Design and assembly of an 8 tesla whole-body MR scanner

PURPOSE

The purpose of this report is to describe the design and construction of an 8 T/80 cm whole-body MRI system operating at 340 MHz.

METHOD

The 8 T/80 cm magnet was constructed from 414 km of niobium titanium superconducting wire. The winding of this wire on four aluminum formers resulted in a total inductance of 4,155 H. Gradient subsystems included either a body gradient or a head gradient along with a removable shim insert. The magnet and gradient subsystems were interfaced to two spectrometers. These provided the control of the gradient amplifiers and the two sets of four RF power amplifiers. The latter provide in excess of 8 kW of RF power from 10 to 140 MHz and 10 kW of RF power from 245 to 345 MHz. A dedicated computer-controlled patient table was designed and assembled. The entire system is located in a clinical setting, facilitating patient-based studies.

RESULTS

The 8 T/80 cm magnet was energized without complication and achieved persistent operation using 198.9 A of current, thereby storing 81.5 MJ of magnetic energy. Exceptional performance was observed for nearly all components both in isolation and when combined within the complete system.

CONCLUSION

An 8 T/80 cm MRI system has been assembled. The magnet subsystem is extremely stable and is characterized by good homogeneity and acceptable boil-off rates.

Environmental interventions in schizophrenia. 1: The individual and the domestic levels

This chapter looks at the research on environmental factors at the individual and domestic levels and speculates on innovations that could reduce the occurrence of schizophrenia, improve its course, and enhance the quality of life.

Environmental interventions in schizophrenia. 2: The community level

This chapter looks at the research on environmental factors at community level and speculates on innovations that could reduce the occurrence of schizophrenia, improve its course, and enhance the quality of life.

Second-generation peptidomimetic inhibitors of protein farnesyltransferase demonstrating improved cellular potency and significant in vivo efficacy

The synthesis and evaluation of analogues of previously reported farnesyltransferase inhibitors, pyridyl benzyl ether 3 and pyridylbenzylamine 4, are described. Substitution of 3 at the 5-position of the core aryl ring resulted in inhibitors of equal or less potency against the enzyme and decreased efficacy in a cellular assay against Ras processing by the enzyme. Substitution of 4 at the benzyl nitrogen yielded 26, which showed improved efficacy and potency and yet presented a poor pharmacokinetic profile. Further modification afforded 30, which demonstrated a dramatically improved pharmacokinetic profile. Compounds 26 and 29 demonstrated significant in vivo efficacy in nude mice inoculated with MiaPaCa-2, a human pancreatic tumor-derived cell line.

Retinal function as a marker for cell membrane omega-3 fatty acid depletion in schizophrenia: a pilot study

BACKGROUND

There is a growing body of evidence that abnormalities of the cell membrane, particularly depletion of n-3 essential fatty acids (EFA), are found in patients suffering from schizophrenia. These fatty acids particularly Docosohexaenoic acid (DHA) are found in particularly high concentrations in the photoreceptor cells of the retina and abnormalities of light sensitivity have been reported in patients with schizophrenia. Animal studies have demonstrated that reduced EFA levels are associated with changes in the electrophysiological response of the retina to light as measured by the electroretinogram (ERG).

METHODS

We measured the ERG of 9 patients with schizophrenia and 9 age and sex matched control subjects. All but one of the patients was medicated.

RESULTS

Schizophrenic subjects had significantly reduced a-wave amplitudes on the ERG when compared with control subjects and the a-wave amplitude was independent of the dose of antipsychotic agents being taken. The a-wave of the ERG is thought to reflect activity of the photoreceptor cells.

CONCLUSIONS

These findings support the hypothesis that patients with schizophrenia have abnormalities of photoreceptor function, which may be a result of reduced levels of n-3 EFA in the cell membrane.

Potent and orally bioavailable noncysteine-containing inhibitors of protein farnesyltransferase

Potent and orally bioavailable nonthiol-containing inhibitors of protein farnesyltransferase are described. Oral bioavailability was achieved by replacement of the pyridyl ether moiety of 1 with a 2-substituted furan ether to give 4. Potency was regained with 2,5-disubstituted furan ethers while maintaining the bioavailability inherent in 4. p-Chlorophenylfuran ether 24 is 0.7 nM in vitro (FTase) and is 32% bioavailable in the mouse, 30% bioavailable in rats, and 21% bioavailable in dogs.

Potent inhibitors of protein farnesyltransferase: heteroarenes as cysteine replacements

Synthesis and biological evaluation of heteroarenes as reduced cysteine replacements are described. Of the heteroaryl groups examined with respect to FT inhibitor FTI-276 (1), pyridyl was the replacement found to be most effective. Substitutions at C4 of the pyridyl moiety did not affect the in vitro activity. Compound 9a was found to have moderate in vivo bioavailability.

The emics and etics of quality of life assessment

BACKGROUND

Among quality of life (QOL) researchers there is a debate over the value of subjective measures, because subjective ratings of different areas of people's lives often bear little relation to their objective life circumstances. Anthropological theory can illuminate this debate, since cultural anthropologists grapple with a similar issue--the difference between emics and etics. Emic data, in anthropology, deal with distinctions that are real and significant to natives of the culture, while etic statements depend on distinctions judged appropriate by scientific observers.

CONCLUSIONS

The study of emics and etics suggests the following conclusions for QOL researchers. Subjective and objective appraisals are different kinds of data, both of which can be collected from subjects. Both are valuable, but it may be necessary to override subjective data to develop a predictive model. Objective circumstances do not reliably predict subjective evaluations of those circumstances or vice versa, particularly in evaluating change over time. The combination of subjective and objective measures, however, can lead more directly to service improvements that are sensitive to consumers' needs.

An evaluation of the impact of clubhouse membership on quality of life and treatment utilization

A group of clubhouse users matched with similar patients (not clubhouse users) in a neighbouring area were compared in terms of quality of life (Lancashire Quality of Life Profile), service utilization and treatment costs over a two year period. The clubhouse group achieved a reasonable employment status and good social relationships, and advantages in subjective well-being favoured the clubhouse group. Over two years the pattern of service utilization and costs also favoured the clubhouse group. When the two groups were disaggregated for employment status the group with least treatment utilization and lowest costs was the employed clubhouse group.

Schizophrenia and the environment: speculative interventions

OBJECTIVE

Starting from research on environmental factors that influence schizophrenia, the author speculates on innovations that could reduce the occurrence of the illness, improve its course and enhance the quality of life of sufferers and their relatives.

RESULTS

Ranging from education about obstetric risks to a stigma-reducing campaign, the suggestions could be of interest, not only to clinicians, but also to advocates, policy-makers and communications specialists.

CONCLUSIONS

Several of the suggestions, which would be innovative in the United States, are already established features of Italian mental health care. These features include social enterprises, family support payments and a disability pension system without severe disincentives to work.

The quality of life of people with schizophrenia in Boulder, Colorado, and Bologna, Italy

The aim of the study was to compare the quality of life (QOL) and needs of people with schizophrenia in comprehensive treatment systems in two countries. One hundred people with schizophrenia and schizoaffective disorder were randomly selected from the caseload of a community mental health center in Boulder, Colorado, and 70 were similarly selected from public psychiatric treatment services in and around Bologna, Italy. Subjects were interviewed with QOL and needs assessment instruments and rated with the Brief Psychiatric Rating Scale. Objective QOL measures favored Bologna subjects over Boulder subjects, particularly with respect to employment, accommodation, and family life. In a factor analysis, objective QOL variables sorted separately from subjective satisfaction ratings, suggesting that they measure different underlying constructs. Patient needs in both Boulder and Bologna samples were primarily psychological and social rather than basic survival issues. Boulder subjects were more likely to report accommodation needs. Many apparent QOL advantages for Bologna subjects could be attributed to the greater frequency with which the Italian patients lived with family of origin. Living with family also appeared to confer practical benefits in meeting needs. Objective QOL measures discriminated between patient populations better than subjective ratings of satisfaction and well-being.

Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries

This study examines attitudes toward work, work incentives, and the impact of work on quality of life for people with schizophrenia, and investigates whether these findings differ among Western countries. We interviewed 24 randomly selected subjects with schizophrenia and schizoaffective disorder (12 employed and 12 unemployed) at each of three sites: Boulder, Colorado, United States; Berlin, Germany; and Berne, Switzerland. No significant differences were found in the subjects' attitudes toward work or subjective well-being, although Swiss patients had a higher cost-of-living-adjusted income. Unemployed subjects reported a lower subjective reservation (minimum financially worthwhile) wage than employed subjects in Berlin and Berne, whereas the reverse was true in Boulder. When subjects from all sites were combined, employed patients displayed less psychopathology and significant advantages in terms of objective and subjective measures of income and well-being: They were also more likely to stress the importance of work. The results suggest that work is associated with a markedly better quality of life for people with schizophrenia, but that disability pension programs in the United States might introduce work disincentives.

Outcome for people with schizophrenia before and after Medicaid capitation at a community agency in Colorado

OBJECTIVE

To investigate the effect of a capitated funding mechanism for the psychiatric care of Medicaid recipients, a study of outcome, satisfaction, and service utilization among adults with schizophrenia and schizoaffective disorder was conducted at a Colorado agency before and after the introduction of the new funding mechanism.

METHODS

Two random samples of 100 clients each were selected, one a year before capitation was introduced and one a year after. Subjects were interviewed about their quality of life, needs, and service satisfaction. Psychopathology and service utilization were also measured.

RESULTS

Psychopathology was lower after capitation in most dimensions. The number of subjects admitted to the hospital during a six-month period beginning a year after capitation was 57 percent lower than in the equivalent period before capitation, with no increase in the amount of outpatient treatment provided. Subjects reported improved quality of life in the domains of work, finances, and social relations. Significant changes in needs or service satisfaction were not detected.

CONCLUSIONS

No evidence was found that Medicaid capitation had an adverse effect on the client population after one year. Findings suggested that capitation led to an efficient use of treatment resources.

Forms and prevalence of intersexuality and effects of environmental contaminants on sexuality in cricket frogs (Acris crepitans)

Cricket frogs (Acris crepitans) from several different sites in Illinois were collected to assess the effects of environmental contamination on the prevalence of intersex gonads. Of 341 frogs collected in 1993, 1994, and 1995, 2.7% were intersex individuals. There was no statistically significant relationship between the chemical compounds detected and cricket frog intersexuality. However, there was an association approaching significance (p = 0.07) between the detection of atrazine and intersex individuals. A comparison of reference sites with sites that had point polychlorinated biphenyl (PCB) and polychlorinated dibenzofuran (PCDF) contamination revealed a significant relationship between sex-ratio reversal and contamination with PCBs and PCDFs. The sex ratio of juvenile frogs studied from three sites with PCB and PCDF point contamination favored males over females, which was the opposite of the sex ratio in control ponds (p = 0.0007). The statistically significant correlation between organochlorine contamination and sex-ratio reversal suggests PCBs and PCDFs can influence cricket frog sexual differentiation. The current study suggests that in cricket frogs, sex ratios and the prevalence of intersex gonads are altered by environmental contamination.

Cryotherapy of metastatic carcinoid tumors

BACKGROUND

To describe the use of hepatic cryotherapy to treat patients with symptomatic carcinoid metastates.

METHODS

Hepatic cryotherapy was performed on five patients with carcinoid syndrome resulting from metastatic carcinoid tumors. Intraoperative ultrasound was used to guide the cryotherapy and to assess the adequacy of freezing.

RESULTS

All five patients had relief of the carcinoid syndrome after treatment. In four of the five patients, the relief was prolonged (>3 months); in one patient, the relief of symptoms was transient (2 months). Four of five patients had a transient reduction in hormonal tumor markers (the fifth patient did not have hormonal-level follow-up). During a follow-up period of 2.5 years, four of the five patients died. The 6-month survival rate was 80%, the 1-year survival rate was 60%, the 2-year survival rate was 40%, and the 2.5-year survival was 20%. One patient is alive 30 months after treatment.

CONCLUSION

Hepatic cryotherapy can provide symptomatic relief for patients with hepatic metastates producing the carcinoid syndrome.

Forms and prevalence of intersexuality and effects of environmental contaminants on sexuality in cricket frogs (Acris crepitans)

Cricket frogs (Acris crepitans) from several different sites in Illinois were collected to assess the effects of environmental contamination on the prevalence of intersex gonads. Of 341 frogs collected in 1993, 1994, and 1995, 2.7% were intersex individuals. There was no statistically significant relationship between the chemical compounds detected and cricket frog intersexuality. However, there was an association approaching significance (p = 0.07) between the detection of atrazine and intersex individuals. A comparison of reference sites with sites that had point polychlorinated biphenyl (PCB) and polychlorinated dibenzofuran (PCDF) contamination revealed a significant relationship between sex-ratio reversal and contamination with PCBs and PCDFs. The sex ratio of juvenile frogs studied from three sites with PCB and PCDF point contamination favored males over females, which was the opposite of the sex ratio in control ponds (p = 0.0007). The statistically significant correlation between organochlorine contamination and sex-ratio reversal suggests PCBs and PCDFs can influence cricket frog sexual differentiation. The current study suggests that in cricket frogs, sex ratios and the prevalence of intersex gonads are altered by environmental contamination.

The care of patients with chronic schizophrenia: a comparison between two services

BACKGROUND

There has been a widespread development of community multi-disciplinary teams aimed to deliver coordinated comprehensive mental health care, yet there is little published evidence on the quality of care and economics of providing such care for people with severe mental illness.

METHOD

This is a clustered randomized controlled economic comparison of the quality of care for patients with chronic schizophrenia by a multi-disciplinary community team with close links with primary care, and a traditional psychiatric service in a district general hospital psychiatric unit.

RESULTS

Two years after it was established, patients with access to the community team had more of their needs met; they had fewer unmet needs; and they were more satisfied with the care they had received. They had more service contacts and received more interventions. The community team resulted in savings in the use of some hospital resources but these were not sufficient to offset the cost of the new service. The community team successfully directed care to patients with more needs, whereas no such relationship was evident for the traditional hospital-based service. Four years after the team was established, it met a greater proportion of needs for underactivity, daily living skills, use of public amenities and managing finances.

CONCLUSIONS

Better quality care was provided at 2 and 4 years after its establishment by the multi-disciplinary community service than the traditional hospital-based service. Resources were targeted more efficiently by the community service.

Substance use among the mentally ill: a comparison of Italian and American samples

Thirty-six patients with long-standing psychotic illness randomly selected among attenders at two community centers of Bologna were interviewed as were their therapists, in order to determine prevalence and patterns of substance use, reasons for use and effects on illness. Protocols were the same as used in previous research carried out in Boulder, Colorado. For all substances, except stimulants and over-the-counter products, prevalence rates were lower in the Bologna sample than in Boulder. Overall lifetime rates of substance use were significantly lower in the Bologna sample. Nevertheless 47.2% of the Bologna sample had a lifetime moderate to severe drug use and nearly two-thirds of the sample had a current drug use of some severity. Reasons for use equally reflected attempts to alleviate unpleasant emotional states and recreational purposes. Patients with high degrees of psychopathology had significantly lower scores on severity of drug use.

Attitudes toward motherhood in postnatal depression: development of the Maternal Attitudes Questionnaire

This article describes the development of the Maternal Attitudes Questionnaire (MAQ), a 14-item self-report instrument measuring cognitions relating to role change, expectations of motherhood, and expectations of the self as a mother in postnatal women. This questionnaire was found to have good test-retest and internal reliability. In a large sample of women (n = 483) at 6-8 weeks postpartum, scores on the questionnaire were highly correlated with scores on the Edinburgh Postnatal Depression Scale (EPDS) and the Revised Clinical Interview Schedule (CIS-R). Cluster analysis demonstrated that, among depressed women with similar symptom scores on the CIS-R, the MAQ discriminated a group with low MAQ scores and a group with high MAQ scores. This finding supports the hypothesis that women who are depressed postnatally are cognitively heterogeneous; such differences may be important in understanding the etiology and determining the treatment of postnatal depression.

Adrenal glands imaging with indium-111-DTPA-D-Phe1-octreotide following ACTH therapy

Somatostatin receptors have been identified in a variety of neuroendocrine tumors and activated leukocytes. A high density of somatostatin receptors is also present in most intestinal intramural veins of patients with inflammatory bowel disease. We present a case of a 25-yr-old female with severe Crohn's disease unresponsive to medical therapy, including adrenocorticotropic hormone (ACTH) administration. The patient underwent (111)In-DTPA octreotide scintigraphy to evaluate the potential role of somatostatin receptor imaging in inflammatory bowel disease. Despite the lack of significant somatostatin receptors in the affected bowel, an unexpected prominent activity of (111)In-DTPA octreotide was noted in the adrenal glands on the SPECT images, presumably resulting from excessive stimulation by ACTH. The expression of somatostatin receptors in the stimulated adrenals may be used to image other adrenal pathologies and could potentially indicate response to therapy.

A controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression

OBJECTIVE

To study the effectiveness of fluoxetine and cognitive-behavioural counselling in depressive illness in postnatal women: to compare fluoxetine and placebo, six sessions and one session of counselling, and combinations of drugs and counselling.

DESIGN

Randomised, controlled treatment trial, double blind in relation to drug treatment, with four treatment cells: fluoxetine or placebo plus one or six sessions of counselling.

SUBJECTS

87 women satisfying criteria for depressive illness 6-8 weeks after childbirth, 61 (70%) of whom completed 12 weeks of treatment.

SETTING

Community based study in south Manchester.

MAIN OUTCOME MEASURES

Psychiatric morbidity after 1, 4, and 12 weeks, measured as mean scores and 95% confidence limits on the revised clinical interview schedule, the Edinburgh postnatal depression scale and the Hamilton depression scale.

RESULTS

Highly significant improvement was seen in all four treatment groups. The improvement in subjects receiving fluoxetine was significantly greater than in those receiving placebo. The improvement after six sessions of counselling was significantly greater than after a single session. Interaction between counselling and fluoxetine was not statistically significant. These differences were evident after one week, and improvement in all groups was complete after four weeks.

CONCLUSIONS

Both fluoxetine and cognitive-behavioural counselling given as a course of therapy are effective treatments for non-psychotic depression in postnatal women. After an initial session of counselling, additional benefit results from either fluoxetine or further counselling but there seems to be no advantage in receiving both. The choice of treatment may therefore be made by the women themselves.