) ChAT/CALB/+/-5-HT-, nitric oxide synthase (NOS)/CALB- and short projecting ( approximately 1.1 mm) ChAT/NPY-neurones were identified as descending interneurones. CALB positive ascending interneurones contained ChAT but rarely 5-HT (code: ChAT/CALB). This study identified ascending and descending interneurones in the gastric myenteric plexus and revealed the neurochemical coding of some of the interneurone populations.

Projections and neurochemical coding of motor neurones to the circular and longitudinal muscle of the guinea pig gastric corpus

The present study identified projection and neurochemical coding patterns of intrinsic circular (CMN) and longitudinal muscle motor neurones (LMN) in the guinea pig stomach by using the retrograde tracer DiI (1,1'-didodecyl-3,3,3',3'-tetramethylindocarbocya-nine perchlorate) in combination with the immunohistochemical demonstration of choline acetyltransferase (ChAT), enkephalin (ENK), neuropeptide Y (NPY), nitric oxide synthase (NOS) and substance P (SP). Populations of LMN and CMN had similar neurochemical coding and a clear polarity of projection. Taking all DiI-labeled cell bodies as 100%, ascending pathways exhibited the coding ChAT/- (CMN:14.7%/LMN: 18.3%), ChAT/ENK (15.7%/10.1%), ChAT/SP/+/-ENK (19.2%/16.4%), or ChAT/NPY (4.4%/7.6%); descending pathways had the coding NOS/- (13.8%/16.9%), NOS/NPY (9.9%/17%), NOS/ENK (4.4%/1.2%) or NOS/NPY/ENK (13.0%/5.5%). The relative contributions of these populations were not different between CMN and LMN. However, target-specific projection patterns were revealed: most LMN (82%) had longitudinal whereas most CMN (58%) had circumferential projection preferences. The results indicate that gastric circular and longitudinal muscle layers are innervated by ascending excitatory and descending inhibitory pathways in the myenteric plexus. The projection patterns of CMN and LMN were different and followed the orientation of the muscle layers. It is suggested that the specific muscle motor pathways in the gastric myenteric plexus coordinate the reflex-mediated phasic and tonic activity of gastric muscle layers.

Recommended care for young people (15-19 years) after suicide attempts in certain European countries

Data on recommended care for young people aged 15-19 years after attempted suicide from nine European research centres during the period 1989-1992 were analysed in terms of gender, history of previous suicide attempt and methods used. Altogether 438 suicide attempts made by 353 boys and 1,102 suicide attempts made by 941 girls were included. Analyses of the total data from all centres showed that young people with a history of previous suicide attempt and those using violent methods had significantly higher chance of being recommended aftercare than first-time attempters or those choosing self-poisoning. There were no significant differences of being recommended care between genders. Logistic regression analyses of the material were performed and the results were similar. Both having previous attempted suicide (odds ratio 2.0, 95% CI 1.53-2.61) and using "hard" methods (odds ratio 1.71, 95% CI 1.49-1.96) were significantly associated with increased possibility of being recommended aftercare. When individual centres were analysed, large disparities of recommended care after suicide attempts were found and there were no uniform criteria of recommending care for young suicide attempters in Europe.

Esophageal obstruction caused by a left aortic arch and an anomalous right patent ductus arteriosus in two German Shepherd littermates

OBJECTIVE

To present details of surgical management of an unusual vascular ring anomaly in two German Shepherd littermates.

STUDY DESIGN

Clinical case report.

STUDY POPULATION

Three-month-old intact male and female German Shepherd littermates.

RESULTS

In each dog, the esophagus was obstructed by a vascular ring comprised of the left aortic arch, an anomalous patent right ductus arteriosus, and the pulmonary artery ventrally. Surgical treatment consisted of dividing and oversewing the patent right ductus arteriosus. Neither dog has clinical signs of esophageal disease one year after treatment.

CONCLUSION AND CLINICAL RELEVANCE

This vascular ring anomaly should be considered a possibility in any young dog with esophageal obstruction and a machinery murmur.

Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide

BACKGROUND

National suicide statistics show remarkable differences in the frequencies of various methods used for completed suicide. The WHO/EURO Multicentre Study on Parasuicide makes possible for the first time an international comparison of the frequencies of methods used in attempted suicide, because the data are based on geographical catchment areas of medical institutions.

METHOD

Ongoing standardized monitoring of attempted suicide in all medical institutions serving the catchment areas was performed in 14 centres in 12 European countries. The data analysis is based on 20,649 events involving 15,530 persons, recorded between 1989 and 1993.

RESULTS

The comparison of rates per 100,000 shows striking differences between the centres. The highest rates for drug overdoses were found for female attempters in Oxford (347/100,000), Helsinki (238/100,000) and Stockholm (221/100,000). Guipuzcoa had the lowest rates (61/100,000). The differences were most prominent in the age group 15-24, with outstanding rates for women in Oxford (653/100,000), which was mainly due to the frequent use of analgesics. Szeged had outstandingly high rates for pesticides and solvents. In some centres the use of multiple methods was frequent.

CONCLUSIONS

There is a need, especially for areas with high frequencies for certain methods, to understand the factors involved and to develop new and specific prevention projects and to monitor their effects. The WHO/EURO Multicentre Study on Parasuicide has proved to be a useful and reliable instrument for continuous monitoring of trends in parasuicide.

Green fluorescent protein as a genetic marker in transgenic Aedes aegypti

We report here the use of the enhanced green fluorescent protein (EGFP) from the jellyfish, Aequorea victoria, as a genetic marker for the genetic transformation of mosquitoes. The EGFP gene, under the control of the actin5C promoter of Drosophila melanogaster was inserted into the Hermes transposable element. Preblastoderm embryos of a wild-type strain of the yellow fever mosquito, Aedes aegypti, were microinjected with this plasmid, together with a helper plasmid containing the Hermes transposase placed under the control of the D. melanogaster hsp70 promoter. Somatic EGFP expression was observed during early instars in approximately one-half of all G0 individuals. Two G1 individuals arising from a G0 female displayed high levels of EGFP gene expression during all stages of development. EGFP was transmitted in a Mendelian fashion to the G2 and G3 generations and molecular analysis confirmed the presence of the Hermes[actin5C:EGFP] gene in these insects. These results clearly demonstrate that EGFP can be used as an effective genetic marker in wild-type Ae. aegypti and most likely in other mosquito species as well.

Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO)

OBJECTIVE

The aim of this research was to identify psychosocial characteristics which might predict future suicidal behavior in parasuicidal subjects in Europe.

METHOD

The interview utilized for the survey (European Parasuicide Study Interview Schedule--EPSIS) was administered to 1269 parasuicides aged fifteen years and over, within one week of hospital admission after a suicide attempt, and is part of a longitudinal multicenter study. EPSIS included a brief medical questionnaire, scales rating depression, hopelessness, self-esteem, suicide intention, questions on sociodemographic characteristics, an interview on life events and social support, a description of the parasuicidal act, and an evaluation of factors precipitating the index parasuicide.

RESULTS

Physical illness proved to be very frequent among suicide attempters. One in two subjects suffered from an acute, chronic, or chronic disorder in relapse at the time of the parasuicide. Subjects with a physical illness were significantly more depressed, particularly subjects from the intermediate age band and ones affected by a chronic physical disease in relapse. Forty-two percent of patients with physical illness rated their somatic problem as a factor precipitating the attempt and 22 percent judged it to be major one. Furthermore, subjects with physical illnesses considered psychiatric symptoms and disorders to be relevant factors in triggering suicidal behavior, to a greater extent than non-sufferers. The importance of physical illness in contributing to suicidal behavior increased with advancing age.

CONCLUSIONS

More careful attention to somatic conditions and their subjective implications would probably augment chances of effectively preventing suicide.

Sporadic tuberculous meningoencephalitis

Tuberculous meningoencephalitis in a 24-month-old boy is reported. He contracted the infection from his apparently healthy grandfather with unnoticed pulmonary tuberculosis, as suggested by restriction fragment length polymorphism analysis of the isolated pathogen.

The enteric nervous system: region and target specific projections and neurochemical codes

The goal of this report is to summarise the current knowledge on the projection pathways of enteric neurones innervating the muscle and mucosa in different regions of the gut. Combination of neuronal tracing, immunohistochemical and electrophysiological methods has allowed researchers to gain insight into the enteric hardwiring of specific target tissue in the gut. A polarised innervation pattern of the circular muscle was demonstrated for the stomach fundus/corpus and the ileum with descending pathways being primarily nitrergic while ascending pathways were primarily cholinergic. This characteristic hardwiring is thought to set in part the functional basis for peristalsis. A similar polarised innervation pathway was found for the enteric innervation of the mucosa in the stomach and large intestine but not in the small intestine. In both the stomach (myenteric neurones) and in the proximal and distal colon (submucosal neurones), ascending pathways to the mucosa are primarily cholinergic while descending pathways are primarily non-cholinergic. In the colon, results suggest that activation of both pathways induces a cross potentiation of cholinergic and vasoactive intestinal polypeptidergic mediated secretion. Furthermore, a large population of myenteric neurone s projecting to the mucosa in the small and large intestine are probably intrinsic primary afferent neurones sensitive to mechanical as well as chemical stimuli.

Immunohistochemical evidence for the presence of calbindin containing neurones in the myenteric plexus of the guinea-pig stomach

Using immunohistochemistry we studied the presence of calbindin in myenteric neurones of the guinea-pig stomach. A rabbit anti recombinant rat calbindin-D28k (CALB) stained 12, 12 and 25% of all myenteric neurones in the fundus, corpus and antrum, respectively. A rabbit anti recombinant human CALB stained 4, 4 and 16%, respectively. A mouse monoclonal antibody against the chicken intestinal CALB showed no labelling. In all regions most calbindin neurones were additionally choline acetyltransferase (ChAT) positive while only a small proportion exhibited nicotinamide adenosine dinucleatide phosphate (NADPH)-diaphorase-activity. Numerous calbindin-positive varicose nerve fibres were present within myenteric ganglia, rarely detectable in the muscle layers and virtually absent in the mucosa. This study demonstrated that a supopulation of cholinergic myenteric neurones in the stomach contain calbindin and suggested that many of these neurones fulfil interneuronal tasks.

Attempted suicide and major public holidays in Europe: findings from the WHO/EURO Multicentre Study on Parasuicide

OBJECTIVE

The aim of the study was to examine the relationship between suicide attempts and major public holidays in Europe.

METHOD

The analysis was based on data on 24 388 suicide attempts by persons aged 15 years or older in the period 1989-1996. Data from 13 centres (representing 11 countries) participating in the WHO/EURO Multicentre Study on Parasuicide were analysed. The analysis of the fluctuation of suicide attempts around public holidays was based on the daily number of suicide attempts for each centre. For each day in the period under examination a mean number of suicide attempts (mu) was calculated. The analysis was based on the assumption that the data followed a Poisson distribution. The observed number of daily suicide attempts was compared with the expected number of attempts. A multiplicative model for the expected number in each centre was developed.

RESULTS

Before Christmas there were fewer suicide attempts than expected, and after Christmas there were approximately 40% more attempts than expected. In addition, more attempts than expected were registered on New Year's Day. In countries where people have the day off work on Whit Monday there were significantly fewer attempts during the 3 days before, but where Whit Monday is a normal working day significantly fewer attempts occurred on the Monday to Wednesday after Whit Sunday.

CONCLUSION

There appears to be a transposition of a significant number of suicide attempts from before (and during) a major public holiday until after it. The division of holidays into non-working and working days showed that a 'holiday effect' could only be found around major public holidays, particularly Christmas, Easter and Whitsun. These findings support the theory of the 'broken-promise effect' for major public holidays.

Synchronous RCC and TCC of the Kidney in a Patient With Multiple Recurrent Bladder Tumors

Development of concomitant renal TCC and RCC is an uncommon occurrence, yet many interesting issues can be addressed with this model. The possibility of misdiagnosing a renal TCC for an RCC, the options and importance of treating a retained ureteral stump after performing a radical nephrectomy for a renal TCC, and the risk of developing lower tract TCC in patients with upper tract TCC are some of the issues raised in this case review.

Attempted suicide. Do we understand the patients' reasons?

This explorative study compared the patients', doctors', and nurses' views regarding their attribution of reasons for attempting suicide and the patients' emotional state immediately preceding their suicide attempts. A sample of 30 out of 94 consecutive patients seen in the emergency room of University Hospital were examined shortly after they had attempted suicide. Immediately after the routine clinical interview, conducted by a psychiatric resident and a nurse, patients filled in a questionnaire giving 14 possible reasons for attempting suicide as well as 8 feelings characterizing the emotional state preceding the suicide attempt. In the meantime, and without prior discussion of the case, the resident and the nurse independently completed the same questionnaire. In addition, sociodemographic and clinical data were obtained. Intrapersonal reasons such as to get relief from a terrible state of mind or from an unbearable situation were most frequently chosen by patients, nurses, and doctors alike. The most striking difference was found for "loss of control": this item was chosen significantly more often by patients than by nurses and doctors. Accordingly, patients reported significantly more often feelings of anxiety/panic and emptiness (mental vacuum), whereas feelings of despair and powerlessness/hopelessness were mentioned most frequently by nurses and doctors. Mental health professionals should bear in mind that many suicide attempters experience feelings of anxiety/panic prior to their suicidal act, and that a majority report having lost control over themselves, thus indicating a state of emotional crisis.

Structural and functional organization of the enteric nervous system in the stomach

This report summarises some features of the gastric enteric nervous system in the guinea-pig model. Particular attention has been paid to relations between neurochemical properties, electrophysiological and putative function of enteric neurones. (1) Cholinergic and nitrergic neurones form separate neuronal populations. (2) Ascending neurones outnumbered descending ones. (3) Transmitter-phenotype and projection were related: cholinergic neurones were primarily ascending while nitrergic neurones were mainly descending. (4) The neurochemical code, i.e. the transmitter colocalisation, could be related to the function of enteric neurones. Colocalisation of substance P and/or enkephaline in cholinergic neurones was characteristic for ascending excitatory muscle neurones. Descending inhibitory muscle neurones were nitrergic often colocalising the neuropeptides neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP). In the intrinsic innervation of the gastric mucosa NPY/VIP was abundant and colocalised in ascending cholinergic as well as descending nitrergic neurones. (5) The vast majority of ascending and descending interneurones were cholinergic and often colocalised NPY. (6) The majority of descending mucosa and descending inhibitory muscle neurones were tonically-firing neurones. Our results revealed the characteristics of some neural components within the enteric nervous system of the stomach which are involved in modulation of mucosa and muscle functions. It may be concluded that muscle and mucosa functions are under the control of the enteric nervous system which contains distinct populations responsible for motor and secretory activity.

Analysis of the expression pattern of the latent transforming growth factor beta binding protein isoforms in normal and diseased human liver reveals a new splice variant missing the proteinase-sensitive hinge region

Latent transforming growth factor beta binding protein (LTBP), a component of the extracellular matrix (ECM) of various tissues, is important for the secretion of TGF-beta and, furthermore, for the storage of TGF-beta in ECM. The proteolytic cleavage of LTBP is assumed to be the prerequisite for the activation of TGF-beta. We investigated the mRNA expression pattern of the three LTBP isoforms (LTBP-1, -2, -3) and the protein distribution of the components of the large latent TGF-beta complex, namely LTBP-1 and -2, latency-associated protein (LAP), and TGF-beta, in human liver using reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemical alkaline phosphatase anti-alkaline phosphatase (APAAP) staining. Parts of explanted livers diagnosed as hepatitis B, hepatitis C, primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC) and normal liver tissue were examined. LTBP transcripts were detected in the same manner in all liver specimens. Interestingly, we found a new splice variant of LTBP-1 (LTBP-1D), in which the sequence coding for the proteinase-sensitive hinge region is deleted. The corresponding parts of the human LTBP-2 and LTBP-3 cDNA coding for the hinge region were sequenced and show neither similar proteinase cleavage sites nor deleted cDNA sequences. The proposed proteinase cleavage site of mouse LTBP-3 seems not to be conserved in the human LTBP-3 gene. By immunohistochemistry, LTBP-1, -2, and LAP were detectable in normal and diseased livers and showed a different staining pattern for both LTBP isoforms. By contrast, TGF-beta showed a spotted staining pattern in diseased livers only, predominantly in the area of parenchymal cells that are close to fibrotic tissue. This strongly suggests the release of active TGF-beta from preexisting latent complexes. The LTBP-1D splice variant, which is probably less sensitive against proteolytic degradation and therefore may protect TGF-beta from activation, may have importance for modulating the biological activity of TGF-beta in normal and diseased liver.

Placement of a low-profile duodenostomy and jejunostomy device in five dogs

Five male crossbred dogs successfully underwent surgical placement of button enterostomy tubes to evaluate the placement technique, maintenance and complications of these tubes. Surgical placement was quick, technically straightforward and similar to techniques used for other feeding tubes. None of the dogs experienced life-threatening complications during the 10 month follow-up period. One device required replacement as it was removed by the dog before a permanent fistula had formed. Open tubes due to loose safety plugs and focal cellulitis surrounding the exit sites of these tubes were noted in all dogs. The button tube may be a feasible option for long-term nutritional support in patients with pancreatic, hepatobiliary or gastrointestinal conditions.

(Latent) transforming growth factor beta in liver parenchymal cells, its injury-dependent release, and paracrine effects on rat hepatic stellate cells

Cultured parenchymal liver cells (PC) were recently recognized to contain (latent) transforming growth factor beta (TGF-beta) while the expression of TGF-beta mRNA remains controversial. This study was designed to analyze PC in different microenvironments (liver in situ, highly purified, isolated, and cultured PC) regarding the qualitative and quantitative content of mature and latent TGF-beta protein (immunostainings, enzyme-linked immunosorbent assay [ELISA], and enzyme-labeled fluorescence [ELF] technique). The results were compared with its gene expression (reverse-transcription polymerase chain reaction [RT-PCR]). In all microenvironments, PC contained latent TGF-beta, which was partially activated after cell isolation and culture. The amount of total TGF-beta (mature plus latent) of latency-associated peptide (LAP) and of latent TGF-beta binding protein (LTBP) were shown to decrease during culture. In contrast, TGF-beta2 and TGF-beta3 mRNA and LTBP-1 and -3 mRNA expression were first detectable after culture. Permeabilization of cell membranes in whole liver and of isolated PC with streptolysin O or carbon tetrachloride, respectively, released TGF-beta, a part of which was integrated in the large latent complex as estimated by analytical gel filtration chromatography. The TGF-beta released by damaged PC induces paracrine effects on hepatic stellate cell cultures. It stimulates hyaluronan synthesis and antagonizes the effect of mitogenic factor(s) of PC on [3H]thymidine incorporation. The results strongly suggest that the main part of hepatocellular TGF-beta is not generated by de novo synthesis but from uptake into the liver in vivo. The immunodetection of preexisting mature TGF-beta after isolation of the cells is probably caused by intracellular activation of latent TGF-beta. The injury-dependent discharge of TGF-beta from PC might be an important mechanism for initiation and perpetuation of various forms of chronic human liver diseases.

Highly efficient and consistent gene transfer into dendritic cells utilizing a combination of ultraviolet-irradiated adenovirus and poly(L-lysine) conjugates

Dendritic cells (DCs) are capable of presenting tumor-associated antigens and subsequently play an essential role in T-cell activation. The aim of this study was to develop an efficient method for gene transfer into DCs. These genetically transduced DCs can then be used as potent inducers of specific cell-mediated immune response. When compared with physical methods for gene transfer (lipofection and calcium phosphate precipitation), adenovirus (AdV) vectors proved to be highly efficient for gene transfer into DCs. To overcome concomitant AdV gene expression and potential immunogenicity, AdVs were irradiated with UV. The UV dose was optimized to block AdV transcription without altering AdV receptor binding and endocytosis capacity. We subsequently used a polycationic amino acid compound, poly(L-lysine), to conjugate the irradiated AdVs to transgenes. The resulting complexes were found to mediate a highly efficient transfer of transgenes into DCs, without concomitant expression of AdV gene products. Low titers of irradiated AdVs were sufficient for a consistent gene transfer into DCs. This is the first study to demonstrate efficient, consistent, and practical gene transfer using an UV approach to irradiated AdV-poly(L-lysine) conjugates and should be useful for the development of DC-based tumor vaccine therapies.

Relation between attempted suicide and suicide rates among young people in Europe

STUDY OBJECTIVE

To determine if there are associations between rates of suicide and attempted suicide in 15-24 year olds in different countries in Europe.

DESIGN

Attempted suicide rates were based on data collected in centres in Europe between 1989 and 1992 as part of the WHO/EURO Multicentre Study of Parasuicide. Comparison was made with both national suicide rates and local suicide rates for the areas in which the attempted suicide monitoring centres are based.

SETTING

15 centres in 13 European countries.

PATIENTS

Young people aged 15-24 years who had taken overdoses or deliberately injured themselves and been identified in health care facilities.

MAIN RESULTS

There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02.

CONCLUSIONS

Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

Isoforms and splice variant of transforming growth factor beta-binding protein in rat hepatic stellate cells

BACKGROUND & AIMS

Hepatic stellate cells (HSCs) are one important source for transforming growth factor beta (TGF-beta). They produce TGF-beta in a latent form associated with latency-associated peptide and latent TGF-beta-binding protein (LTBP). This study was designed to investigate, on RNA and protein levels, which isoforms of LTBP and TGF-beta are expressed in HSCs and myofibroblasts.

METHODS

HSCs isolated from rat liver were analyzed for LTBP and TGF-beta at various times of culture during transdifferentiation into myofibroblasts using immunocytochemical staining, metabolic labeling and immunoprecipitation, reverse-transcription polymerase chain reaction (RT-PCR), and sequencing.

RESULTS

Alkaline phosphatase-anti-alkaline phosphatase staining and fluorescence immunostainings indicated the expression of all three components of the large latent TGF-beta complex in HSCs and myofibroblasts. Transcripts of three TGF-beta and LTBP isoforms were detected by RT-PCR and confirmed by sequence analyses. A new LTBP-1 splice form was found lacking part of the hinge region with a potential proteinase cleavage site. Metabolic labeling followed by immunoprecipitation with LTBP antiserum confirmed the synthesis and secretion of various LTBP-related proteins.

CONCLUSIONS

The existence of different LTBP isoforms and splice variants in HSCs and myofibroblasts suggests multiple functions of the LTBP family in rat liver, which might not be restricted to the maintenance of TGF-beta latency.

Subpopulations of gastric myenteric neurons are differentially activated via distinct serotonin receptors: projection, neurochemical coding, and functional implications

The enteric nervous system coordinates various gut functions. Functional studies suggested that neurotransmitters and neuromodulators, one of the most prominent among them being 5-HT, may act through a specific modulation of ascending and descending enteric pathways. However, it is still mostly unknown how particular components of enteric reflex circuits are controlled. This report describes experiments aimed at identifying a differential activation of enteric pathways by 5-HT. Electrophysiological and immunohistochemical methods were combined to investigate the projection pattern and the transmitter phenotype of 5-HT-sensitive gastric myenteric neurons. Of 294 intracellularly labeled neurons, 60.5% showed responses mediated via 5-HT3 receptors, 11.3% were 5-HT1P-responsive, 3.7% exhibited both 5-HT3 and 5-HT1P receptor-mediated depolarization, and 24.5% were not responding to 5-HT. The 5-HT3-responsive cells were mainly cholinergic (79%) and had ascending projections, whereas the 5-HT1P-responsive cells had primarily descending projections and were nitrergic (67%). Substance P-positive neurons were cholinergic; most of the cells (75%) exhibited 5-HT3 mediated responses and had ascending projections. Muscle strip recordings supported the functional significance of the differential location of 5-HT receptor subtypes. Thus, contractile responses of gastric circular muscle strips were dose-dependently increased by a 5-HT3 and decreased by a 5-HT1P agonist. Results indicated that excitatory ascending enteric pathways consisting of cholinergic, substance Pergic neurons were activated by 5-HT3 receptors, whereas 5-HT1P receptors were involved in activation of inhibitory descending pathways using nitrergic neurons. This suggested that different effects of 5-HT on gastric functions are related to specific activation of receptors located on different subsets of enteric neurons.

[The suicidal patient]

Suicide prevention in the general practitioner's practice should not only be a topic for patients that are close to putting an end to their lives. It should start with the recognition of an emotional crisis or depressive symptoms. Such patients have to be asked about suicidal thoughts or plans. Depressive states have to be assessed very carefully and treated adequately. The Gotland study has clearly shown that competence in the recognition and treatment of depression can significantly reduce the frequency of suicide.

Complications associated with use of jejunostomy tubes in dogs and cats: 40 cases (1989-1994)

OBJECTIVE

To evaluate complications and outcomes of surgeries in which jejunostomy tubes were used in critically ill dogs and cats.

DESIGN

Retrospective review of medical records.

ANIMALS

32 dogs and 8 cats.

PROCEDURE

In each animal, a 5-F or 8-F red rubber urethral/feeding catheter was surgically placed in the proximal portion of the jejunum.

RESULTS

The most common indication for jejunostomy tube placement in dogs was a gastrointestinal condition (20 dogs; 62.5%). Neoplasms were detected in 11 of the 20 dogs. Pancreatic disease was the most common indication for tube placement in cats (7 cats; 87.5%). Thirty-three animals (27 dogs, 6 cats; 82.5%) did not have complications. Five dogs and 2 cats had 10 tube-related complications, including focal cellulitis (3 dogs), tube dislodgement (2 dogs, 1 cat), and tube occlusion (1 dog, 1 cat). Twenty-four animals (20 dogs, 4 cats; 60%) were discharged from the hospital. Fifteen dogs and 4 cats were alive 2 weeks after discharge, and 5 dogs and 2 cats survived for at least 4 weeks after discharge. Deaths were related to disease and were not associated with jejunostomy tubes.

CLINICAL IMPLICATIONS

The complication rate associated with jejunostomy tubes appears to be low. Complications usually are nonfatal.

Contacts of suicide attempters with GPs prior to the event: a comparison between Stockholm and Bern

The aim of this study was to investigate patterns of contact made with GPs by subjects in two cities prior to attempting suicide, in order to determine whether differences in the health care systems could be a possible factor influencing the help-seeking behaviour of people experiencing suicidal crises. Structured interviews were conducted with suicide attempters from geographically defined catchment areas in two countries with private and national health care systems, respectively. The subjects were suicide attempters, admitted consecutively, aged > or = 15 years and living either in Stockholm (n=202) or in Bern (n=66). Patients living in Bern had seen their GPs more regularly and more frequently throughout the year. There was an increase in the number of visits to the GP prior to the suicide attempt in both cities, but it was greater in Stockholm than in Bern. However, in Stockholm fewer patients who saw their GP in the week before the attempt talked about their suicidal thoughts. The differences in help-seeking behaviour between the two patient samples may be related to the higher number of practising GPs and a more personal and consistent patient-doctor relationship in Bern. It is possible that the private medical care system in Switzerland lowers the threshold enabling patients to talk to their GP about their suicidal plans. The results suggest that in both cities there is scope for improving communication of the suicidal patient with his or her doctor.

Identification of a positive regulatory element responsible for tissue-specific expression of prostate-specific antigen

The prostate-specific antigen (PSA) promoter (PSA-P) has been identified, characterized, and determined to be tissue specific. Compared with high expression of the genomic PSA gene in prostate cells, expression of the transgene driven by the putative PSA promoter is low. This suggests that the identified promoter may be incomplete or may function optimally with additional regulatory elements. To identify the presence of additional regulatory elements, we screened sequences upstream of the PSA promoter and identified a DNA fragment of 822 bp, which enhances PSA gene expression. Combining the newly identified PSA gene regulatory sequence (PSAR) with our previously identified PSA promoter (PCPSA-P) exhibited enhanced expressional activity in the PSA-producing LNCaP cell line. With the addition of 10 to 100 nM dihydrotestosterone, a more than 1000-fold increase in expression was observed as compared to androgen-negative controls. Furthermore, although the combined regulatory element (PSAR)-PSA promoter (PCPSA-P) sequence resulted in high transgene expression in LNCaP cell lines, the combined regulatory element-promoter sequence resulted in minimal expression in the non-PSA-producing prostate cell line PC-3, renal tumor cell line R11, and cervical adenocarcinoma cell line HeLa. The newly identified 822 bp alone could also function as a promoter. Compared with the combined promoter, however, the 822-bp fragment alone demonstrated lower activity and lower responsiveness to androgen stimulation. Our results suggest that coupling the PSA promoter with an upstream regulatory element results in a marked increase in PSA expression, suggesting that the complete PSA promoter contains two functional domains: a proximal promoter and a distal promoter, which can also function as an enhancer. The enhanced gene expression of the new construct, combined with its tissue specificity and androgen responsiveness, in turn provides a foundation for the development of tissue-specific vectors for prostate cancer gene therapy.

A repetition-prediction study of European parasuicide populations: a summary of the first report from part II of the WHO/EURO Multicentre Study on Parasuicide in co-operation with the EC concerted action on attempted suicide

One of the aims of the European Study on Parasuicide, which was initiated by the Regional Office for the European Region of the World Health Organization in the mid-1980s, was to try to identify social and personal characteristics that are predictive of future suicidal behaviour. A follow-up interview study (the Repetition-Prediction Study) was designed, and to date 1145 first-wave interviews have been conducted at nine research centres, representing seven European countries. The present paper provides an abridged version of the first report from the study. The design and the instrument used (The European Parasuicide Study Interview Schedules, EPSIS I and II) are described. Some basic characteristics of the samples from the various centres, such as sex, age, method of suicide attempt, and history of previous attempts, are presented and compared. The male/female sex ratio ranged from 0.41 to 0.85; the mean age range for men was 33-45 years and that for women was 29-45 years. At all of the centres, self-poisoning was the most frequently employed method. On average, more than 50% of all respondents had attempted suicide at least once previously. The representativeness of the samples is discussed. There were differences between the centres in several respects, and also in some cases the representativeness of the different samples varied. Results obtained from analyses based on pooled data should therefore be treated with caution.

Effect of Rennie Liquid versus Maalox Liquid on intragastric pH in a double-blind, randomized, placebo-controlled, triple cross-over study in healthy volunteers

OBJECTIVES

Despite years of successful use of calcium-containing antacids in acid-related disease, allegations of gastric rebound following their intake has brought these agents into disrepute. By assessing intragastric acidity over the 24-h period, we evaluated whether antacids induce a clinically relevant acid rebound.

METHODS

Twelve healthy volunteers were assigned to a double-blind, placebo-controlled, triple cross-over comparison of placebo, Maalox Liquid, and a calcium-containing antacid, Rennie Liquid. The two antacids had identical neutralizing capacity. Each drug was administered at standard doses q.i.d 1 h after the main meals (at 1000, 1400, and 1900 h) and at bedtime (2300 h). Intragastric acidity was monitored by continuous ambulatory 24-h pH-metry on 3 separate days with a wash-out period of 1 wk. Special attention was given to the acidity of pre-determined postantacid time intervals during the day and night.

RESULTS

Both antacids led to a significant increase of the median 24-h pH and the median pH of the first postantacid hour, compared with placebo. Neither Rennie Liquid nor Maalox Liquid led to a drop of intragastric pH during the putative acid rebound time (2nd and 3rd postantacid hr and at night). A marginal increase in serum calcium and gastrin concentration with Rennie Liquid, and magnesium concentration with Maalox Liquid, were observed.

CONCLUSIONS

No gastric acid rebound was detected with the calcium carbonate-containing antacid, Rennie Liquid, or with Maalox Liquid at standard doses. An identical increase of intragastric pH was achieved with Rennie Liquid and Maalox Liquid during the first postantacid hour and the entire 24-h period.

Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide

The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, "Health for All by the Year 2000', for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age-standardized rate of suicide attempts was found for Helsinki, Finland (314/100,000), and the lowest rate (45/100,000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age-standardized rate was found for Cergy-Pontoise, France (462/100,000), and the lowest (69/100,000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person-based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person-based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily "soft' (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.

The WHO-EURO Multicentre Study: risk of parasuicide and the comparability of the areas under study

The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.

A repetition-prediction study on European parasuicide populations. Part II of the WHO/Euro Multicentre Study on Parasuicide in cooperation with the EC Concerted Action on Attempted Suicide

One of the aims of the inter-European study on parasuicide, which was initiated by WHO/Euro in the mid-1980s, was to try and identify social and personal characteristics predictive of future suicidal behavior. A follow-up interview study (the Repetition-Prediction Study) was designed, and so far 1145 interviews have been carried out at nine research centers, representing seven European countries. The study and the instrument used (the European Parasuicide Study Interview Schedules, EPSIS I and II) are described here. Some basic characteristics of the material from the various centers are presented and compared, and the representativeness of the samples are discussed. There were differences between the centers in several respects. Results from analyses based on pooled data have to be treated with some caution because of the possible lack of representativeness.

A comparison of the drugs taken in fatal and nonfatal self-poisoning

The objective of this study was a) to compare patterns of drug use in fatal and nonfatal overdoses and b) to find out if toxic drugs are overrepresented in overdoses with fatal outcome. A total of 179 cases of fatal overdoses in Switzerland (population 6.6 million) were compared with 269 medically treated self-poisoners from the agglomeration of Berne (population 301,630). Because of frequent multiple drug use, all the different compounds taken singly or in combination with other drugs were recorded and grouped according to drug types. The patterns of the frequencies of drugs used were remarkably similar in both groups. The majority of the drugs were psychotropics (81% in fatal and 68% in nonfatal overdose). Twenty-nine completed suicides were the result of drug combinations specifically recommended by EXIT. In the remaining cases benzodiazepines were used most frequently in both attempted and completed suicide, often in combination with other drugs or alcohol. Barbiturates were the only drugs recorded significantly more often in fatal overdoses (9% vs 3%). No significant difference was found for tricyclic antidepressants (13% vs 10%), or other types of drugs. The results are consistent with our assumption that drugs with higher toxicity would be overrepresented in overdoses with fatal outcome. Barbiturates, which are well known to be dangerous in overdose, were clearly associated with fatal overdoses, but not tricyclic antidepressants. This, in our view, suggests that the risk of prescribing tricyclic antidepressants should not be overestimated. The frequent use of benzodiazepines in completed suicide, however, indicates that there are no truly safe drugs in overdose.

Suicide with psychotropic drugs in Switzerland

All suicides in Switzerland in 1990 where drugs were involved (179 persons; 12.2% of all suicides) were analyzed by examination of death certificates and direct contacts with physicians and medico-legal institutions. Nearly 50% of these people took overdoses of combinations of different drugs and in 26% of the cases alcohol was reported to have been taken with the drugs. Unexpectedly, we found 29 suicides in which persons had obviously used drug combinations recommended by EXIT, an organization advocating the freedom of the individual to decide about his own time and nature of death. In EXIT-suicides usually barbiturates and anticholinergic drugs were taken together. Interestingly, the barbiturate compound used most often had officially been withdrawn from the market the previous year. Altogether, psychotropic drugs represented 78.7% of all drugs taken, with benzodiazepines being named most often (38.9%), followed by barbiturates (16.6%) and antidepressants (13.6%). Among the benzodiazepines flunitrazepam, diazepam, and triazolam were used most often and surprisingly, benzodiazepines were named as single drugs on 27 death certificates. Among the antidepressants (taken in 20.3% of overdoses) maprotiline was the most common drug used, followed by mianserin and trimipramine. This order of frequency reflects the prescribing habits of Swiss doctors. Two suicides were recorded with neuroleptics alone.

[Characteristics of young suicide attempters and their importance for helpers]

66 suicide attempters were interviewed with the European Parasuicide Study Interview Schedule (EPSIS) and characteristics of persons under the age of 26 were compared with those over 26.82% of the young suicide attempters gave interpersonal conflicts as reasons for their suicide attempts while most older persons gave psychiatric disorders as reasons. The younger group also had significantly lower scores on the Beck Depression Inventory and the Hopelessness Scale. While younger suicide attempters rarely had sought help from their GP within the month preceding the attempt one third of the older group had done so. It is concluded that in order to understand the reasons why people attempt suicide a differential approach combining the concept of crisis as well as the concept of illness is needed. Helpers should know that young suicide attempters rarely show signs of clear psychiatric disorder but usually attempt suicide because they are unable to cope with interpersonal conflicts.