EVestG: responses in depressed patients

Depression is a mood disorder characterized by a sustained period of low mood or loss of interest or pleasure in activities. Dysfunction of the limbic system is implicated in depression. Different areas of this system have bidirectional links with the vestibular nucleus. The diagnosis of depression is subjective. Electrovestibulography (EVestG) might be able to assist in the diagnosis of depression in a more objective way. A dynamic measure of the excitatory (ipsilateral) responses during the background, acceleration and deceleration phases of an active tilt are compared with a small group (n=5) of depressive patients and age matched controls (n=10).

Tryptophan catabolism in females with irritable bowel syndrome: relationship to interferon-gamma, severity of symptoms and psychiatric co-morbidity

Irritable bowel syndrome (IBS) has been linked with abnormal serotonin functioning and immune activation. Tryptophan forms the substrate for serotonin biosynthesis, but it can alternatively be catabolized to kynurenine (Kyn) by the enzyme indoleamine 2,3-dioxygenase (IDO), the main inducer of which is interferon-gamma. The primary aim of this study was to test the hypothesis that IBS is associated with increased tryptophan (Trp) catabolism along the Kyn pathway due to increased IFN-gamma levels. Plasma Kyn, Trp and IFN-gamma levels were measured in 41 female IBS subjects and 33 controls. Indoleamine 2,3-dioxygenase activity was assessed using the Kyn to Trp ratio. Psychiatric co-morbidity was assessed using the Patient Health Questionnaire, and severity of IBS assessed using self-report ordinal scales. Irritable bowel syndrome subjects had increased Kyn concentrations compared with controls (P = 0.039) and there was a trend for Kyn:Trp to be increased in the IBS group (P = 0.09). There was a positive correlation between IBS severity and Kyn:Trp (r = 0.57, P < 0.001). Those with severe IBS symptoms had increased Kyn:Trp (P < 0.005) compared to those with less severe symptoms and controls, and were over twice as likely to have depression or anxiety compared to those with less severe IBS (RR = 2.2, 95% CI 1.2-3.9). No difference in IFN-gamma levels was observed between groups; however, IFN-gamma was positively correlated with Kyn:Trp in IBS (r = 0.58, P = 0.005) but not controls (r = 0.12, P = 0.5). Females with IBS have abnormal Trp catabolism. The Kyn:Trp is related to symptom severity, and those with severe IBS symptoms have increased shunting of Trp along the Kyn pathway which contributes to the abnormal serotonergic functioning in this syndrome.

Neurology referrals to a liaison psychiatry service

The objective of the present study was to assess the activity of the Liaison Psychiatry service of Cork University Hospital in relation to all in-patient neurology referrals over a 12-month period. Of 1685 neurology admissions, 106 (6%) were referred to liaison psychiatry for assessment. 91 referrals (86%) met criteria for a psychiatric disorder according to DSM-IV, the commonest being major depression (24%) and somatoform disorder (23%). Patients with multiple sclerosis or epilepsy comprised nearly half of all referrals (48 cases; 45%). Approximately 20% of M.S. in-patients (21 cases) were referred for psychiatric assessment, with the corresponding figure in epilepsy being 25% (18 cases). Although only 106 (6%) neurology in-patients were referred to liaison psychiatry, psychiatric diagnoses were documented in 327 (20%) discharge forms, presumably reflecting previous diagnosis. The above findings indicate that psychiatric illness is common among neurology inpatients screened by liaison psychiatry yet referral rates are relatively low in terms of the overall number of neurology in-patients. Psychiatric disorders were diagnosed in 86% of referrals indicating high concordance between neurologists and liaison psychiatry regarding the presence of a psychiatric disorder.

Describing the structure and assembly of protein filaments by EPR spectroscopy of spin-labeled side chains

In this review we summarize our approach to the study of Intermediate Filament (IF) structure and assembly by electron paramagnetic resonance (EPR) spectroscopy of site-directed spin labels. Using vimentin, a homopolymeric type III IF protein, we demonstrate that this approach serves as a general paradigm for studying protein filament structure and assembly. These strategies will be useful in exploring the structure and assembly properties of other filamentous or aggregation-prone systems.

Brain stimulation techniques for the treatment of depression and other psychiatric disorders

OBJECTIVE

The aim of this paper was to review the development of repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), vagal nerve stimulation (VNS), deep brain stimulation (DBS) and other recent brain stimulation techniques for their potential use in the treatment of a range of psychiatric disorders.

CONCLUSIONS

A considerable number of studies have been conducted to investigate the efficacy of rTMS. Although there are considerable problems with this research base, globally the studies suggest that rTMS has antidepressant efficacy. However, more research is required to define the most effective way of applying this technique. There is a much smaller research base supporting the use of VNS and to date the research suggests that only a minority of patients benefit from this procedure. Considerably more research is required in the use of the other techniques which at this stage have been tested only to a very small degree. It is likely that one, and possibly a number, of the new brain stimulation techniques will become available clinically in the psychiatric armamentarium in the coming years. However, considerable research is still required to establish efficacy and define the appropriate place in clinical practice for these treatment approaches.

Preliminary findings from the National Register of Antipsychotic Medication in Pregnancy

OBJECTIVE

Following the presentation of a case study and an overview of current data highlighting the need for further research into the use of antipsychotic medication during pregnancy, the aim of the present paper was to outline the establishment of, and present preliminary data from, the National Register of Antipsychotic Medication in Pregnancy (NRAMP).

METHOD

Australian women with a history of psychosis, including schizophrenia, bipolar affective disorder with psychosis, schizoaffective disorder and first-episode psychosis, who are pregnant, are currently being invited to participate. The confluence of speculated national pregnancy rates and epidemiological data regarding child-bearing-age women with psychosis suggested an enrollment target of 100 women over a 24 month period. Details of antipsychotic medication are recorded throughout the pregnancy and for 1 year postnatally. Interviews with the mother are conducted 6 weekly antenatally, and then at 6 and 12 weeks, and 6 and 12 months postnatally, to assess symptoms of psychosis and depression, and attitudes towards parenting. In addition, consultations are conducted with the women's health-care providers to collate information regarding pharmacology and related side-effects, obstetric outcomes, psychiatric diagnoses and symptoms during pregnancy and for 1 year after delivery, and the provision of details on the baby's health and well-being.

RESULTS

NRAMP was launched in 2005. Ethics approvals have been gained at 14 sites nationally. Thirty women have consented, and 11 have completed. Data including demographics, health-care provision and medication for the first 30 participants are presented.

CONCLUSIONS

The establishment of NRAMP is an important strategy in improving the management of serious mental illness such as schizophrenia and related disorders, in women who are pregnant. This project involves extensive collaboration between many different clinical groups and industry, and shall culminate in an important resource to improve the quality of life for both patients and future generations.

History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder

BACKGROUND

There are obstacles to early identification of bipolar disorder. Identifying and treating illness early in its time course may be associated with a better prognosis.

METHODS

A questionnaire was administered at interview, when the participant was euthymic, to participants (n=240) enrolled in the Bipolar Comprehensive Outcomes Study (BCOS). Information was collected about the sequential timeline of specific symptoms of mental illness up to when they first received a diagnosis of Bipolar Disorder or Schizoaffective Disorder.

RESULTS

Any symptoms of mental illness were first experienced at 17.5 years (median; Inter Quartile Range (IQR) 13.8-24.3; n=216) and mood swings at 18.0 years (IQR 14-25; n=197). Symptoms of depression were experienced at 18.0 years (IQR 14-25; n=197), a full episode of depression at 21.2 years (IQR 17-28.5; n=200), symptoms of mania at 21.0 years (IQR 16.8-29.5; n=212) and a full episode of mania at 24.1 years (IQR 19-30.5; n=205). Medical treatment was sought at 24.0 years (IQR 19-31.5; n=217). Participants received a diagnosis of Bipolar Disorder or Schizoaffective Disorder at 30.0 years (IQR 23-37.3; n=215). Having had a previous diagnosis other than Bipolar Disorder or Schizoaffective Disorder was reported by 120 of 216 participants who answered this question, most commonly unipolar depression (26.6%). Diagnostic delay was greater in individuals with early onset disorder.

CONCLUSIONS

Participants typically experience a long sequential course of symptoms, episodes, treatments and diagnosis. The polarity of onset is most commonly depressive, and subthreshold symptoms tend to precede threshold symptoms of both polarities.

LIMITATIONS

Data were collected retrospectively.

Mapping the structural transition in an amyloidogenic apolipoprotein A-I

The single amino acid mutation G26R in human apolipoprotein A-I (apoA-IIOWA) leads to the formation of beta-secondary structure rich amyloid fibrils in vivo. Here we show that full-length apoA-IIOWA has a decreased lipid-binding capability, an increased amino-terminal sensitivity to protease, and a propensity to form annular protofibrils visible by electron microscopy. The molecular basis for the conversion of apolipoprotein A-I to a proamyloidogenic form was examined by electron paramagnetic resonance spectroscopy. Our recent findings [Lagerstedt, J. O., Budamagunta, M. S., Oda, M. N., and Voss, J. C. (2007) J. Biol. Chem. 282, 9143-9149] indicate that Gly26 in the native apoprotein separates a preceding beta-strand structure (residues 20-25) from a downstream largely alpha-helical region. The current study demonstrates that the G26R variant promotes a structural transition of positions 27-56 to a mixture of coil and beta-strand secondary structure. Microscopy and staining by amyloidophilic dyes suggest that this alteration extends throughout the protein within 1 week of incubation in vitro, leading to insoluble aggregates of distinct morphology. The severe consequences of the Iowa mutation likely arise from the combination of losing the contribution of the native Gly residue in terminating beta-strand propagation and the promotion of beta-structure when an Arg is introduced adjacent to the succeeding residue of identical charge and size, Arg27.

49. Effect of a resident-as-teacher training programme on surgical resident clinical teaching skills

This study was designed to assess the benefits of a resident-as-teacher training programme on surgical residents within a surgical clinical teaching unit. A randomized controlled trial was conducted at McMaster University between July 2005 and June 2006. Twenty-eight (28) General Surgery Residents and one 134 Medical Students participated in the study. Residents were randomly assigned to participate in a two-day training course on clinical teaching skills at the 3 or 12-month interval. Medical Students completed teaching evaluations on residents whom they had significant exposure. Resident scores on teaching evaluations as well as medical student performance on rotation examinations were assessed. The intervention (n=14) and control (n=14) groups were at similar levels of training. Only 5 intervention and 9 control residents had both pre and post intervention evaluations. Evaluations were measured on a 1 to 5 Likert scale. Data was analyzed by intention-to-treat. The mean evaluation score in both control and intervention groups were higher than pre-intervention (8% and 14%, p=0.03). However, the magnitude of change between the 2 groups was not statistically significant. Medical student performance by those exposed to more intervention residents was not significantly different from those exposed to more control residents. There is a significant improvement in resident teaching over an academic year, as determined by medical student evaluations of the resident-teachers. Although there was a trend of improved teaching with the teaching- skills intervention, the difference was not statistically significant, and did not affect medical student performance on the end-of rotation examinations. Blue AV, et al. Surgical Teaching Quality Makes a Difference. American Journal of Surgery 1999; 177:86-9. Dunnington GL, DaRosa D. A prospective Randomized Trial of Residents-as-teachers Training Program. Academic Medicine 1998; 73: 696-700. Griffith CH, et al. Relationship of How Well Attending Physicians Teach to Their Students’ Performances and Residency Choices. Academic Medicine 1997; 72:S118-120.

Structural Specializations Emerging Late in Mouse Lens Fiber Cell Differentiation

PURPOSE

To describe a previously uncharacterized structural specialization in the mouse lens fiber cell and to delineate its emergence relative to lens development and fiber cell differentiation.

METHODS

Lens fixation efficiency was explored using (14)C-formaldehyde and autoradiography. Lens fiber cell architecture was examined by scanning electron microscopy and by DiI labeling of methacrylate sections in lenses ranging from 2 weeks to 8 months.

RESULTS

Scanning electron microscopy identified an elaborate structural specialization that emerges late in fiber cell differentiation, largely after the cell has lost its nucleus. These elaborations project from the short side of the cell, are regularly spaced throughout the central region of the cell and are aligned with similar structures in adjacent cells. The structures are not found in fiber cells of lenses younger than two weeks of age, nor in the fiber cells that initially differentiate before that time.

CONCLUSIONS

Fiber cells that arise later than 2 weeks of age undergo a structural differentiation program that is different from that of cells that arise earlier in development. This program includes the assembly of a series of regularly spaced, complex, lateral projections from the fiber cell that align themselves with similar structures in adjacent cells. Most if not all of the structural specialization occurs in cells that have lost their nuclei and organelles, suggesting that this component of fiber cell differentiation may not require ongoing transcription/translation.

Non-invasive screening of lung nodules in mice comparing a novel volumetric computed tomography with a clinical multislice CT

In vivo imaging of small animal models will play an increasingly important role in cancer research, as new imaging systems that employ non-invasive protocols and offer high-resolution capability become available. A flat-panel volumetric computed tomograph (fpvCT) was evaluated to determine if minimally invasive protocols can be used to provide the spatial resolution required for lung imaging in small animals. The detection of small pulmonary nodules in a Lewis carcinoma model was investigated, and fpvCT was compared with a multislice computed tomograph (MSCT). Five C57/BL6 mice with Lewis lung carcinoma were monitored with both modalities over two weeks. Sensitivity of the systems was measured by comparing the results with histology, and the incidence of first visualization of the tumors in the two systems was determined. Compared to MSCT, fpvCT proved its superior sensitivity in detection of lung nodules. Due to its isotropic resolution and a significant reduction of partial volume effects, early detection and reasonable determination of growth in very small tumors was only possible with fpvCT. fpvCT is a high-resolution imaging system that proved its ability to perform in vivo monitoring of a pulmonary lung tumor model in mice. This permits longitudinal investigations in small animals for cancer research.

Anxiety and performance in elite non-professional athletes

Anxiety is one of the main motivators with regards to performance of individuals in any given task, including sporting endeavours. Our study sought to assess state anxiety levels in elite non-professional sportsmen, and to investigate if anxiety correlated with sporting performance, the IDA-Q (irritability, depression & anxiety questionnaire) was used to assess 3 mental state variables in an inter-county hurling team as well as a matched non-sporting control group, and performance was judged by completion of a standard task in 2 different settings: a non-pressurised one and a highly pressurised setting. Subjects had significantly higher anxiety scores on the IDA-Q than the controls (p = 0.019). There were no significant differences and controls in the depression and irritability scales. There was a significantly negative correlation between anxiety scores and performance on the IDA-Q; spearman r = -0.57. High anxiety levels impair sporting performance.

A comparison of the SNAP II™ and BIS XP™ indices during sevoflurane and nitrous oxide anaesthesia at 1 and 1.5 MAC and at awakening

BACKGROUND

Monitoring level of consciousness during anaesthesia, with the ability to predict the intentional or unintentional return to consciousness, is desirable. The purpose of this study was to compare two processed electroencephalographic depth of anaesthesia monitors (SNAP II and BIS XP) during sevoflurane and sevoflurane/nitrous oxide anaesthesia.

METHODS

In total, 42 subjects received an interscalene block, followed by general anaesthesia with sevoflurane or sevoflurane/nitrous oxide. The indices were recorded at baseline, at 1.5 and 1.0 minimum alveolar concentration (MAC) equivalents, and during emergence.

RESULTS

The SNAP and BIS indices decreased from baseline at 1.5 and 1.0 MAC equivalents, but there was no difference within groups between subjects who received nitrous oxide and those who did not. The SNAP index returned to baseline by 1 min before awakening and was higher than baseline at eye opening, but the BIS index remained below baseline at awakening. There was a bias of -1 (95% CI: -3 to 1) between the SNAP and BIS at baseline; this increased to 21 (95% CI: 19-23) during maintenance of anaesthesia and was 6 (95% CI: 4-8) at awakening.

CONCLUSIONS

The SNAP index tracks loss of consciousness and emergence from sevoflurane and sevoflurane/nitrous oxide anaesthesia. There is significant bias between the SNAP and BIS indices and therefore, the indices are not interchangeable. The SNAP index returns to baseline before awakening, whereas the BIS index remains below baseline at awakening, suggesting that the SNAP index may be more sensitive to unintentional awareness.

A pilot study of hormone modulation as a new treatment for mania in women with bipolar affective disorder

We tested and compared the use of two adjunctive hormonal agents, tamoxifen and medroxyprogesterone acetate (MPA), for the treatment of acute mania or hypomania. A total of 13 women with acute Bipolar Affective Disorder in the manic or hypomanic phase were recruited from a clinical population to participate in this 28-day, three-arm, double blind, placebo-controlled study. The women who received tamoxifen exhibited significant improvement in symptoms of mania from baseline to final assessment compared with the placebo group. The MPA group improved more than the placebo group. Further exploration of tamoxifen as a useful adjunct in the treatment of acute manic symptoms in women with Bipolar Affective Disorder is warranted.

Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes

PURPOSE

Gemcitabine-platinum combination activity has been clearly established in a number of phase II studies. It has also been compared against other combinations in many phase III trials. It is generally believed that all such regimens have an equivalent impact on survival. This meta-analysis aims to quantify the treatment effect of gemcitabine plus a platinum agent in the treatment of advanced NSCLC and compare the combination to other regimens used globally.

DESIGN

Data from a total of 4556 patients from 13 randomized trials investigating gemcitabine in combination with a platinum agent versus any other platinum-containing regimen were included in a meta-analysis of time-to-event outcomes.

RESULTS

A significant reduction in overall mortality in favor of gemcitabine-platinum regimens was observed, hazard ratio (HR) 0.90 (95% CI: 0.84-0.96) with an absolute benefit at 1 year of 3.9%. Median survival was 9.0 months for the gemcitabine-platinum regimens and 8.2 months for the comparator regimens. Sub-group analysis of the first- and second-generation platinum-based comparator regimens also indicated a significant benefit for gemcitabine-platinum regimens, HR 0.84 (CI: 0.71-0.9985). Analysis of third-generation agent plus platinum regimens showed a non-significant trend favoring gemcitabine-platinum regimens, HR 0.93 (CI: 0.86-1.01). There was a significant decrease in the risk of disease progression in favor of gemcitabine-platinum regimens, HR 0.88 (CI: 0.82-0.93). An absolute benefit of 4.2% at 1 year was estimated. Median progression-free survival was 5.1 months for gemcitabine-platinum regimens compared with 4.4 months for the comparator regimens. Sub-group analysis indicated a statistically significant progression-free survival benefit for patients assigned to gemcitabine-platinum treatment compared to first- and second-generation platinum regimens, HR 0.85 (CI: 0.77-0.94), and third-generation agent plus platinum regimens, HR 0.89 (CI: 0.82-0.96).

Repetitive transcranial magnetic stimulation and electroconvulsive therapy: complementary or competitive therapeutic options in depression?

OBJECTIVE

To examine issues pertaining to the potential clinical roles of repetitive transcranial magnetic stimulation (rTMS) and the relationship of these to the use of electroconvulsive therapy (ECT).

METHODS

A review of studies was carried out comparing the use of rTMS and ECT, with consideration of issues relating to the populations in which rTMS may be applied.

RESULTS

There have been a number of randomized comparisons of rTMS and ECT. There are limitations with these studies, but in general they indicate that in non-psychotic patients rTMS appears to have a similar rate of response to ECT and certainly seems to have meaningful clinical effects. There are a number of clinical subpopulations in whom rTMS, but not ECT, is suitable, and assessment of the effectiveness of TMS in these populations is required.

CONCLUSIONS

Repetitive TMS and ECT are likely to prove to be complementary clinical tools and the introduction of clinical programmes with rTMS will enhance patient options rather than replace the use of ECT.

Hydroxy-methylglutaryl-coenzyme A reductase inhibition improves endothelial dysfunction in type-1 diabetes

OBJECTIVE

We hypothesize that treatment with Pravastatin, a HMG CoA reductase inhibitor would improve flow-mediated dilation (FMD), a nitric oxide dependent phenomenon and the earliest detectable marker of endothelial dysfunction, in asymptomatic patients with type-1 diabetes.

MATERIALS AND METHODS

FMD of the brachial artery in response to reactive hyperaemia was measured using high-resolution ultrasonography. Young male patients with type-1 diabetes (n=9) were compared with age matched non-diabetic controls (n=8).

RESULTS

The FMD response in the control group was a median increase in diameter of 7.9 (range 3.8-12.6)%. In the diabetic group the FMD response was impaired when compared with controls with a median increase only of 4.4 (range 3.7-5.8)% (p<0.01). Following Pravastatin, 40 mg per day for one month in the diabetic group, there was a significant diameter change in response to reactive hyperaemia with a median of 8.4 (range 6.9-12.6)% (p<0.01).

CONCLUSIONS

These data confirm the presence of endothelial dysfunction in young patients with type-1 diabetes. We have shown that 1-month of Pravastatin treatment normalizes FMD. This suggests that HMG CoA reductase inhibitors may have a role in the management of diabetes mellitus, even in the presence of normal serum cholesterol levels.