An ecological momentary assessment study of age effects on perceptive and non-perceptive clinical high-risk symptoms of psychosis

Among individuals with clinical high risk for psychosis (CHR), perceptive symptoms are more frequent but have less clinical significance in children/adolescents compared to adults. However, findings are based on clinical interviews relying on patient's recall capacity. Ecological momentary assessment (EMA) can be used to explore experiences in real-time in the subject's daily life. The aim of this study was to assess frequency and stability of (perceptive and non-perceptive) CHR symptoms and to explore potential age effects. EMA was used in a sample of an early detection for psychosis service in Bern, Switzerland (N = 66; 11-36 years). CHR symptoms were recorded in random time intervals for seven days: eight assessments per day per subject, minimum time between prompts set at 25 min. CHR symptoms were additionally assessed with semi-structured interviews including the 'Structured Interview for Psychosis-Risk Syndromes' and the 'Schizophrenia Proneness Instruments'. Mixed-effects linear regression analysis on the frequency of CHR symptoms revealed a significant effect of age group, and the interaction CHR symptoms x age group for both perceptive and non-perceptive symptoms. Further, regarding stability of CHR symptoms, there was a significant effect of the interaction CHR symptoms x age group for perceptive symptoms only. Based on EMA, perceptive CHR symptoms were more frequently reported but less stable in children/adolescents compared with adults. Together with previous findings, our finding of higher instability/variability of perceptive symptoms in younger persons might suggest that with advancing age and more stability of CHR symptoms, clinical relevance (reduced psychosocial functioning) may increase.

Diet-dependent function of the extracellular matrix proteoglycan Lumican in obesity and glucose homeostasis

Objective

Extracellular matrix remodeling is required for adipose expansion under increased caloric intake. In turn, inhibited expandability due to aberrant collagen deposition promotes insulin resistance and progression towards the metabolic syndrome. An emerging role for the small leucine-rich proteoglycan Lumican in metabolically driven nonalcoholic fatty liver disease sparks an interest in further understanding its role in diet-induced obesity and metabolic complications.

Methods

Whole body ablation of Lumican (Lum^−/−) gene and adeno-associated virus-mediated over-expression were used in combination with control or high fat diet to assess energy balance, glucose homeostasis as well as adipose tissue health and remodeling.

Results

Lumican was found to be particularly enriched in the stromal cells isolated from murine gonadal white adipose tissue. Likewise murine and human visceral fat showed a robust increase in Lumican as compared to fat from the subcutaneous depot. Lumican null female mice exhibited moderately increased fat mass, decreased insulin sensitivity and increased liver triglycerides in a diet-dependent manner. These changes coincided with inflammation in adipose tissue and no overt effects in adipose expandability, i.e. adipocyte formation and hypertrophy. Lumican over-expression in visceral fat and liver resulted in improved insulin sensitivity and glucose clearance.

Conclusions

These data indicate that Lumican may represent a functional link between the extracellular matrix, glucose homeostasis, and features of the metabolic syndrome.

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The extracellular matrix proteoglycan Lumican (Lum) is particularly enriched in stromal cells within white adipose tissue.

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Visceral fat from obese patients displays increased levels of Lum compared to subcutaneous fat.

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Lum-Ko female mice exhibit decreased insulin sensitivity and increased triglycerides upon high-fat diet (HFD) feeding.

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Lum-Ko female mice on HFD have increased inflammation in white fat in the absence of overt effects on adipocyte formation.

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· Lum over-expression in visceral fat and liver resulted in improved insulin sensitivity and glucose clearance.

[Arthroscopic subacromial decompression]

OBJECTIVE

Coracoacromial ligament release to widen the subacromial space, resection of the anterior undersurface of the acromion and, if needed, caudal exophytes at the acromioclavicular joint.

INDICATIONS

All types of outlet impingement after 3 months of conservative treatment.

CONTRAINDICATIONS

Impingement syndrome with instability/muscular imbalance, massive rotator cuff tear, unstable os acromionale, posterior-superior impingement, joint infection, freezing phase of a secondary frozen shoulder.

SURGICAL TECHNIQUE

Lateral decubitus position with traction device for the arm. Diagnostic arthroscopy of the glenohumeral joint via standard portals. With arthroscope moved to the subacromial space, bursectomy, electrosurgical release of coracoacromial ligament, resection of acromial hook through standard posterior portal.

POSTOPERATIVE MANAGEMENT

Physiotherapy or self-exercises on postoperative day 1, pain-adapted analgesia to avoid shoulder stiffness.

RESULTS

Several studies present positive long-term results compared to conservative treatment (and open acromioplasty) for partial rotator cuff tears and for elderly patients. With a 20-year follow-up, successful results have been achieved for all patients with isolated impingement syndrome.

Mixture EMOS model for calibrating ensemble forecasts of wind speed

Ensemble model output statistics (EMOS) is a statistical tool for post-processing forecast ensembles of weather variables obtained from multiple runs of numerical weather prediction models in order to produce calibrated predictive probability density functions. The EMOS predictive probability density function is given by a parametric distribution with parameters depending on the ensemble forecasts. We propose an EMOS model for calibrating wind speed forecasts based on weighted mixtures of truncated normal (TN) and log-normal (LN) distributions where model parameters and component weights are estimated by optimizing the values of proper scoring rules over a rolling training period. The new model is tested on wind speed forecasts of the 50 member European Centre for Medium-range Weather Forecasts ensemble, the 11 member Aire Limitée Adaptation dynamique Développement International-Hungary Ensemble Prediction System ensemble of the Hungarian Meteorological Service, and the eight-member University of Washington mesoscale ensemble, and its predictive performance is compared with that of various benchmark EMOS models based on single parametric families and combinations thereof. The results indicate improved calibration of probabilistic and accuracy of point forecasts in comparison with the raw ensemble and climatological forecasts. The mixture EMOS model significantly outperforms the TN and LN EMOS methods; moreover, it provides better calibrated forecasts than the TN-LN combination model and offers an increased flexibility while avoiding covariate selection problems.

The scent of stress: environmental challenge in the peripartum environment of mice affects emotional behaviours of the adult offspring in a sex-specific manner

Early adverse experiences are known to influence the risk of developing psychiatric disorders later. To shed further light on the development of laboratory mice, we systematically examined the influence of a prenatal or postnatal olfactory stressor, namely unfamiliar male mouse faeces, presented to pregnant or nursing mouse dams. Maternal and offspring behaviours were then examined. Maternal behaviours relative to controls revealed changes in nest building by the pregnant dams exposed to the unfamiliar faeces. There were no differences among groups on pup retrieval or exploration by the dams. Behavioural phenotyping of male and female offspring as adults included measures of exploration, anxiety, social and depressive-like behaviours. Additionally, serum corticosterone was assessed as a marker of physiological stress response. Group differences were dependent on the sex of the adult offspring. Males raised by dams that were stressed during pregnancy presented elevated emotionality as indicated by increased numbers of faecal boluses in the open field paradigm. Consistent with the effects of prenatal stress on the males only the prenatally stressed females had higher body weights than their respective controls. Indeed, males in both experimental groups had higher circulating corticosterone levels. By contrast, female offspring of dams exposed to the olfactory stressor after parturition were more anxious in the O-maze as indicated by increased latencies in entering the exposed areas of the maze. These findings emphasize the necessity for researchers to consider the pre- and postnatal environments, even of mice with almost identical genetic backgrounds, in designing experiments and interpreting their data.

[Arthroscopic release for shoulder stiffness]

OBJECTIVE

Arthroscopic capsular release for refractory shoulder stiffness to recreate active and passive shoulder joint mobility.

INDICATIONS

Adhesive capsulitis of the shoulder (primary and secondary frozen shoulder) after receiving at least 3 months of conservative treatment.

CONTRAINDICATIONS

Boney-related stiffening of the shoulder joint, joint infection, freezing phase of the primary frozen shoulder and shoulder stiffness after reconstructive surgery.

SURGICAL TECHNIQUE

Opening of the lower shoulder joint capsule over a gentle unidirectional manipulation under general anesthesia. A diagnostic arthroscopy in lateral position with extension of the arm is then performed. The release is completed with incision of the ventral and the dorsal part of the capsule under arthroscopic control.

POSTOPERATIVE MANAGEMENT

While still in the operation room, the anesthetist places an interscalene brachial plexus catheter, thus, delivering the best possible analgesia. This enables full range of active and passive movement of the shoulder joint for at least 3 days. Outpatient continuation of physiotherapy with anti-inflammatory and analgesic medication.

RESULTS

The literature shows good functional results with age- and gender-related Constant scores greater than 75 %. Our retrospective inquiry of 37 cases with a mean follow-up of 40 months confirms this outcome. The disease duration was shortened by arthroscopic release. Ability to work was achieved after a mean of 1.9 months; treatment ended 3.6 months after operation. In 10 cases with secondary shoulder stiffness, residual symptoms remained.

Bevacizumab and pegylated liposomal doxorubicin as first-line therapy for locally recurrent or metastatic breast cancer: A multicenter, single-arm phase II trial of the Swiss Group for Clinical Cancer Research (SAKK)

1030

Background: Bevacizumab in combination with taxanes has become a standard first-line treatment of advanced breast cancer in some countries, but there is no information on its use in combination with pegylated lipsomal doxorubicin in metastatic breast cancer. Therefore, we performed a multicenter, single-arm phase II trial to evaluate the toxicity and efficacy of pegylated liposomal doxorubicin (PLD) and bevacizumab (B) as first-line treatment in advanced breast cancer. Methods: PLD at a dose of 20 mg/m2 and B at 10 mg/kg were infused on days 1 and 15 of each 4-week cycle for a maximum of 6 cycles. Thereafter, B monotherapy was continued at the same dose until progression or toxicity. Primary endpoint was the occurrence of specific toxic events known to strongly interfere with quality of life, i.e., severe cardiac toxicity, any grade 4/5 toxicity, and selected grade 3 nonhematological toxicities (hand-foot-syndrome, cognitive disturbance, CNS hemorrhage, and mucositis/stomatitis). Secondary endpoints included overall response, progression free survival (PFS), time to treatment failure, and duration of response. Eligibility criteria included documentation of metastatic or inoperable breast cancer; measurable disease according to RECIST; erbB2-negativity; LVEF of ≥ 55%; WHO performance status 0 or 1. The study used a Herndon's two-stage design with 14 and 29 patients for stages 1 and 2, respectively. The promising rate of primary toxicity was <15% and the uninteresting rate >33%. The type I error probability was 5% and the power 80%. Results: The trial had to be stopped prematurely because of toxicity after the enrollment of 41 evaluable patients. Among these patients, 16 (39%) had grade 3 hand-foot syndrome, 1 grade 3 mucositis and 1 grade 4 cardiac toxicity. Thus, a total of 18/41 (44%, exact 95% c.i. 28–60%) of all patients had a primary toxicity. Best overall response rate was 23.3% (exact 95% c.i. 12–39%), median PFS was 7.5 months (95% c.i. 4.6–8.1 months). Conclusions: The combination of 2-weekly PLD and B in advanced breast cancer is surprisingly toxic and only modestly active and should not be further investigated.

[Table: see text]

Multicenter phase II trial of gefitinib first-line therapy followed by chemotherapy in advanced non-small-cell lung cancer (NSCLC): SAKK protocol 19/03

BACKGROUND

Gefitinib is active in patients with pretreated non-small-cell lung cancer (NSCLC). We evaluated the activity and toxicity of gefitinib first-line treatment in advanced NSCLC followed by chemotherapy at disease progression.

PATIENTS AND METHODS

In all, 63 patients with chemotherapy-naive stage IIIB/IV NSCLC received gefitinib 250 mg/day. At disease progression, gefitinib was replaced by cisplatin 80 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1, 8 for up to six 3-week cycles. Primary end point was the disease stabilization rate (DSR) after 12 weeks of gefitinib.

RESULTS

After 12 weeks of gefitinib, the DSR was 24% and the response rate (RR) was 8%. Median time to progression (TtP) was 2.5 months and median overall survival (OS) 11.5 months. Never smokers (n = 9) had a DSR of 56% and a median OS of 20.2 months; patients with epidermal growth factor receptor (EGFR) mutation (n = 4) had a DSR of 75% and the median OS was not reached after the follow-up of 21.6 months. In all, 41 patients received chemotherapy with an overall RR of 34%, DSR of 71% and median TtP of 6.7 months.

CONCLUSIONS

First-line gefitinib monotherapy led to a DSR of 24% at 12 weeks in an unselected patients population. Never smokers and patients with EGFR mutations tend to have a better outcome; hence, further trials in selected patients are warranted.

Quality of life (QoL) in SAKK 19/03: A multicenter phase II study of first-line gefitinib followed by chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Swiss Group for Clinical Cancer Research (SAKK)

18559

Background: 63 patients (pts) were accrued in this first study testing first-line tyrosine-kinase inhibitor treatment with gefitinib followed by chemotherapy at disease progression (gemcitabine-cisplatin q3w x6, 41 pts) in stage IIIB/IV NSCLC (ASCO 2005 # 7128). We investigated the longitudinal QoL patterns on both subsequent treatment modalities. Methods: FACT-L including TOI (Trial Outcome Index) and LCS (Lung Cancer Subscale) scores were assessed during both treatment phases (gefitinib: baseline, weeks 3,6,12,18 and every 12 weeks thereafter; chemotherapy: baseline and at d1 of cycle 3 and 5). QoL changes from baseline were descriptively analysed. Improvement was defined as a 6 point (FACT-L, TOI) and 2 point (LCS) increase. Results: QoL-scores are shown in the table below. On gefitinib, at week 6 31/18/32% of pts had improvements of FACT-L, TOI and LCS, respectively and 29/15/41% at week 12 (% based on pts with available data). During chemotherapy the respective improvement rates were 60/60/70% of pts at week 6 and 43/29/43% at week 12. At week 12 of gefitinib, 4 of the pts analysed had partial remission (PR, independently confirmed), 31 pts dropped out (none due to toxicity) and QoL submission rate was 84% based on expected forms. Chemotherapy week 12: 5 PR in analysed pts, 18 drop outs (5 due to toxicity), 43% submission rate. Conclusions: QoL was maintained in pts continuing treatment with gefitinib and decreased at disease progression. QoL and tumor symptoms improved in a considerable part of pts during gefitinib therapy despite low remission rates. Declining submission rate during treatment introduces a potential, unquantifiable bias in QoL.

[Table: see text]

[Table: see text]

Pilotstudie zur Rezeptierung von Benzodiazepinen in der Schweiz: Beeinflusst die kognitive Verfügbarkeit von Gesetzesvorschriften das ärztliche Verschreibungsverhalten?

All 481 prescriptions of benzodiazepines from five Zurich pharmacies during a 6 week period were evaluated with respect to their compliance with the Swiss Law on Narcotics, which was formulated to prevent benzodiazepine dependence. Three weeks into the study, all 17 physicians with prescriptions of benzodiazepines practising in the catchment areas of two of the five pharmacies randomly selected were faxed an information sheet explaining formal juridical requirements for benzodiazepine prescription stipulated by the law. 28 % of all prescriptions were not compliant with the law. The older a patient, the greater his/her risk of receiving a non-compliant prescription. Neither sex of patients nor professional specialization of the prescribing doctor did impact prescription compliance. The preventive intervention, i. e. information on legal requirements, also had no significant impact on the compliance of prescriptions with the law. As other studies with soft interventions and educational measures directed to the prescribing physician also failed to reduce inappropriate prescription of benzodiazepines, it is concluded that sanctions against incompliant prescription behaviour should be considered as a preventive alternative.

Thyroid autonomy with color-coded image-directed Doppler sonography: internal hypervascularization for the recognition of autonomous adenomas

In a prospective study, we assessed the possibility of recognizing autonomous adenomas of the thyroid with color-coded image-directed Doppler sonography using internal hypervascularization in thyroid nodules for identification. Fifty-three patients with thyroid nodules underwent additional CCDS examination and nuclear scintigraphy (reference). Of 29 patients having autonomous adenomas, 28 patients presented internal hypervascularization in their nodules resulting in a sensitivity of 96% and a specificity was 75%. Interestingly CCDS detected six adenomas in patients showing normal laboratory data (bTSH, TT3, FT4). CCDS could be used to exclude focal adenomas with a negative predictive value of 94%. The positive predictive value for adenoma was 82%.