Nerve growth factor serum levels in treatment-resistant schizophrenic patients following electroconvulsive therapy

BACKGROUND

Electroconvulsive Therapy (ECT) has been widely applied to treat schizophrenia (SCZ) in the presence of resistance to pharmacotherapy. The mechanism of action of ECT in schizophrenia has not been fully clarified, though its intrinsic mechanism presents analogies with some neurobiological processes mediated by nerve growth factor (NGF).

OBJECTIVES

The aim of this study was to investigate in patients with treatment-resistant schizophrenia (TRS) the effect of ECT on acute and long-term NGF serum levels and the association with the clinical outcomes.

METHODS

Twelve male inpatients with TRS underwent eight sessions of ECT. Blood samples were collected during the first and the eighth ECT at the following time points: 5 minutes before the induction of seizure and then at 0, 5, 15 and 30 minutes after seizure.

RESULTS

Following ECT treatment, a substantial clinical improvement in symptom severity was indicated by a significant reduction in the Positive and Negative Syndrome Scale (PANSS) total and subscales scores. Even though the baseline NGF levels showed an increase over time, there were no statistical differences in NGF at time 0 at the first and the eighth ECT session. Furthermore, no correlation was observed between the severity of schizophrenic symptoms and NGF levels.

CONCLUSIONS

This is the first study addressing peripheral NGF during ECT treatment in TRS, as well as the first study in which NGF has been evaluated in different ECT sessions at various time points. These findings may potentiate the knowledge about the neurotrophic effects of ECT and the role of NGF in synaptic plasticity related to possible mechanisms of schizophrenia treatment.

Is the consumption of sweets a risk factor for thyroid cancer?

Background

Several studies have investigated the role of diet as a risk and/or protective factor on the development of the thyroid cancer but the results are unclear. The aim of this study was to investigate the role of eating habits on the risk of thyroid cancer.

Methods

We carried out a hospital-based case-control study. The eating habits of the participants were investigated through a validated Lifestyles Questionnaire. The frequency of consumption of the different types of food was reported on a 4-level scale (never, 1 time per week, 2-3 times a week, 6 times a week). Logistic regression models were used to estimate the ORs and their 95% confidence intervals adjusted for age, gender and BMI. Statistical data analysis was conducted using the IBM SPSS Statistics 21.0 program.

Results

One hundred and six cases (91.2% CA papillary type) and 217 controls were recruited. A positive association was observed for BMI (OR: 1.085; IC95% = 1.022-1.152), consumption of complex carbohydrates (OR: 2,324; IC95%: 1,364-3,960) and a low consumption of legumes, cereals, potatoes, fruit and vegetables (OR: 2.285, 95% CI: 1.330-3.926). The consumption of sweets decreased with age (Rho: -0.445, N = 318, p = 0.000), but at the same age the cases had a higher consumption than controls. In particular, the consumption of sweets was higher in the age group between 39 and 52 years old.

Conclusions

Our study adds new and relevant information to support the hypothesis that a sugar rich diet may increase the risk of developing thyroid cancer.

Funding

This research was funded by Intradepartmental Research Plan 2016/2018 of Department of Medical, Surgical and Advanced Technologies, University of Catania, grant number: 5C722012104.

Key messages

Future studies need to clarify the mechanisms that associate the diet with the risk of thyroid cancer. More research is also needed to explain the differences in thyroid cancer among women and men.

The role of cytokines in head and neck squamous cell carcinoma: A review

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide, accounting for approximately 6% of all cancer cases and responsible for an estimated 1-2% of all cancer deaths. Much research evidence has accumulated in the recent years on the changes in the expression of pro-inflammatory and, to a lesser extent, anti-inflammatory cytokines, that (i) may have a role in the malignant transformation of HNSCC, (ii) may be used as diagnostic markers in the sera of patients because of their excessive production by the tumor cells and (iii) may act as possible immunotherapeutic targets. Among pro-inflammatory cytokines, interleukin-8 (IL--8) has been reported to have an important role in cancer invasion, angiogenesis and metastasis. Recent studies have shown an increased concentration of IL--8 in patients with HNSCC and a positive association with lymph node metastasis and tumor classification, although IL--8 was not significantly associated with shorter overall survival and cancer progression-free survival. Additional evidence on the pathological mechanism of origin, invasion, and metastasis of HNSCC, as well as a better understanding of the implications of cytokines, chemokines and growth factors, are of paramount importance for the advancement of research in head and neck oncology.

BLOC1S5 pathogenic variants cause a new type of Hermansky-Pudlak syndrome

PURPOSE

Hermansky-Pudlak syndrome (HPS) is characterized by oculocutaneous albinism, excessive bleeding, and often additional symptoms. Variants in ten different genes have been involved in HPS. However, some patients lack variants in these genes. We aimed to identify new genes involved in nonsyndromic or syndromic forms of albinism.

METHODS

Two hundred thirty albinism patients lacking a molecular diagnosis of albinism were screened for pathogenic variants in candidate genes with known links to pigmentation or HPS pathophysiology.

RESULTS

We identified two unrelated patients with distinct homozygous variants of the BLOC1S5 gene. Patients had mild oculocutaneous albinism, moderate bleeding diathesis, platelet aggregation deficit, and a dramatically decreased number of platelet dense granules, all signs compatible with HPS. Functional tests performed on platelets of one patient displayed an absence of the obligate multisubunit complex BLOC-1, showing that the variant disrupts BLOC1S5 function and impairs BLOC-1 assembly. Expression of the patient-derived BLOC1S5 deletion in nonpigmented murine Bloc1s5^-/- melan-mu melanocytes failed to rescue pigmentation, the assembly of a functional BLOC-1 complex, and melanosome cargo trafficking, unlike the wild-type allele.

CONCLUSION

Mutation of BLOC1S5 is disease-causing, and we propose that BLOC1S5 is the gene for a new form of Hermansky-Pudlak syndrome, HPS-11.

Cohort study of electronic cigarette use: safety and effectiveness after 4 years of follow-up

OBJECTIVE

More than a decade after e-cigarette (e-cig) market launch, limited information are available on their safety after 24 months of use. In 2013, we started the first observational study assessing e-cig long-term effectiveness and safety, directly comparing tobacco smokers and e-cig users. Here we report the results after four years of follow-up.

PATIENTS AND METHODS

Adults (30-75 years) were included if: smokers of ≥1 tobacco cigarette/day (tobacco smokers); users of any type of e-cig inhaling ≥50 puffs weekly (e-cig users); users of both tobacco and e-cig (dual users). Data were collected by phone and/or internet, and carbon monoxide levels tested in 50% of those declaring tobacco abstinence. Main outcomes were: possibly smoking-related diseases (PSRD; validated through hospital discharge data or visit in 62.6% of the sample); 4-year tobacco abstinence; number of tobacco cigarettes/day.

RESULTS

Data were available for 228 e-cig users (all ex-smokers), 471 tobacco smokers, 216 dual users. A PSRD was observed in 73 subjects (8.0%). No differences emerged across groups in PSRD rates, with negligible variations in self-reported health. Of e-cig users, 63.6% remained tobacco abstinent; dual users and tobacco smokers showed non-significantly different rates of tobacco (33.8% vs. 26.8%) and all-product (20.2% vs. 19.4%) cessation, and a similar decrease in cigarettes/day. Almost 40% of the sample switched at least once (tobacco smokers: 17.2%; dual users: 81.9%).

CONCLUSIONS

After four years, a scarce, non-significant harm reduction was observed among e-cig or dual users. Given the long-lasting health effects of tobacco smoking, the benefits of e-cig use may start being detectable at the next follow-up (six years). The complete switch to e-cig may help tobacco quitters remain abstinent, but e-cig use in addition to tobacco did not increase the likelihood of smoking cessation or reduction.

Isolated limb perfusion for soft tissue sarcoma: Current practices and future directions. A survey of experts and a review of literature

Soft tissue sarcomas constitute 1% of adult malignant tumors. They are a heterogeneous group of more than 50 different histologic types. Isolated limb perfusion is an established treatment strategy for locally advanced sarcomas. Since its adoption for sarcomas in 1992, after the addition of TNFα, few modifications have been done and although indications for the procedure are essentially the same across centers, technical details vary widely. The procedures mainly involves a 60 min perfusion with melphalan and TNFα under mild hyperthermia, achieving a limb preservation rate of 72-96%; with an overall response rates from 72 to 82.5% and an acceptable toxicity according to the Wieberdink scale. The local failure rate is 27% after a median follow up of 14-31 months compared to 40% of distant recurrences after a follow up of 12-22 months. Currently there is no consensus regarding the benefit of ILP per histotype, and the value of addition of radiotherapy or systemic treatment. Further developments towards individualized treatments will provide a better understanding of the population that can derive maximum benefit of ILP with the least morbidity.

[Fatal intracerebral hemorrhage in a patient with chronic neutrophilic leukemia: About one case and literature review]

INTRODUCTION

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative syndrome characterized by a significant increase in mature neutrophils. One of the most serious complications is the occurrence of bleeding events, which may sometimes lead to death.

CASE REPORT

A 75-year-old patient presented with CNL, complicated by a severe bleeding phenotype. Biological investigations revealed platelet function defect and increase in neutrophil elastase. The follow-up was marked by an intracranial hemorrhage leading to the patient's death 7 months after diagnosis.

CONCLUSION

This bleeding phenotype has been reported several times in patients with CNL. However, the pathophysiological mechanisms that cause bleeding are not yet fully understood.

A new case with Hermansky-Pudlak syndrome type 9, a rare cause of syndromic albinism with severe defect of platelets dense bodies

Hermansky-Pudlak syndrome (HPS) is a rare form of syndromic oculocutaneous albinism caused by disorders in lysosome-related organelles. Ten genes are associated with different forms of HPS. HPS type 9 (HPS-9) is caused by biallelic variants of BLOC1S6. To date, only three patients with HPS-9 have been reported. We described one patient presenting with ocular features of albinism. Genetic analysis revealed two compound heterozygous variants in the BLOC1S6 gene. Extended hematological studies confirmed the platelet storage pool disease with absence of dense granules and abnormal platelet aggregation. By reviewing the previous published cases we confirm the phenotype of HPS-9 patients. This patient is the only one described with dextrocardia and abnormal psychomotor development.

Tobacco vs. electronic cigarettes: absence of harm reduction after six years of follow-up

OBJECTIVE

Information on the long-term safety of electronic cigarettes (e-cig) is still limited. We report the results after six years of follow-up of the first observational study assessing e-cig long-term effectiveness and safety.

PATIENTS AND METHODS

Participants were adults who smoked ≥1 tobacco cigarette/day (tobacco smokers); or used any type of e-cig inhaling ≥50 puffs weekly (e-cig users); or used both (dual users). Participants were contacted directly or by phone and/or internet interviews. Hospital discharge abstract data and carbon monoxide level tests were also used.

RESULTS

Data were available for 228 e-cig users (all ex-smokers), 469 tobacco smokers, 215 dual users. A possibly smoking-related disease (PSRD) was recorded in 90 subjects (9.9%); 11 deceased (1.2%). No differences were observed across groups in PSRD rates, with minor changes in self-reported health. Among e-cig users, 64.0% remained tobacco abstinent. Dual users and tobacco smokers did not significantly differ in the rate of cessation of tobacco (38.6% vs. 33.9%, respectively) and all products (23.7% vs. 26.4%). A comparable decrease in daily cigarettes was also observed. 39.5% of the sample switched at least once (tobacco smokers: 15.1%; dual users: 83.3%).

CONCLUSIONS

After six years, no evidence of harm reduction was found among e-cig or dual users. The complete switch to e-cig might support tobacco quitters remain abstinent, but the use of e-cig in addition to tobacco did not improve smoking cessation or reduction.

Physiological Responses to Induced Stress in Individuals Affected by Alcohol Use Disorder with Dual Diagnosis and Alexithymia

Alcohol use disorders (AUD) are among the most common and undertreated mental disorders in developed countries. The co-occurrence of psychiatric comorbidity and AUD has already been well documented. Moreover, alexithymia was found associated with heavy drinking and alcohol dependence. A large part of AUD individuals, between 45 and 67%, have been identified as alexithymics. Both psychiatric comorbidity and alexithymia can negatively impact the course of recovery from alcohol. Alcohol consumption has also been shown to significantly influence autonomic responses. Chronic use of alcohol may induce significant changes in heart rate variability, respiratory frequency, electrodermal activity and skin temperature. To date, only a few studies have comprehensively investigated the comorbidity of alexithymia in AUD individuals with dual diagnosis. Thus, the aim and also the novelty of the present investigation were to disclose in individuals with AUD the emotional and cognitive stress responses to selected physiological parameters measured by ProComp5 Infiniti™ encoder in AUD patients suffering alexithymia with or without concomitant dual diagnosis. Quite interestingly, in AUD subjects with concomitant dual diagnosis we found that the alexithymia elevated skin temperature, heart rate variability and decreased respiratory frequency. Alexithymia, if associated with the dual diagnosis condition in AUD individuals, can be considered as a further vulnerability factor to stressing factors, impacting psychosomatic processing and inducing alterations in physiological parameters. In this paper, we discuss the implications of these findings in the early treatment of alexithymic AUD individuals.

Reply for comment on "Exposure to microplastics (<10 μm) associated to plastic bottles mineral water consumption: The first quantitative study by Zuccarello et al. [Water Research 157 (2019) 365-371]"

Microplastics (MPs) are a threat to both the environment and human health. In the absence of an official method that would allow the analysis of all MPs with diameters less than 10 μm, it was not possible to estimate the exact exposure to these contaminants, yet. In the last years, few studies are available in literature with the first data concerning the concentrations of MPs on bottle mineral waters. Zuccarello et al. (2019) carried out an exposure assessment study where a high value of EDI (Estimated Daily Intake) has been reported. This rebuttal letter aims to reply to the comments of Oßmann et al. (2018) on the article of Zuccarello et al. (2019) about the new analytical method and both the use and the interpretation of Principal Component Analysis.

Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas

Background

Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy.

Methods

A collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis.

Results

Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow-up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P &lt; 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long-term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively.

Conclusion

Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.

Case-control study about exposure to BPA and DEHP and risk of endometriosis

Background

BPA and DEHP are endocrine disruptors. BPA-G and MEHP are their main metabolites. The main exposure route for human is the diet. Endometriosis is a pathology with uncertain etiopathogenesis, characterized by disturbances in sex hormones balance with a prevalence in women ranged from 1% to 7% in women aged 15-45 years.

Methods

A case-control study should highlight a possible relationship between exposure to DEHP and BPA and endometriosis. Patients (n = 40) with a surgical diagnosis of endometriosis will compose the group of cases; healthy women (n = 40) will compose the control group. Cases and controls will be studied by means of questionnaires and by means of urinary analysis of these endocrine disruptors concentration.

Results

BPA values ranged between 0.05-8.55 and 0.05-1.84 in cases and in controls, respectively; BPA-G values ranged between 0.05-16.1 and 0.05-7.38 in cases and in controls, respectively; total BPA values ranged between 0.05-3.26 and 0.05-3.51 in cases and in controls, respectively. DEHP values ranged between 13.63-57.78 and 16.66-61.93 in cases and in controls, respectively; MEHP values ranged between 1.74-6.16 and 4.26-14.16 in cases and in controls, respectively; total DEHP ranged between 15.27-63.93 and 21.72-72.73 in cases and in controls, respectively. A reverse correlation was found between endometriosis and phthalates, while a direct correlation was found between BPA and endometriosis.

Conclusions

The direct correlation between BPA and endometriosis suggests the decreasing the use of plasticizer in food packaging and the importance to implement interventions and strategy to minimize exposure. The reverse correlation between endometriosis and DEHP could be explained by the small size of sample and by the monitoring of urine that are representative of a short-time exposure.

Key messages

Improve epidemiological studies with analysis of alternative matrices that are more representative of long-time exposure. Implement interventions and strategy to minimize exposure to plasticizer.

Vaccine hesitancy among parents in the general population in Sicily (South Italy): A survey study

Background

Vaccine hesitancy (VH) has become the focus of growing attention because of decreased vaccination rates and increased emergency department use, morbidity, and mortality. VH has not been deeply studied in Sicily. The aim of this study was to estimate the prevalence of VH among parents and to investigate the potential determinants.

Methods

We performed a survey from 1 March to 1 June 2018, using a random sample of parents who reported on median 10 year-old children. The parents were recruited in pediatrician’s offices and elementary schools. Information pertaining to socio-demographic characteristics, sources of information regarding vaccination and VH was collected. VH was calculated using the Parents Attitudes about Childhood Vaccines (PACV) questionnaire. Associations between VH and predictors were tested using Multivariable Logistic Regression.

Results

In total 471 questionnaires were collected, 77.7% of respondents were mothers. Based on the PACV 100-point scale, 73.2% (95% CI: 69.0-77.2) of parents had a 0 to &lt;49 score (low level of VH); and 26.8% (95% CI: 22.8-31.0) had a score of 50 and higher (high level of VH). Internet (66.9%, 95% CI: 62.4-71.1) was the main source of information on vaccination followed by television (29.1%, 95% CI: 25.0-33.4). In the bivariate analyses, VH was associated with education, marital status and occupation, but not with gender and age of parents. In multivariate analyses, highly educated (ORadj = 0.297, 95% CI = 0.141-0.626) and married (ORadj = 0.457, 95% CI = 0.213-0.977) parents were more prone to be nonhesitant, but not so unemployed parents (ORadj = 1.787, 95% CI = 1.083-2.956).

Conclusions

The prevalence of VH among the Sicilian parents was comparable with other populations. These results could be an important starting point to support the implementation of effective vaccination strategies.

Key messages

Implement interventions and strategies to further understand the issue of VH, to restore trust in authorities and vaccines. Suggest strategies that could improve childhood vaccination rates.

Exposure to microplastics (<10 μm) associated to plastic bottles mineral water consumption: The first quantitative study

The uncontrolled introduction into the environment of plastic polymers have caused the dispersion of plastic fragments, known as Microplastics (MPs), that represent an important topic for public health. This study was the first to investigate the cause of the release of MPs in mineral waters and to estimate the concentration of MPs smaller than 10 μm both in number of particles and in mass unit. This study was carried out using a patent method regarding the extraction and analysis of MPs in more kind of matrix. Therefore, aims of this study were a) to assess the number of MPs with diameters of between 0.5 and 10 μm in mineral waters contained in plastic bottles, b) to evaluate if the physical-chemical properties of mineral waters and bottle quality could influence the release of MPs and, finally, c) to estimate the human daily exposure to MPs due to mineral water consumption. The Mps were found in every sample. The main concentration of MPs was 656.8 μg/L ± 632.9 or 5.42E+07 p/L ± 1.95E+07. The main diameter of detected MPs was 2.44 μm ± 0.66 (where p/L, where p was the number of MPs). The Estimated Daily Intake (EDI) for adults and children were 1,531,524 p/kg/body-weight/day corresponding to 40.1 μg/kg/body-weight/day and 3,350,208 p/kg/body-weight/day corresponding to 87.8 μg/kg/body-weight/day, respectively. The number of MPs contamination in bottled mineral waters was strongly correlated to the pH of waters and to plastic density of bottle. Otherwise, micrograms of MPs per liter and the MPs diameters were strongly affected by plastic thickness. The most mineral water brand contaminated by MPs was the one whose bottles were made from poor quality plastic. In absence of reference values, it was no possible carried out a risk assessment for MPs exposure. It is fundamental to establish the reference method of analysis to monitoring every source of human intake.

First description of an IgM monoclonal antibody causing αIIb β3 integrin activation and acquired Glanzmann thrombasthenia associated with macrothrombocytopenia

Essentials Acquired Glanzmann thrombasthenia (GT) is generally caused by anti-αIIb β3 autoantibodies. We report the case of a man with an acquired GT phenotype associated with macrothrombocytopenia. Perturbed platelet function were associated with an activating anti-αIIb β3 IgM autoantibody. This novel clinical entity raises interesting questions about the αIIb β3 integrin signaling. SUMMARY: Background Acquired Glanzmann thrombasthenia (GT) is a bleeding disorder generally caused by anti-αIIb β3 autoantibodies. Objectives We aimed to characterize the molecular mechanism leading to a progressive GT-like phenotype in a patient with chronic immune thrombocytopenia. Patient, Methods, and Results The patient suffered from repeated episodes of gastrointestinal bleeding; further studies indicated a moderate platelet aggregation defect. A few months later, platelet function showed abolished aggregation using all agonists, but normal agglutination with ristocetin. No platelet-bound antibodies were detected, but the presence of large amounts of an IgM type antibody detected together with αIIb β3 in the patient permeabilized platelets suggested that this IgM was an autoantibody causing the internalization of the complex. This was confirmed by the fact that the patient IgM bound to normal platelets but not to platelets from GT type I patients. Moreover, patient's plasma activated αIIb β3 on controls' platelets as evidenced by increased PAC-1 binding. We also demonstrated that the patient plasma triggered αIIb β3 outside-in signaling, as β3 Tyr773 and FAK were phosphorylated, and increased the rate of actin polymerization in resting platelets reflecting an impairment of cytoskeletal reorganization. Because different signs of dysmegakaryopoiesis were also observed in our patient, we evaluated the ability of its serum to impair proplatelets formation and showed that it significantly decreased the number of proplatelet-bearing megakaryocytes in controls' bone marrow stem cells culture compared with normal serum. Conclusions We present the case of a patient with a progressive and severely perturbed platelet function associated with the presence of an IgM activating autoantibody directed against αIIb β3 .