Factors influencing long-term changes in mental health after interferon-alpha treatment of chronic hepatitis C

BACKGROUND

Antiviral treatment with interferon-alpha (IFN-alpha) is associated with several acute psychiatric side effects. Little is known about long-term effects on mental health after treatment independent from viral response and the influence of pre-existing psychiatric risk-factors.

AIM

To evaluate long-term effects of antiviral treatment with interferon-alpha (IFN-alpha) on mental health in patients with psychiatric risk factors.

METHOD

We prospectively investigated long-term mental health changes in 81 hepatitis C virus-infected patients. Psychiatric outcome was measured with the Montgomery-Asberg Depression Scale (MADRS), Brief Psychiatric Rating Scale, the Global Social Functioning Scale and the Global Clinical Impression Scale 6 months after the end of antiviral treatment with IFN-alpha and ribavirin.

RESULTS

Six months after antiviral therapy, 49% of the patients showed a worsening and 27.2% an improvement of depression scores. The most important predictor for a long-term improvement of depression scores was a pre-treatment MADRS score > or =5 (OR 14.21, 95% CI: 2.51-81.30). Patients with pre-existing psychiatric disorders (OR = 0.117, 95% CI: 0.024-0.558), methadone substitution (OR = 0.20, 95% CI: 0.045-0.887) or genotype 2/3 (OR = 0.341, 95% CI: 0.138-0.845) were significantly less likely to show a long-term worsening of depressive symptoms.

CONCLUSIONS

Pre-existing psychiatric risk factors increase the chance for a long-term improvement and reduce the risk for a long-term worsening of mental health after antiviral treatment of chronic hepatitis C with IFN-alpha.

Twenty-four-hour ambulatory urodynamics in healthy young men

OBJECTIVE

To describe normal natural fill urodynamics in young men during normal and increased fluid intake.

MATERIAL AND METHODS

Thirty healthy males aged 21-32 years volunteered for an ambulatory urodynamic 24 h investigation with a suprapubic catheter. The recorded micturition data were: frequency (f), voided volume (VV), voiding time, maximal flow rate (Qmax) and time to Qmax. The number of sensed and not-sensed bladder contractions, duration and time in relation to voiding were also recorded. During the recording day subjects were randomized to normal (30 ml/kg body weight per day) or larger (60 ml/kg body weight per day) fluid intake.

RESULTS

As expected there was a larger urine production and an increased voiding frequency in the fluid-loaded group (p<0.0001). The detrusor pressure (Pdet) Qmax was significantly higher in the fluid-loaded group (73 cmH2O, range 57-94) than in the normal fluid intake group (60 cmH2O, range 45-86) (p=0.003). No other urodynamic data differed significantly between the two groups. When comparing the ambulatory urodynamic data with previously obtained home flowmetry recordings from the same volunteers differences were only found in voiding frequency. The majority of participants had detrusor contractions, felt and unfelt, during the filling phase. Three types of detrusor activity during voiding phase could be described: type 1, with one micturition contraction, type 2, with several small contractions before micturition, and type 3, with large prolonged contractions leading to micturition.

CONCLUSIONS

Ambulatory urodynamics in normal young men showed a large interindividual variation. Bladder contractions during filling were frequently recorded, and premicturition contractions were consistently found. The data found in this study were similar to previous home flow recordings in the same group.

Perchlorate and ethylenethiourea induce different histological and molecular alterations in a non-mammalian vertebrate model of thyroid goitrogenesis

Despite evidence for a conserved role of thyroid-stimulating hormone (TSH) in regulating vertebrate thyroid function, molecular data on thyroid responses to TSH are mainly limited to mammalian species. In this study, we examined histological and molecular changes in the thyroid of Xenopus laevis tadpoles during a 12-day treatment with 20mg/l perchlorate (PER) and 50mg/l ethylenethiourea (ETU). Inhibition of thyroid hormone (TH) synthesis by PER and ETU was evident from developmental retardation, reduced expression of TH-regulated genes and up-regulation of tshb-A mRNA. Thyroid histopathology revealed goiters with strikingly different follicular morphologies following PER and ETU treatment. Using real-time PCR, we analyzed thyroids sampled on day 12 for differential expression of 60 candidate genes. Further temporal analyses were performed for a subset of 14 genes. Relative to the control, PER and ETU treatment modulated the expression of 51 and 49 transcripts, respectively. Particularly genes related to TH synthesis and protein metabolism were similarly affected by PER and ETU. However, several genes were differentially expressed in PER- and ETU-treated tadpoles. Specifically, goiter formation in the PER treatment was associated with low expression of genes related to DNA replication but high expression of negative growth regulators. Results from this work provide for the first time a characterization of gene expression profiles during goitrogenesis in a non-mammalian vertebrate model. Overall, our data suggest that, in addition to TSH over-stimulation, further mechanisms related to the mode of goitrogen action contribute to the regulation of thyroid gene expression.

Dependencies of micro-pillar cavity quality factors calculated with finite element methods

We present simulation results for optical modes in micro-pillar cavities that were computed with the finite element method and that show good agreement with experimental data. By means of this viable tool various influences on the quality factor of the fundamental mode were calculated: Firstly, the light confinement depends strongly on the absorption of the semiconductor cavity material. Here we were able to determine absolute maximum quality factors achievable in a GaAs/AlAs Bragg micro-pillar cavity. Furthermore, small pillar diameters as well as the inclination of pillar sidewalls show critical features with respect to light confinement. Additional effects of the top and bottom Bragg stacks in the pillar were calculated as well.

Observation of the suppression of the flux of cosmic rays above 4 x 10 (19) eV

The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.

Upper limit on the diffuse flux of ultrahigh energy tau neutrinos from the Pierre Auger Observatory

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.

[Soft-tissue management in primary knee arthroplasty: common techniques, navigation and force-sensing devices]

Soft-tissue management is essential for the outcome in total knee arthroplasty. In combination with osseous resections and component positioning, correction of the underlying ligamentous dysbalance should yield a stable joint throughout the flexion arc. Different "philosophies" with regard to technique, timing and tactics in ligament balancing are described. So far, surgeons have not been provided with standardised devices that allow the objective measurement of this complex issue. Moreover, knowledge concerning the "ideal" soft-tissue stability following knee arthroplasty is still sparse. As part of the scientific project "OrthoMIT" (minimal invasive orthopaedic therapy) an approach to combine conventional soft-tissue management with navigation and force-sensing devices should be realized technically. The aim is to develop an instrument for the objective measurement of soft-tissue management in scientific and clinical applications.

Effects of age and symptom status on silent ischemic lesions after carotid stenting with and without the use of distal filter devices

BACKGROUND AND PURPOSE

The routine use of distal filter devices during carotid angioplasty and stent placement (CAS) is controversial. The aim of this study was to analyze their effects on the incidence of new diffusion-weighted imaging (DWI) lesions as surrogate markers for stroke in important subgroups.

MATERIALS AND METHODS

DWI was performed immediately before and after CAS in 68 patients with and 175 without protection, and patients were further subdivided according to their age or symptom status.

RESULTS

The proportion of patients with new ipsilateral DWI lesion(s) was significantly lower after protected versus unprotected CAS (52% versus 68%), as well as in symptomatic patients (56% versus 74%) or those at or younger than 75 years of age (46% versus 67%; all P < .05). Similarly, the total number of lesions was significantly lower after protected versus unprotected CAS (median, 1; interquartile range [IQR], 0-2; versus median, 1; IQR 0-4.75) and in symptomatic patients (median, 1; IQR, 0-3; versus median, 2; IQR, 0-6) or those at or younger than 75 years of age (median, 0; IQR, 0-2; versus median, 1; IQR, 0-4; all P < .05). In contrast, for asymptomatic patients (48% versus 52%; P = .8; median, 0; IQR, 0-2; versus median, 1; IQR, 0-2.5; P = .6) or those older than 75 years of age (73% versus 69%; P = .7; median, 1; IQR, 0-4; versus median, 1.5; IQR, 0-5.75; P = .6), the proportion of patients with new lesion(s) and the total number of these lesions were not significantly different between protected and unprotected CAS.

CONCLUSIONS

The use of distal filter devices generally reduces the incidence of new DWI lesions; however, this beneficial effect might not necessarily pertain to older and asymptomatic patients.

Preprocedural C-reactive protein levels predict stroke and death in patients undergoing carotid stenting

BACKGROUND AND PURPOSE

Elevated baseline levels of C-reactive protein (CRP) are associated with an adverse outcome during coronary stent placement. The aim of this study was to evaluate whether preprocedural CRP levels also are predictive of stroke and death in patients undergoing carotid stent placement (CAS).

MATERIALS AND METHODS

We reviewed data prospectively collected from 130 patients (97 men, 33 women; mean age, 68.5 +/- 10.1 years; range, 43-89 years) who underwent CAS for symptomatic carotid stenosis and from whom preprocedural CRP values had been obtained. A CRP value of >5 mg/L was considered to be elevated. The frequency of stroke and death within 30 days was compared between patients with and without elevated baseline CRP levels using chi(2) and multivariate logistic regression analysis.

RESULTS

Baseline CRP values were normal in 94 (72.3%) patients but were elevated in 36 (27.7%) patients. The demographic and clinical characteristics were similar in both treatment groups. The 30-day stroke and death rate was significantly higher in patients with elevated CRP values (8/36; 22.2%) than in those without (3/94; 3.2%; P < .01). After adjusting for demographic characteristics, degree of carotid stenosis, and use of cerebral protection devices and/or statin therapy, an elevated CRP value before CAS remained a significant and independent predictor of stroke and death within 30 days after CAS (odds ratio, 7.7; 95% confidence interval: 1.8-32.8, P = .006).

CONCLUSIONS

Baseline CRP is a powerful predictor of outcome in patients undergoing CAS, which underscores the role of inflammation in the pathogenesis of embolic complications during this procedure.

[Positioning therapy in intensive care medicine in Germany. Results of a national survey]

BACKGROUND

The effects of a systematic change in a patient's position [prone position, continuous lateral rotational therapy (CLRT)] have been investigated in recent years in acute lung injury and have shown an improvement in oxygenation, but controversial results regarding duration of mechanical ventilation, intensive care treatment and mortality compared to conventionally treated patients. We were interested in the practice and acceptance of positioning therapy in German intensive care units (ICU) and performed a national postal survey with respect to evaluation of indications, preference of particular positions, observed complications and additional aspects (costs, influence on other intensive care measures etc.).

METHODS

A questionnaire (12 multiple choice items) was sent to 1,763 ICUs, which were identified from the "Deutsches Krankenhausadressbuch" (German hospital address book 2005). The analysis was performed anonymously.

RESULTS

A total of 702 questionnaires (40.4%) were returned and analysed. The 135 degrees position (incomplete prone position) was most frequently used (50%), while the prone position (25%) and CLRT (18%) were less frequent. The improvement in oxygenation (95%) and the prevention of ventilator-associated complications (75.7%) were important indications for positioning therapy. Results of a blood gas analysis provided the necessary criteria for determining positional therapy. Supporters of the prone position advocated lower cost and better efficacy in comparison to CLRT. The frequency of complications during positioning therapy was reported to be high: hemodynamic instability (73.6%), accidental loss of tube/catheters (50.4%) and patient intolerance (40.7%) were often observed, and complication-free positioning therapy was reported in only 8.6%.

CONCLUSIONS

The 135 degrees position (incomplete prone position) is the most frequently used positioning therapy in Germany for improvement of oxygenation in patients with acute lung injury. Prone position and CLRT are less frequently used, probably due to an increased frequency of (expected) complications. The authors assume that clear guidelines and algorithms are needed to establish a more routine, safe practical application and a reduction in the complication rate.

TMPRSS2:ERG gene fusion associated with lethal prostate cancer in a watchful waiting cohort

The identification of the TMPRSS2:ERG fusion in prostate cancer suggests that distinct molecular subtypes may define risk for disease progression. In surgical series, TMPRSS2:ERG fusion was identified in 50% of the tumors. Here, we report on a population-based cohort of men with localized prostate cancers followed by expectant (watchful waiting) therapy with 15% (17/111) TMPRSS2:ERG fusion. We identified a statistically significant association between TMPRSS2:ERG fusion and prostate cancer specific death (cumulative incidence ratio=2.7, P<0.01, 95% confidence interval=1.3-5.8). Quantitative reverse-transcription-polymerase chain reaction demonstrated high ets-related [corrected] gene (ERG) expression to be associated with TMPRSS2:ERG fusion (P<0.005). These data suggest that TMPRSS2:ERG fusion prostate cancers may have a more aggressive phenotype, possibly mediated through increased ERG expression.

PCV chemotherapy for recurrent glioblastoma

The authors administered procarbazine, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU, lomustine), and vincristine (PCV) to 86 patients with recurrent glioblastoma. There were three partial responses, but no complete responses. Median progression-free survival was 17.1 weeks and progression-free survival at 6 months was 38.4%. World Health Organization grade III/IV hematologic toxicity was common (25.6%), but nonhematologic toxicity was mild.

Efficacy and Safety of Outpatient Alcohol Detoxification with a Combination of Tiapride/Carbamazepine: Additional Evidence

BACKGROUND

Few medications have been tested for outpatient alcohol detoxification. Previously we had shown a combination of carbamazepine and tiapride to be effective in an open study. This database is an extension of our previous work.

METHODS

This was an open prospective study to examine the efficacy, practicability and medical safety of a combination of tiapride and carbamazepine in outpatient detoxification of alcohol dependent patients. Patients were carefully screened for relevant neuropsychiatric disorders and then seen on a daily outpatient basis.

RESULTS

A total number of 116 consecutively admitted patients entered the programme; 107 (92%) successfully ended the treatment. The mean initial dose for tiapride was 289 mg and for carbamazepine 502 mg. No serious medical complications or adverse events were observed except for one case of delirium tremens. Only four patients dropped out because of side effects. In general medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A-scores decreased over time.

CONCLUSIONS

Results from this study give further evidence for a combination of tiapride and the anticonvulsant carbamazepine as an effective and safe treatment for outpatient alcohol detoxification in patients with moderate severity of withdrawal syndrome. Further randomized trials are warranted to examine the efficacy of this combination in outpatient alcohol withdrawal.

Magnetic metamaterials at telecommunication and visible frequencies

Arrays of gold split rings with a 50-nm minimum feature size and with an LC resonance at 200 THz frequency (1.5 microm wavelength) are fabricated. For normal-incidence conditions, they exhibit a pronounced fundamental magnetic mode, arising from a coupling via the electric component of the incident light. For oblique incidence, a coupling via the magnetic component is demonstrated as well. Moreover, we identify a novel higher-order magnetic resonance at around 370 THz (800 nm wavelength) that evolves out of the Mie resonance for oblique incidence. Comparison with theory delivers good agreement and also shows that the structures allow for a negative magnetic permeability.

[MR-guided core biopsy of the shoulder: possibilities and experience with a vertically open 0.5T system]

PURPOSE

The availability of open whole body MRI magnets and MR-compatible instrumentarium were essential conditions for the progression of interventional MRI. The advantages of an MR-guided biopsy at the musculoskeletal system are the visualization of the puncture site of a representative area for tumor histology, the absence of exposure to radiation and the free selection of imaging planes. The purpose of the study was the development of a new technique of a secure MR-guided biopsy of intraosseus lesions in the humeral head.

MATERIAL AND METHODS

MR-guided core biopsy of a intraosseus lesion of the humeral head was performed in five male patients on a vertical open, whole body MRI magnet (SIGNA SP/i 0.5T, GE Medical Systems). The technique using interactive MRI and the MR-compatible instrumentarium are described.

RESULTS

A secure core biopsy could be obtained from a representative area for tumor histology in all cases. No complications occurred, especially no nerve or vessel lesion, no rotator cuff lesion and no intra-articular contamination of the shoulder joint were observed.

CONCLUSION

A new technique is presented to obtain MR-guided core biopsies of intraosseous lesions of the humeral head. Furthermore, clinical indications of this technique are described.

Pediatric MR-guided interventions

MRI guided interventions are a relatively new but steadily growing field within surgery in pediatric age. Besides the advantages of MRI, such as multiplanar capability and excellent soft tissue contrast and spatial resolution, particularly relevant for the pediatric population is the lack of ionizing radiation. There is meanwhile a group of well defined diagnostic or therapeutic indications for applying MR imaging during pediatric interventions. Aim of this review is to give an overview about indications of MR-guided procedures in children as well as the advantages and disadvantages of MR-guided interventions. We also briefly discuss interventional MR-systems and MR-compatible devices. It is our opinion that MR-guidance for pediatric interventions is a promising technique at the beginning of its development.

Anterior sciatic nerve block--new landmarks and clinical experience

BACKGROUND

Anterior sciatic nerve blocks can be complicated by several problems. Pain can be caused by bony contacts and, in obese patients, identification of the landmarks is frequently difficult.

METHODS

In a first step, 100 normal anterior-posterior pelvic X-rays were analyzed. The landmarks of the classical anterior approach were drawn on these X-rays and assessed for their sufficiency. Then, in a prospective case study, 200 consecutive patients undergoing total knee replacement were investigated. These patients received femoral and sciatic nerve catheters for postoperative pain management. Using modified anatomical landmarks, sciatic nerve catheters were inserted 5 cm distal from the insertion site of the femoral nerve block perpendicularly in the midline of the lower extremity. This midline connected the insertion site of the femoral nerve catheter to the midpoint between the medial and lateral epicondyle. Correct catheter positioning was verified by magnetic resonance imaging (MRI) in six patients.

RESULTS

Evaluation of pelvic X-rays showed that puncture following the classical landmarks pointed in 51% at the lesser trochanter, in 5% medial to the lesser trochanter and in 42% directly at the femur. In the latter patients, location of the sciatic nerve would have been difficult or even impossible. Using our modified anterior approach, the sciatic nerve could be blocked in 196 patients (98%). In nine patients (4.5%) blockade of the posterior femoral cutaneous nerve failed. Vascular puncture happened in 10 (5%) and bony contact in 35 patients (17.5%). Median puncturing depth was 9.5 (7.5-14) cm. Correct sciatic nerve catheter positioning was verified in all patients who underwent MRI.

CONCLUSION

Our landmarks for locating the sciatic nerve help to avoid bony contacts and thereby reduce pain during puncture. Our method reliably enabled catheter placement.

Bilateral Wallerian degeneration of the middle cerebellar peduncles due to paramedian pontine infarction: MRI findings

Wallerian degeneration is a frequent finding in lesions of the pyramidal tract, but has been observed after damage of the other fibre systems as well. Few reports exist about Wallerian degeneration of cerebellar fibres after distant lesions to the axons. Here, we report on a patient who developed degeneration of both middle cerebellar peduncles after a paramedian pontine infarction.