Stabilization of biomass ash granules using accelerated carbonation to optimize the preparation of soil improvers

After the revision of the Fertilizer Regulation (EC 2019/1009), biomass ash can be used as component material for soil improvers to be placed on the EU market. This provides opportunities for large scale recycling of biomass ash. However, this material cannot be directly applied to soil without stabilization by carbonation, which also creates an opportunity for CO₂ capture and storage. Here, accelerated carbonation in an atmospheric fixed-bed reactor (AFR) was applied to prepare ash granules (AG). Relative humidity of gas, temperature, reaction time and CO₂ concentration were optimized and further tested in a closed high-pressure reactor (HPR). Materials resulting from both reactors were compared with those obtained after 1-year of carbonation under atmospheric conditions. This study showed that AFR accelerated tests resulted in a significant reduction of the reaction time than HPR to achieve a similar pH adjustment. Also, under 100 vol.% CO₂ atmospheric conditions, pH and electrical conductivity reached target values faster than under 15 vol.% CO₂ conditions. Based on results obtained here we recommend AFR operating at 25 °C and 100 vol.% CO₂ for 20 h, as the optimal procedure for stabilization of AG. In this study we provide evidence that accelerated carbonation enables a much faster and cost-efficient preparation of potentially valuable soil additives than natural carbonation. Also, leaching tests revealed that plant nutrient availability (B, Mg, Mn, Mo and P) was increased under accelerated carbonation compared to natural carbonation. The present work paves the way towards the development of optimized protocols to effectively recycle biomass ashes for soil recovery.

Alumina as an Antifungal Agent for Pinus elliottii Wood

This work deals with the durability of a Pinus elliotti wood impregnated with alumina (Al₂O₃) particles. The samples were impregnated at three different Al₂O₃ weight fractions (c.a. 0.1%, 0.3% and 0.5%) and were then exposed to two wood-rot fungi, namely white-rot fungus (Trametes versicolor) and brown-rot fungus (Gloeophyllum trabeum). Thermal and chemical characteristics were evaluated by Fourier transform infrared spectroscopy (FT-IR) and thermogravimetric (TG) analyses. The wood which incorporated 0.3 wt% of Al₂O₃ presented a weight loss 91.5% smaller than the untreated wood after being exposed to the white-rot fungus. On the other hand, the highest effectiveness against the brown-rot fungus was reached by the wood treated with 5 wt% of Al₂O₃, which presented a mass loss 91.6% smaller than that of the untreated pine wood. The Al₂O₃-treated woods presented higher antifungal resistances than the untreated ones in a way that: the higher the Al₂O₃ content, the higher the thermal stability. In general, the impregnation of the Al₂O₃ particles seems to be a promising treatment for wood protection against both studied wood-rot fungi. Additionally, both FT-IR and TG results were valuable tools to ascertain chemical changes ascribed to fungal decay.

First spatially resolved measurements of the D-3He α-particle source with the upgraded JET gamma-ray camera

The Joint European Torus (JET) gamma-ray camera has been recently upgraded with the installation of new gamma-ray detectors, based on LaBr₃(Ce) scintillation crystals, which add spectroscopic capability to the existing system allowing measurements with good energy resolution (5% at 0.622 MeV), a dynamic range from hundreds of keV up to about 30 MeV, and high counting rate capabilities of MCps. First gamma-ray measurements during the C38 campaign of the JET have been successfully carried out, in particular, in D-³He plasmas from three-ion ion cyclotron resonance heating experiments, where the detection of 16.4 MeV γ-rays from D + ³He → γ + ⁵Li reactions with the gamma-ray camera upgrade allowed determining the spatial profile of alpha particles born in D + ³He fusion reactions.

P581Electronic health records (EHRs) data validation in atherosclerotic/cardiovascular clinical phenotypes

Background

Research efforts to develop strategies to effectively identify patients and reduce the burden of cardiovascular diseases is essential for the future of the health system. Most research studies have used only coded parts of electronic health records (EHRs) for case-detection obtaining missed data cases, reducing study quality and in some case bias findings. Incorporating information from free-text into case-detection through Big Data and Artificial Intelligence techniques improves research quality. Savana has developed EHRead, a powerful technology that applies Natural Language Processing, Machine Learning and Deep Learning, to analyse and automatically extracts highly valuable medical information from unstructured free text contained in the EHR to support research and practice.

Purpose

We aimed to validate the linguistic accuracy performance of Savana, in terms of Precision (P), Recall (R) and overall performance (F-Score) in the cardiovascular domain since this is one of the most prevalent disease in the general population. This means validating the extent to which the Savana system identifies mentions to atherosclerotic/cardiovascular clinical phenotypes in EHRs.

Methods

The project was conducted in 3 Spanish sites and the system was validated using a corpus that consisted of 739 EHRs, including the emergency, medical and discharge records, written in free text. These EHRs were randomly selected from the total number of clinical documents generated during the period of 2012–2017 and were fully anonymized to comply with legal and ethical requirements. Two physicians per site reviewed records (randomly selected) and annotated all direct references to atherosclerotic/cardiovascular clinical phenotypes, following the annotation guidelines previously developed. A third physician adjudicated discordant annotations. Savana's performance was automatically calculated using as validation resource the gold standard created by the experts.

Results

We found good levels of performance achieved by Savana in the identification of mentions to atherosclerotic/cardiovascular clinical phenotypes, yielding an overall P, R, and F-score of 0.97, 0.92, and 0.94, respectively. We also found that going through all the EHRs and identifying the mentions to atherosclerotic/cardiovascular clinical phenotypes, the expert spent ∼ 60h while Savana ∼ 36 min.

Conclusion(s)

Innovative techniques to identify atherosclerotic/cardiovascular clinical phenotypes could be used to support real world data research and clinical practice. Overall Savana showed a high performance, comparable with those obtained by an expert physician annotator doing the same task. Additionally, a significant reduction of time in using automatic information extraction system was achieved.

3T MRI Whole-Brain Microscopy Discrimination of Subcortical Anatomy, Part 2: Basal Forebrain

BACKGROUND AND PURPOSE

The basal forebrain contains multiple structures of great interest to emerging functional neurosurgery applications, yet many neuroradiologists are unfamiliar with this neuroanatomy because it is not resolved with current clinical MR imaging.

MATERIALS AND METHODS

We applied an optimized TSE T2 sequence to washed whole postmortem brain samples (n = 13) to demonstrate and characterize the detailed anatomy of the basal forebrain using a clinical 3T MR imaging scanner. We measured the size of selected internal myelinated pathways and measured subthalamic nucleus size, oblique orientation, and position relative to the intercommissural point.

RESULTS

We identified most basal ganglia and diencephalon structures using serial axial, coronal, and sagittal planes relative to the intercommissural plane. Specific oblique image orientations demonstrated the positions and anatomic relationships for selected structures of interest to functional neurosurgery. We observed only 0.2- to 0.3-mm right-left differences in the anteroposterior and superoinferior length of the subthalamic nucleus (P = .084 and .047, respectively). Individual variability for the subthalamic nucleus was greatest for angulation within the sagittal plane (range, 15°-37°), transverse dimension (range, 2-6.7 mm), and most inferior border (range, 4-7 mm below the intercommissural plane).

CONCLUSIONS

Direct identification of basal forebrain structures in multiple planes using the TSE T2 sequence makes this challenging neuroanatomy more accessible to practicing neuroradiologists. This protocol can be used to better define individual variations relevant to functional neurosurgical targeting and validate/complement advanced MR imaging methods being developed for direct visualization of these structures in living patients.

3T MRI Whole-Brain Microscopy Discrimination of Subcortical Anatomy, Part 1: Brain Stem

BACKGROUND AND PURPOSE

The brain stem is compactly organized with life-sustaining sensorimotor and autonomic structures that can be affected by numerous pathologies but can be difficult to resolve on conventional MR imaging.

MATERIALS AND METHODS

We applied an optimized TSE T2 sequence to washed postmortem brain samples to reveal exquisite and reproducible brain stem anatomic MR imaging contrast comparable with histologic atlases. This resource-efficient approach can be performed across multiple whole-brain samples with relatively short acquisition times (2 hours per imaging plane) using clinical 3T MR imaging systems.

RESULTS

We identified most brain stem structures at 7 canonical axial levels. Multiplanar or oblique planes illustrate the 3D course and spatial relationships of major brain stem white matter pathways. Measurements of the relative position, course, and cross-sectional area of these pathways across multiple samples allow estimation of pathway location in other samples or clinical subjects. Possible structure-function asymmetries in these pathways will require further study-that is, the cross-sectional area of the left corticospinal tract in the midpons appeared 20% larger (n = 13 brains, P < .10).

CONCLUSIONS

Compared with traditional atlases, multiplanar MR imaging contrast has advantages for learning and retaining brain stem anatomy for clinicians and trainees. Direct TSE MR imaging sequence discrimination of brain stem anatomy can help validate other MR imaging contrasts, such as diffusion tractography, or serve as a structural template for extracting quantitative MR imaging data in future postmortem investigations.

Evaluation of a single extraction test to estimate the human oral bioaccessibility of potentially toxic elements in soils: Towards more robust risk assessment

Intake of soil by children and adults is a major exposure pathway to contaminants including potentially toxic elements (PTEs). However, only the fraction of PTEs released in stomach and intestine are considered as bioaccessible and results from routine analyses of the total PTE content in soils, therefore, are not necessarily related to the degree of bioaccessibility. Experimental methods to determine bioaccessibility usually are time-consuming and relatively complicated in terms of analytical procedures which limits application in first tier assessments. In this study we evaluated the potential suitability of a recently developed single extract method (ISO-17586:2016) using dilute (0.43M) nitric acid (HNO₃) to mimic the bioaccessible fraction of PTEs in soils. Results from 204 soils from Portugal, Brazil and the Netherlands including all major soil types and a wide range of PTEs' concentrations showed that the extraction efficiency using 0.43M HNO₃ of Ba, Cd, Cu, Ni, Pb and Zn in soils is related to that of in vitro methods including the Simple Bioaccessibility Extraction Test (SBET) and Unified BARGE Method (UBM). Also, differences in the degree of bioaccessibility resulting from differences in parent material, geology and climate conditions did not affect the response of the 0.43M HNO₃ extraction which is a prerequisite to be able to compare results from different soils. The use of 0.43M HNO₃ as a first screening of bioaccessibility therefore offers a robust and representative way to be included in first tier standard soil tests to estimate the oral bioaccessibility.

CAPSULE

The single dilute (0.43M) nitric acid extraction can be used in first tier soil risk assessment to assess both geochemical reactivity and oral bioaccessibility of PTEs.

Advantages and limitations of chemical extraction tests to predict mercury soil-plant transfer in soil risk evaluations

In this study, we compared the size of the mobile Hg pool in soil to those obtained by extractions using 2 M HNO3, 5 M HNO3, and 2 M HCl. This was done to evaluate their suitability to be used as proxies in view of Hg uptake by ryegrass. Total levels of Hg in soil ranged from 0.66 to 70 mg kg(-1) (median 17 mg kg(-1)), and concentrations of Hg extracted increased in the order: mobile Hg < 2 M HNO3 < 5 M HNO3 < 2 M HCl. The percentage of Hg extracted relative to total Hg in soil varied from 0.13 to 0.79 % (for the mobile pool) to 4.8-82 % (for 2 M HCl). Levels of Hg in ryegrass ranged from 0.060 to 36 mg kg(-1) (median 0.65 mg kg(-1), in roots) and from 0.040 to 5.4 mg kg(-1) (median 0.34 mg kg(-1), in shoots). Although results from the 2 M HNO3 extraction appeared to the most comparable to the actual total Hg levels measured in plants, the 2 M HCl extraction better expressed the variation in plant pools. In general, soil tests explained between 66 and 86 % of the variability of Hg contents in ryegrass shoots. Results indicated that all methods tested here can be used to estimate the plant total Hg pool at contaminated areas and can be used in first tier soil risk evaluations. This study also indicates that a relevant part of Hg in plants is from deposition of soil particles and that splashing of soil can be more significant for plant contamination than actual uptake processes. Graphical Abstract Illustration of potential mercury soil-plant transfer routes.

Soil-pore water distribution of silver and gold engineered nanoparticles in undisturbed soils under unsaturated conditions

Release of engineered nanoparticles (ENPs) to soil is well documented but little is known on the subsequent soil-pore water distribution of ENPs once present in soil. In this study, the availability and mobility of silver (Ag) and gold (Au) ENPs added to agricultural soils were assessed in two separate pot experiments. Pore water samples collected from pots from day 1 to 45 using porous (<0.17 μm) membrane samplers suggest that both Ag and Au are retained almost completely within 24 h with less than 13% of the total added amount present in pore water on day 1. UV-Vis and TEM results showed that AuENPs in pore water were present as both homoaggregates and heteroaggregates until day 3 after which the concentration in pore water was too low to detect the presence of aggregates. A close relation between the concentration of Au and Fe in pore water suggests that the short term solubility of Au is partly controlled by natural soil colloids. Results suggest that under normal aerated soil conditions the actual availability of Ag and AuENPs is low which is relevant in view of risk assessment even though the impact of environmental conditions and soil properties on the reactivity of ENPs (and/or large ENPs aggregates) retained in the solid matrix need to be addressed further.

Testing single extraction methods and in vitro tests to assess the geochemical reactivity and human bioaccessibility of silver in urban soils amended with silver nanoparticles

To assess if the geochemical reactivity and human bioaccessibility of silver nanoparticles (AgNPs) in soils can be determined by routine soil tests commonly applied to other metals in soil, colloidal Ag was introduced to five pots containing urban soils (equivalent to 6.8 mg Ag kg(-1) soil). Following a 45 days stabilization period, the geochemical reactivity was determined by extraction using 0.43 M and 2 M HNO3. The bioaccessibility of AgNPs was evaluated using the Simplified Bioaccessibility Extraction Test (SBET) the "Unified BARGE Method" (UBM), and two simulated lung fluids (modified Gamble's solution (MGS) and artificial lysosomal fluid (ALF)). The amount of Ag extracted by 0.43 M and 2 M HNO3 soil tests was <8% and <50%, respectively of the total amount of Ag added to soils suggesting that the reactivity of Ag present in the soil can be relatively low. The bioaccessibility of Ag as determined by the four in vitro tests ranged from 17% (ALF extraction) to 99% (SBET) indicating that almost all Ag can be released from soil due to specific interactions with the organic ligands present in the simulated body fluids. This study shows that to develop sound soil risk evaluations regarding soil contamination with AgNPs, aspects of Ag biochemistry need to be considered, particularly when linking commonly applied soil tests to human risk assessment.

Oral bioaccessibility and human exposure to anthropogenic and geogenic mercury in urban, industrial and mining areas

The objective of this study was to characterize the link between bioaccessibility and fractionation of mercury (Hg) in soils and to provide insight into human exposure to Hg due to inhalation of airborne soil particles and hand-to-mouth ingestion of Hg-bearing soil. Mercury in soils from mining, urban and industrial areas was fractionated in organometallic forms; mobile; semi-mobile; and non-mobile forms as well as HCl-extractable Hg. The in vitro bioaccessibility of Hg was obtained by extracting soils with (1) a simulated human gastric fluid (pH1.5), and (2) a simulated human lung fluid (pH7.4). Total soil Hg concentrations ranged from 0.72 to 1.8 mg kg(-1) (urban areas), 0.28 to 94 mg kg(-1) (industrial area) and 0.92 to 37 mg kg(-1) (mining areas). Both organometallic Hg as well as 0.1M HCl extractable Hg were lower (<0.5% of total Hg) than Hg extracted by gastric fluid (up to 1.8% of total Hg) and lung fluid (up to 12% of total Hg). In addition, Hg extracted by lung fluid was significantly higher in urban and industrial soils (average 5.0-6.6% of total Hg) compared to mining soils. Such differences were related to levels of mobile Hg species in urban and industrial soils compared to mining soils. These results strengthen the need to measure site-specific Hg fractionation when determining Hg bioaccessibility. Results also show that ingestion and/or inhalation of Hg from soil particles can contribute up to 8% of adult total Hg intake when compared to total Hg intake via consumption of contaminated fish and animal products from contaminated areas.

Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study

OBJECTIVE

Predominant polarity (PP) is an important variable in maintenance treatment of bipolar disorder (BD). This study aimed at determining the role of polarity index (PI), a metric indicating antimanic versus antidepressive prophylactic potential of drugs, in clinical decision-making.

METHOD

Two hundred and fifty-seven of 604 (43%) of patients with BD-I or II fulfilled criteria for manic (MPP) or depressive PP (DPP). The PI, representing the ratio of number needed to treat (NNT) for depression prevention to NNT for mania prevention, was calculated for patients' current treatment. MPP and DPP groups were compared regarding sociodemographic, clinical and therapeutic characteristics.

RESULTS

One hundred and forty-three patients (55.6%) fulfilled criteria for DPP and 114 (44.4%) for MPP. Total PI, Antipsychotics' PI, and mood stabilizers PI were higher, indicating a stronger antimanic action, in MPP. MPP presented higher prevalence of BD-I, male gender, younger age, age at onset and at first hospitalization, more hospitalizations, primary substance misuse, and psychotic symptoms. DP correlated with BD-II, depressive onset, primary life events, melancholia, and suicide attempts.

CONCLUSION

The results confirm the usefulness of the PI. In this large sample, clinical differences among these groups justify differential treatment approach. The PI appears to be a useful operationalization of what clinicians do for maintenance therapy in BD.

Risk assessment for Cd, Cu, Pb and Zn in urban soils: chemical availability as the central concept

To assess the geochemical reactivity and oral bioaccessibility of Cd, Cu, Pb and Zn in urban soils from the Porto area, four extractions were performed including Aqua Regia (AR; pseudototal), 0.43 M HNO3 (reactive), 0.01 M CaCl2 (available), and 0.4 M glycine at pH = 1.5, SBET method (oral bioaccessible pool). Oral bioaccessibility in urban soils was higher than in samples from rural, industrial and mining areas which is most likely related to sources of metals and parent materials of corresponding soils. The availability and reactivity were described well by non-linear Freundlich-type equations when considering differences in soil properties. The resulting empirical models are able to predict availability and reactivity and can be used to improve the accuracy of risk assessment. Furthermore, a close 1:1 relationship exists between results from the 0.43 M HNO3 method and the SBET method which substantially facilitates risk assessment procedures and reduces analytical costs.

[Intravitreal ranibizumab in the treatment of subretinal neovascularization in a case of punctate inner choroidopathy]

CASE REPORT

We report the case of a 28-year old woman suffering loss of visual acuity in her left eye, who presented an image suggestive of a subretinal neovascular membrane in her left eye, and bilateral retinal lesions compatible with punctate inner choroidopathy (PIC). She was treated with intravitreal ranibizumab obtaining excellent results.

DISCUSSION

The differential diagnosis must be made between PIC and the rest of "white dot syndromes" and the presumed ocular histoplasmosis syndrome (POHS). Antiangiogenic drugs may be a good alternative for the treatment of such diseases when they develop a subretinal neovascular membrane.

Risks associated with the transfer of toxic organo-metallic mercury from soils into the terrestrial feed chain

Although the transfer of organo-metallic mercury (OrgHg) in aquatic food webs has long been studied, it has only been recently recognized that there is also accumulation in terrestrial systems. There is still however little information about the exposure of grazing animals to OrgHg from soils and feed as well as on risks of exposure to animal and humans. In this study we collected 78 soil samples and 40 plant samples (Lolium perenne and Brassica juncea) from agricultural fields near a contaminated industrial area and evaluated the soil-to-plant transfer of Hg as well as subsequent trophic transfer. Inorganic Hg (IHg) concentrations ranged from 0.080 to 210mgkg(-1) d.w. in soils, from 0.010 to 84mgkg(-1) d.w. in roots and from 0.020 to 6.9mgkg(-1) d.w. in shoots. OrgHg concentrations in soils varied between 0.20 and 130μgkg(-1) d.w. representing on average 0.13% of the total Hg (THg). In root and shoot samples OrgHg comprised on average 0.58% (roots) and 0.66% (shoots) of THg. Average bioaccumulation factors (BAFs) for OrgHg in relation to soil concentrations were 3.3 (for roots) and 1.5 (for shoots). The daily intake (DI) of THg in 33 sampling sites exceeded the acceptable daily intake (ADI) of THg of both cows (ADI=1.4mgd(-1)) and sheep (ADI=0.28mgd(-1)), in view of food safety associated with THg in animal kidneys. Estimated DI of OrgHg for grazing animals were up to 220μgd(-1) (for cows) and up to 33μgd(-1) (for sheep). This study suggested that solely monitoring the levels of THg in soils and feed may not allow to adequately taking into account accumulation of OrgHg in feed crops and properly address risks associated with OrgHg exposure for animals and humans. Hence, the inclusion of limits for OrgHg in feed quality and food safety legislation is advised.

The usefulness of mood stabilizers in the treatment of bipolar depression

Aims

Considering bipolar depression a diagnostic and therapeutic challenge, distinct from unipolar depression and associated with significant morbidity and mortality, we aim to systematically review guidelines, consensus meetings and treatment algorithms on the acute treatment of bipolar depression to critically underline the role of mood-stabilizers.

Method

The MEDLINe/PubMed/Index Medicus, PsycINFO/PsycLIT, Excerpta Medica/EMBASE, databases were searched using “depression”, “bipolar”, “mood-stabilizers”, “manic-depressive” and “treatment guidelines” as key words since 2005 onward.

Results

Among mood-stabilizers, the use of lamotrigine is overall recommended as first-line choice. Monotherapy is suggested on the basis of several positives clinical trials, however, pooled data analysis showed that lamotrigine was only modestly useful. Valproate monotherapy is suggested as first-line treatment option in the WFSBP and BAP guidelines, and in combination with lithium or antidepressants, but it is not mentioned among first-line choices neither in monotherapy nor as adjunctive treatment in two guidelines (ICG, NICE).

Lithium monotherapy is suggested in three of all guidelines (ICG, BAP, CANMAT and ISBD) as first-line treatment on the basis of positive evidence, but it is not recommended as first-choice by WFSBP and NICE guidelines. Its combination with lamotrigine, valproate and other agents is instead recommended as first choice treatment.

Conclusions

In summary, mood-stabilizers are considered a key point in the management of bipolar depression, preferably in combination. Despite algorithms evidence-based could be helpful to guide clinicians, they always need the case by case pharmacotherapeutic consideration.

Postpartum bipolar episodes are not distinct from spontaneous episodes: implications for DSM-V

INTRODUCTION

DSM course modifiers should be based on enough evidence on his impact in the clinical prognosis of patients presenting with a certain clinical feature. The presence of postpartum onset of a mood episode in bipolar disorders has not been sufficiently studied. This is the first prospective clinical study comparing female bipolar patients with and without lifetime history of postpartum mood episode.

METHODS

Systematic prospective follow-up (12 years) of 200 female bipolar I or II patients with or without history of postpartum episodes. Postpartum mood episode was defined according to DSM-IV criteria. Patients with and without postpartum onset of a mood episode were compared regarding clinical and sociodemographic variables.

RESULTS

Lifetime history of postpartum episode was present in 43 patients and absent in 137 patients. Twenty patients were excluded from the study because lack of agreement of the two independent psychiatrist. Both groups showed almost no differences regarding clinical features, functioning or severity.

LIMITATIONS

The present study does not take account of potential factors that may influence the outcome of a postpartum episode, including obstetric complications and social support before delivery. Similarly, dimensional and qualitative aspects of bipolar disorder were not included in our analysis.

CONCLUSION

The role of postpartum onset as a DSM course modifier should be reconsidered, as it seems to have no impact on prognosis or functioning.

Age at onset in 3014 Sardinian bipolar and major depressive disorder patients

OBJECTIVE

To test if onset age in major affective illnesses is younger in bipolar disorder (BPD) than unipolar-major depressive disorder (UP-MDD), and is a useful measure.

METHOD

We evaluated onset-age for DSM-IV-TR major illnesses in 3014 adults (18.5% BP-I, 12.5% BP-II, 69.0% UP-MDD; 64% women) at a mood-disorders center.

RESULTS

Median and interquartile range (IQR) onset-age ranked: BP-I = 24 (19-32) < BP-II = 29 (20-40) < UP-MDD = 32 (23-47) years (P < 0.0001), and has remained stable since the 1970s. In BP-I patients, onset was latest for hypomania, and depression presented earlier than in BP-II or UP-MDD cases. Factors associated with younger onset included: i) being unmarried, ii) more education, iii) BPD-diagnosis, iv) family-history, v) being employed, vi) ever-suicidal, vii) substance-abuse and viii) ever-hospitalized. Onset-age distinguished BP-I from UP-MDD depressive onsets with weak sensitivity and specificity.

CONCLUSION

Onset age was younger among BPD than MDD patients, and very early onset may distinguish BPD vs. UP-MDD with depressive-onset.

Onset-age of bipolar disorders at six international sites

BACKGROUND

Onset-age is a stable characteristic of bipolar disorder (BPD) patients of clinical and probable psychobiological importance, but large pooled clinical samples from multiple sites employing modern diagnostic criteria to quantify onset-age remain rare.

METHODS

We pooled diagnostic, demographic, and clinical data from 1566 BPD patients from six international sites (5 European, 1 US) to compare onset-ages in subgroups.

RESULTS

Median+/-IQR onset in 1090 BP-I patients was 5.8 years younger than 476 BP-II cases (24.3+/-18.3 vs. 30.1+/-13.8 years; p<0.0001). Onset-age ranked: [a] BP-I men (23.0+/-12.8); [b] BP-I women (26.0+/-14.2); [c] BP-II men (29.7+/-19.1); and [d] BP-II women (30.1+/-17.5 years. Juvenile-onset (<or=age 20) was more common in Europe than the US (27% vs. 16%), as was childhood-onset (<13 years: 3.3% vs. 0%; both p<0.001). Proportion of all cases, and median onset for first episodes ranked: [a] BP-I psychotic (6.3%; 22.7+/-9.2); [b] BP-I manic (29.3%; 24.0+/-12.1); [c] BP-I depressed (25.1%; 24.5+/-14.9); [d] BP-I mixed (9.7%; 27.9+/-16.0); [e] BP-II depressed (26.9%; 30.0+/-19.5); and [f] BP-II hypomanic (2.8%; 33.6+/-15.1 years; p<0.0001). Among BP-I patients, onset was similar for various forms of mania and major depression; in BP-II patients initial depression was 9.6-times more frequent and diagnosed earlier than hypomania.

LIMITATIONS

There was some variance among sites and only 34.1% of patients were evaluated at onset.

CONCLUSIONS

Type I BPD began much earlier than type II; its mainly psychotic presentations occurred earliest, but BP-I men were younger than women, especially at psychotic or mixed onsets.

Rapid-cycling bipolar I disorder: course and treatment outcome of a large sample across Europe

OBJECTIVES

To evaluate the baseline characteristics and follow-up outcomes of rapid-cycling (RC) bipolar I patients in a large, prospective, observational study.

METHODS

EMBLEM (European Mania in Bipolar Longitudinal Evaluation of Medication) is a long-term prospective observational study of in- and outpatients with an acute mania/mixed episode conducted in 14 European countries. Demographic and clinical variables were collected at baseline, including the presence or absence of DSM-IV rapid-cycling during the past year. Outcome measures included the 5-item Hamilton Depression Rating Scale (HAMD-5) and Young Mania Rating Scale (YMRS) over 12 weeks, as well as the Clinical Global Impressions-Bipolar Disorder Scale (CGI-BP overall, mania and depression) over 12 months.

RESULTS

Of 3684 patients enrolled, 3089 patients provided reliable data to qualify for either RC (N=535, 17.3%) or non-RC (NRC, N=2554), according to DSM-IV. RC prevalence varied across countries (p<0.001). Baseline and 12 week outcomes on the YMRS and HAMD-5, 12 month ratings on the CGI-BP subscales and work impairment at 12 months were significantly different (p<0.001) between groups, being worse in RC. RC patients were more likely to receive antidepressants and lamotrigine (p<0.001). Using logistic regression, RC was associated to country (p<0.001), female sex (p=0.029), outpatients (p=0.035), more history of attempted suicide (p<0.001) and alcohol abuse (p<0.001).

CONCLUSIONS

The EMBLEM results suggest that in naturalistic settings, patients with mania and RC differ from NRC in socio-demographic characteristics, treatment prescriptions and clinical outcome measures with a consistently worse occupational outcome and comorbidities. RC represents a longitudinally severe form of bipolar disorder, with poorly evidence-based diagnostic and therapeutic tools.

Depression subtypes in bipolar I and II disorders

BACKGROUND

Depression is the predominant mood alteration in bipolar I and II disorders. In this study, the nature of major depressive episodes of bipolar I versus bipolar II patients is specifically assessed, as regards lifetime history of rapid cycling, melancholia, atypical and psychotic symptoms.

METHODS

The patient sample consisted of 184 bipolar I and 80 bipolar II patients, according to the research diagnostic criteria, who entered the bipolar disorders program in our hospital. Subsets of patients are compared according to DSM-IV criteria for rapid cycling, melancholic, atypical and psychotic features.

RESULTS

Bipolar I patients had significantly more psychotic symptoms in their lifetime histories (p < 0.001), whereas bipolar II patients had significantly more atypical symptoms in their lifetime histories (p < 0.003). Although melancholia was more prevalent in the bipolar I and rapid cycling was more prevalent in the bipolar II subgroup, these differences did not reach statistical significance.

CONCLUSIONS

The results of the study suggest that marked differences exist in the nature of major depressive episodes between bipolar I and II patients, as they in the long term emerge from the two conditions. To what extent both conditions are related cannot be ascertained in the present study. Clinical differences may have relevant therapeutic implications and separate trials for bipolar I and bipolar II depression are warranted.

Association of genetic markers within the KIT and KITLG genes with human male infertility

BACKGROUND

There is much evidence involving the KIT tyrosine kinase receptor and its ligand KITLG in the survival and proliferation of germ cells. Animal models and functional studies in humans suggest that this signalling pathway plays a role in male infertility.

METHODS

We studied three and two single-nucleotide polymorphisms (SNPs) (rs3819392, rs3134885, rs2237012, rs10506957 and rs995030) located within the genomic region of the KIT and KITLG genes, respectively. A total of 167 idiopathic infertile men (sperm counts <5 million spz/ml) and 465 unrelated healthy controls from the same geographical region were genotyped for these SNPs.

RESULTS

We found a statistically significant association of the rs3819392 polymorphism, which is located within the KIT gene, with idiopathic male infertility. In addition, a deviation from the Hardy-Weinberg equilibrium (HWE) law was observed for rs10506957 polymorphism within the KITLG gene only in the infertile group.

CONCLUSIONS

Our data indicate that the KIT/KITLG system may be involved in a low sperm count trait in humans.

Purification and characterization of two serine protease inhibitors from the hemolymph of Mythimna unipuncta

Two serine protease inhibitors, trypsin inhibitor and alpha-chymotrypsin inhibitor, were isolated from the hemolymph of Mythimna unipuncta. Mythimna trypsin and alpha-chymotrypsin inhibitors were purified by gel filtration and anion-exchange chromatography. They displayed molecular masses of 52 kDa and 43 kDa, respectively, as determined by electrophoresis under reducing and non-reducing conditions on denaturing polyacrylamide gels. Their isoelectric points were evaluated by isoelectric focusing and two-dimensional electrophoresis. Their N-terminal sequences have been analyzed as APSDTTIAETLTITEEFFPD and FDESFGFQGPSTYEKTPLGEP, respectively. The role of these inhibitors in the regulation of the defense reaction of the insect is discussed.

Detection and identification of human parainfluenza viruses 1, 2, 3, and 4 in clinical samples of pediatric patients by multiplex reverse transcription-PCR

We describe a multiplex reverse transcription-PCR (m-RT-PCR) assay that is able to detect and differentiate all known human parainfluenza viruses (HPIVs). Serial dilution experiments with reference strains that compared cell culture isolation and m-RT-PCR showed sensitivities ranging from 0.0004 50% tissue culture infective dose (TCID(50)) for HPIV type 4B (HPIV-4B) to 32 TCID(50)s for HPIV-3. As few as 10 plasmids containing HPIV PCR products could be detected in all cases. When 201 nasopharyngeal aspirate specimens from pediatric patients hospitalized for lower respiratory illness were tested, m-RT-PCR assay detected 64 HPIVs (24 HPIV-3, 23 HPIV-1, 10 HPIV-4, and 7 HPIV-2), while only 42 of them (21 HPIV-1, 14 HPIV-3, 6 HPIV-2, and 1 HPIV-4 isolates) grew in cell culture. Our m-RT-PCR assay was more sensitive than either cell culture isolation or indirect immunofluorescence with monoclonal antibodies for the detection of HPIV infections. Also, HPIV-4 was more frequently detected than HPIV-2 in this study, suggesting that it may have been underestimated as a lower respiratory tract pathogen because of the insensitivity of cell culture.