Is dialdehyde starch a valuable cross-linking agent for collagen/elastin based materials?

Collagen and elastin are the main structural proteins in mammal bodies. They provide mechanical support, strength, and elasticity to various organs and tissues, e.g. skin, tendons, arteries, and bones. They are readily available, biodegradable, biocompatible and they stimulate cell growth. The physicochemical properties of collagen and elastin-based materials can be modified by cross-linking. Glutaraldehyde is one of the most efficient cross-linking agents. However, the unreacted molecules can be released from the material and cause cytotoxic reactions. Thus, the aim of our work was to investigate the influence of a safer, macromolecular cross-linking agent--dialdehyde starch (DAS). The properties of hydrogels based on collagen/elastin mixtures (95/5, 90/10) containing 5 and 10% of DAS and neutralized via dialysis against deionized water were tested. The homogenous, transparent, stiff hydrogels were obtained. The DAS addition causes the formation of intermolecular cross-linking bonds but does not affect the secondary structure of the proteins. As a result, the thermal stability, mechanical strength, and, surprisingly, swelling ability increased. At the same time, the surface properties test and in vitro study show that the materials are attractive for 3T3 cells. Moreover, the materials containing 10% of DAS are more resistant to enzymatic degradation.

Genetic variants associated with response to lithium treatment in bipolar disorder: a genome-wide association study

BACKGROUND

Lithium is a first-line treatment in bipolar disorder, but individual response is variable. Previous studies have suggested that lithium response is a heritable trait. However, no genetic markers of treatment response have been reproducibly identified.

METHODS

Here, we report the results of a genome-wide association study of lithium response in 2563 patients collected by 22 participating sites from the International Consortium on Lithium Genetics (ConLiGen). Data from common single nucleotide polymorphisms (SNPs) were tested for association with categorical and continuous ratings of lithium response. Lithium response was measured using a well established scale (Alda scale). Genotyped SNPs were used to generate data at more than 6 million sites, using standard genomic imputation methods. Traits were regressed against genotype dosage. Results were combined across two batches by meta-analysis.

FINDINGS

A single locus of four linked SNPs on chromosome 21 met genome-wide significance criteria for association with lithium response (rs79663003, p=1·37 × 10(-8); rs78015114, p=1·31 × 10(-8); rs74795342, p=3·31 × 10(-9); and rs75222709, p=3·50 × 10(-9)). In an independent, prospective study of 73 patients treated with lithium monotherapy for a period of up to 2 years, carriers of the response-associated alleles had a significantly lower rate of relapse than carriers of the alternate alleles (p=0·03268, hazard ratio 3·8, 95% CI 1·1-13·0).

INTERPRETATION

The response-associated region contains two genes for long, non-coding RNAs (lncRNAs), AL157359.3 and AL157359.4. LncRNAs are increasingly appreciated as important regulators of gene expression, particularly in the CNS. Confirmed biomarkers of lithium response would constitute an important step forward in the clinical management of bipolar disorder. Further studies are needed to establish the biological context and potential clinical utility of these findings.

FUNDING

Deutsche Forschungsgemeinschaft, National Institute of Mental Health Intramural Research Program.

21st century psychiatry: The need for a unitary framework

While the plurality of approaches is a richness of psychiatry, we need today a unitary framework in which the vast majority of psychiatrists are able to place and recognize themselves. An essential component of this framework should be the awareness that a major outcome of research efforts of the past thirty years is the notion that a simple deterministic etiological model cannot be applied to mental disorders, which instead represent the product of the complex interaction of a multiplicity of vulnerability and protective factors of different nature (biological, intrapsychic, interpersonal, psychosocial). Most current significant etiological research in psychiatry can be accommodated within this framework, thus appearing much less chaotic, inconsistent and fragmentary. This first level of the framework affects in a probabilistic, not a deterministic, way the second one, that of neurobiological, cognitive and psychological intermediate processes. It is unavoidable that different languages be used to describe these processes, but these languages may be translatable into each other to some extent. Furthermore, comprehensive pathogenetic models usually require the integration of different languages. This second level leads, again in a probabilistic way, to the third level, that of symptoms, signs, cognitive dysfunctions and psychopathological dimensions. These are the elements composing the fourth level, the syndromal one. The ICD/DSM formulation of this fourth level is not optimal, but it is the best we have at the moment. Certainly, the fact that two major diagnostic systems exist in psychiatry adds to the confusion and the uncertainty, and should be overcome in the future.

Disclosure of interest

The author has not supplied his declaration of competing interest.

A comprehensive systematic screening protocol for assessment of medical comorbidities in schizophrenia

Introduction

Difficult access and low quality of health care are recognized as factors that may account for the excess deaths widely reported in patients with schizophrenia. As a matter of fact, psychiatrists not always possess adequate competences in the assessment of physical health, while non-psychiatric physicians receive little training in psychiatry and are not prepared to take care of subjects with severe mental illnesses.

Objectives

We present a comprehensive and systematic algorithm for screening medical comorbidities, conceived to be easy to use for psychiatrists, after a brief training.

Aims

The study is aimed to implement an instrument for proper detection and management of physical illnesses in people with schizophrenia.

Methods

The screening protocol, developed by internal medicine specialists, was applied to 15 subjects in two independent assessments, one performed by trainees in psychiatry, after a brief training, and one carried out by one specialist and two trainees in internal medicine. The analysis of the inter-rater reliability was carried out by calculating the Cohen's kappa coefficient and the intraclass correlation coefficient as appropriate.

Results

The agreement among raters resulted excellent for 61% of items, good for 17%, moderate for 18% and scarce for 4%. The few items showing scarce inter-rater reliability were excluded. The final algorithm is being tested for feasibility in psychiatric settings.

Conclusions

The proposed screening protocol resulted in a suitable tool, showing moderate to excellent inter-rater reliability, that can be used in clinical practice by psychiatrists after a brief training.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A multicentric study on cognitive functions in a large sample of patients with schizophrenia and their unaffected first-degree relatives

Introduction

Neurocognition may represent an indicator of genetic risk and poor outcome in schizophrenia patients (SCZ) predicting real life functioning.

Objectives

As cognitive performance of unaffected first-degree relatives (UR) is intermediate between SCZ and healthy controls (HC), neurocognitive impairment may represent a marker of vulnerability to schizophrenia.

Aims

To investigate social and neurocognition in all subjects and their impact on functional capacity of patients as markers of vulnerability.

Methods

Sample: 922 SCZ, 379 UR and 780 HC. Assessment: MATRICS Consensus Cognitive Battery (neurocognition), Facial Emotion Identification Test and Awareness of Social Inference Test (social cognition) and Specific Level of Functioning Scale (social functioning). Analyses: Structural Equation Model (SEM) analyses to model the impact of all variables on functional outcome.

Results

SCZ scored worse in all domains than UR and HC. UR had significant impairments in all cognitive domains with respect to HC. Cognitive functioning had direct and indirect impacts on functional outcome mainly through social cognition and functional capacity. Social cognition had a direct impact on outcome, independent of neurocognition.

Conclusion

SCZ and UR display similar patterns of social and neurocognition deficits. Our results confirm a strong impact of neurocogniton on functional outcome. Social cognition has become an interesting object of study and its conceptualization as trait variable and the existence of a continuum between SCZ and UR are hypotheses for further research.

Acknowledgements

The study was carried out within the project “Multicenter study on factors influencing real-life social functioning of people with a diagnosis of schizophrenia” of the Italian Network for Research on Psychoses.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Relationships between neurocognition, social cognition and functional outcome in schizophrenia

Introduction

The inter-relationships of neurocognition, social cognition, residual psychopathology and real-life functioning are poorly understood. A large multicenter study was carried out by the Italian Network for Research on Psychoses to model relationships between neurocognitive deficits, psychopathology and real-life functioning, taking into account the role of functional capacity and social cognition.

Methods

A structural equation model was used to investigate direct and indirect effects of neurocognition and psychopathology on real-life functioning. Social cognition and functional capacity were modeled as mediators.

Results

In 921 patients with schizophrenia, neurocognition had both direct and indirect effects, through functional capacity and social cognition, on real-life functioning. Neurocognition predicted to a large extent social cognition on which depression and disorganization had a modest effect. Social cognition showed a significant direct impact on real-life functioning.

Conclusion

Our results support a strong link between neurocognition and functional outcome, independent of psychopathology. Social cognition accounted for unique incremental variance in real-life functioning.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Ghrelin response to hedonic eating in underweight and short-term weight restored patients with anorexia nervosa

Recently, anorexia nervosa (AN) has been conceptualized as a reward-related disorder, and alterations in brain reward processes have been documented in both acute and recovered AN patients. However, the role of endogenous biochemical mediators, such as ghrelin, in the modulation of reward processes has been poorly investigated in this eating disorder. Hedonic eating, that is the consumption of food exclusively for pleasure and not to maintain energy homeostasis, is a useful paradigm to investigate the physiology of food-related reward. Therefore, we assessed the response of peripheral ghrelin to hedonic eating in 7 underweight and 7 recently weight-restored AN patients and compared it to that of previously studied healthy controls. We found that in satiated underweight patients with AN plasma ghrelin levels progressively decreased after the exposure and the consumption of both the favorite and unfavorite food whereas in satiated weight-restored AN patients and satiated healthy controls plasma ghrelin concentrations significantly increased after the exposure to the favorite food and after eating it, but decreased after the unfavorite food. These results suggest a derangement in the ghrelin modulation of food-related pleasurable and rewarding feelings, which might sustain the reduced motivation toward food intake of acute AN patients.

Responses of peripheral endocannabinoids and endocannabinoid-related compounds to hedonic eating in obesity

PURPOSE

Hedonic eating occurs independently from homeostatic needs prompting the ingestion of pleasurable foods that are typically rich in fat, sugar and/or salt content. In normal weight healthy subjects, we found that before hedonic eating, plasma levels of 2-arachidonoylglycerol (2-AG) were higher than before nonhedonic eating, and although they progressively decreased after food ingestion in both eating conditions, they were significantly higher in hedonic eating. Plasma levels of anandamide (AEA), oleoylethanolamide (OEA) and palmitoylethanolamide (PEA), instead, progressively decreased in both eating conditions without significant differences. In this study, we investigated the responses of AEA, 2-AG, OEA and PEA to hedonic eating in obese individuals.

METHODS

Peripheral levels of AEA, 2-AG, OEA and PEA were measured in 14 obese patients after eating favourite (hedonic eating) and non-favourite (nonhedonic eating) foods in conditions of no homeostatic needs.

RESULTS

Plasma levels of 2-AG increased after eating the favourite food, whereas they decreased after eating the non-favourite food, with the production of the endocannabinoid being significantly enhanced in hedonic eating. Plasma levels of AEA decreased progressively in nonhedonic eating, whereas they showed a decrease after the exposure to the favourite food followed by a return to baseline values after eating it. No significant differences emerged in plasma OEA and PEA responses to favourite and non-favourite food.

CONCLUSION

Present findings compared with those obtained in our previously studied normal weight healthy subjects suggest deranged responses of endocannabinoids to food-related reward in obesity.

Collagen/elastin hydrogels cross-linked by squaric acid

Hydrogels based on collagen and elastin are very valuable materials for medicine and tissue engineering. They are biocompatible; however their mechanical properties and resistance for enzymatic degradation need to be improved by cross-linking. Up to this point many reagents have been tested but more secure reactants are still sought. Squaric acid (SqAc), 3,4-dihydroxy 3-cyclobutene 1,2-dione, is a strong, cyclic acid, which reacts easily with amine groups. The properties of hydrogels based on collagen/elastin mixtures (95/5, 90/10) containing 5%, 10% and 20% of SqAc and neutralized via dialysis against deionized water were tested. Cross-linked, 3-D, transparent hydrogels were created. The cross-linked materials are stiffer and more resistant to enzymatic degradation than those that are unmodified. The pore size, swelling ability and surface polarity are reduced due to 5% and 10% of SqAc addition. At the same time, the cellular response is not significantly affected by the cross-linking. Therefore, squaric acid would be regarded as a safe, effective cross-linking agent.

Mental health research priorities for Europe

Mental and brain disorders represent the greatest health burden to Europe-not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) health-care and welfare spending, and via productivity losses, all of which substantially affect European development. Funding for research to mitigate these effects lags far behind the cost of mental and brain disorders to society. Here, we describe a comprehensive, coordinated mental health research agenda for Europe and worldwide. This agenda was based on systematic reviews of published work and consensus decision making by multidisciplinary scientific experts and affected stakeholders (more than 1000 in total): individuals with mental health problems and their families, health-care workers, policy makers, and funders. We generated six priorities that will, over the next 5-10 years, help to close the biggest gaps in mental health research in Europe, and in turn overcome the substantial challenges caused by mental disorders.

High frequency ultrasonography: a complementary diagnostic method in evaluation of primary cutaneous melanoma

AIM

The aim of our study was to assess the usefulness of high frequency ultrasonography in the diagnosis of melanoma.

METHODS

We examined 84 patients with suspicious melanocytic skin lesions, including 19 cases of melanoma. In vivo high-resolution ultrasonography (30 MHz) was performed prior to excision.

RESULTS

In ultrasound scans early melanomas presented as flat oval or fusiform shaped structures and were clearly demarcated, while advanced melanomas were characterized by a roundish shape with less distinct borders. The ultrasonographic thickness of in situ melanomas ranged from 0.02 to 0.85 mm. In the case of invasive tumors, the mean thickness evaluated by high frequency ultrasonography was 10.7% higher compared to the Breslow Score (1.44±0.8 mm and 1.3±0.88 mm, respectively). In all melanomas of Breslow Score of 1 mm or more ultrasound also indicated a Breslow Score of 1 mm or more.

CONCLUSION

High frequency ultrasound examination has limited value in differential diagnosis of melanoma, but it gives a clear picture of the size and depth of the tumor. The method should be used as a complementary method (after dermoscopy and, where applicable, reflectance confocal microscopy) in preoperative evaluation of the tumor. In some cases of locally advanced melanoma, ultrasound examination may allow to reduce the number of surgical procedures and favor the decision of a one-time surgical treatment (removal of primary tumor and sentinel lymph node biopsy at the same time).

Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa

OBJECTIVE

Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls.

METHOD

Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales.

RESULTS

According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups.

DISCUSSION

The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation.

Is avolition in schizophrenia associated with a deficit of dorsal caudate activity? A functional magnetic resonance imaging study during reward anticipation and feedback

BACKGROUND

The neurobiological underpinnings of avolition in schizophrenia remain unclear. Most brain imaging research has focused on reward prediction deficit and on ventral striatum dysfunction, but findings are not consistent. In the light of accumulating evidence that both ventral striatum and dorsal caudate play a key role in motivation, we investigated ventral striatum and dorsal caudate activation during processing of reward or loss in patients with schizophrenia.

METHOD

We used functional magnetic resonance imaging to study brain activation during a Monetary Incentive Delay task in patients with schizophrenia, treated with second-generation antipsychotics only, and in healthy controls (HC). We also assessed the relationships of ventral striatum and dorsal caudate activation with measures of hedonic experience and motivation.

RESULTS

The whole patient group had lower motivation but comparable hedonic experience and striatal activation than HC. Patients with high avolition scores showed lower dorsal caudate activation than both HC and patients with low avolition scores. A lower dorsal caudate activation was also observed in patients with deficit schizophrenia compared to HC and patients with non-deficit schizophrenia. Dorsal caudate activity during reward anticipation was significantly associated with avolition, but not with anhedonia in the patient group.

CONCLUSIONS

These findings suggest that avolition in schizophrenia is linked to dorsal caudate hypoactivation.

Development and validation of the Family Coping Questionnaire for Eating Disorders

OBJECTIVE

To develop and validate a new instrument, the Family Coping Questionnaire for Eating Disorders (FCQ-ED), specifically designed to assess the coping strategies of relatives of patients with eating disorders (EDs).

METHOD

The study was articulated in the following seven stages: (1) in-depth analysis of scientific literature; (2) focus groups with expert researchers and clinicians in the fields of EDs and family assessment; (3) development of a pre-final version of the questionnaire; (4) recruitment of relatives and patients with EDs; (5) data collection; (6) statistical analysis; (7) finalization of the questionnaire.

RESULTS

The final version of the questionnaire consists of 32 items, grouped in five subscales ("avoidance," "coercion," "collusion," "information," and "positive communication with the patient"), with a Cronbach's alpha ranging between 0.820 and 0.625. All Items with a Cohen's Kappa > 0.60 were included in the final version of the questionnaire. Factor analysis led to the identifications of two factors, the problem-oriented and the emotion-focused coping strategies.

DISCUSSION

The final version of the questionnaire shows good psychometric properties, and it requires a short time to be completed. The five subscales correspond to those adopted by relatives of patients with schizophrenia, confirming that relatives of patients with EDs need to be supported and informed on how to cope with patient's disturbing behaviours. This questionnaire may be particularly useful for the development of psychoeducational packages for relatives of patients with EDs and the evaluation of the impact of family functioning on the course of the disease.

The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia

BACKGROUND

The Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research.

METHODS

The present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia.

RESULTS

Our results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n=912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n=496). The BNSS factor structure was supported in both groups.

CONCLUSIONS

The study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies.