Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.

Bile Acid Recognition by NAPE-PLD

The membrane-associated enzyme NAPE-PLD (N-acyl phosphatidylethanolamine specific-phospholipase D) generates the endogenous cannabinoid arachidonylethanolamide and other lipid signaling amides, including oleoylethanolamide and palmitoylethanolamide. These bioactive molecules play important roles in several physiological pathways including stress and pain response, appetite, and lifespan. Recently, we reported the crystal structure of human NAPE-PLD and discovered specific binding sites for the bile acid deoxycholic acid. In this study, we demonstrate that in the presence of this secondary bile acid, the stiffness of the protein measured by elastic neutron scattering increases, and NAPE-PLD is ∼7 times faster to catalyze the hydrolysis of the more unsaturated substrate N-arachidonyl-phosphatidylethanolamine, compared with N-palmitoyl-phosphatidylethanolamine. Chenodeoxycholic acid and glyco- or tauro-dihydroxy conjugates can also bind to NAPE-PLD and drive its activation. The only natural monohydroxy bile acid, lithocholic acid, shows an affinity of ∼20 μM and acts instead as a reversible inhibitor (IC₅₀ ≈ 68 μM). Overall, these findings provide important insights into the allosteric regulation of the enzyme mediated by bile acid cofactors and reveal that NAPE-PLD responds primarily to the number and position of their hydroxyl groups.

Genetic polymorphisms influence Plasmodium ovale PCR detection accuracy

Detection of Plasmodium ovale by use of a nested PCR assay with a novel Plasmodium ovale primer set was superior to detection of Plasmodium ovale by real-time PCR assays. Nested PCR was also better at detecting P. malariae. The detection of P. ovale in many patients first admitted >2 months following their return to Italy indicated that P. ovale relapses are common.

Comparative evaluation of molecular assays for the identification of intestinal spirochaetes from diseased pigs

Rapid identification of porcine Brachyspira species is required in order to differentiate pathogenic from non-pathogenic species. The aim of our study was to compare a recently described genetic method based on polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP), nox RFLP-PCR assay, and three species-specific PCRs described previously in the literature with a 16S rRNA gene RFLP-PCR discriminatory reference assay (16S RFLP-PCR) for the identification of Brachyspira spp. of swine origin. In this study, 20 porcine spirochaetal strains were identified and compared to 33 reference strains by 16S RFLP-PCR and nox RFLP-PCR and three species-specific PCRs. RFLP-PCR methods showed concordant results for 47 strains and discordances for 6 strains (2 differently identified and 4 not revealed by nox RFLP-PCR). In our hands species-specific PCRs showed concordant results with 16S and nox RFLP-PCR for 43 strains and discordances for 10 strains (2 differently identified and 8 not amplified). The same results observed testing the 20 field-isolated spirochaetes were obtained for the corresponding porcine faecal samples. The detection limit was 10(2) -10(3) cells/g of faeces for 16S rRNA gene PCR and 10(4) cells/g of faeces for nox PCR. In our experience nox RFLP-PCR appeared successful for the speciation of B. hyodysenteriae reserving 16S RFLP-PCR for all other pathogenic and non-pathogenic Brachyspira species. Among the species-specific PCR assays tested only that for B. pilosicoli was useful in our hands.

Experimental evaluation of Surgisis as scaffold for neointestine regeneration in a rat model

The aim of the study was to evaluate the use of Surgisis (Cook Biotech Inc.), a porcine derived extracellular matrix already used in tissue engineering, as a scaffold for neointestinal regeneration in a rat model. A 3-cm length of tubular Surgisis graft was interposed with bilateral anastomoses in the middle of an isolated ileal loop of Sprague Dawley rats with an ileostomy. The grafts were harvested and analyzed using histology and immunohistochemistry at 24 weeks after operation. Macroscopic examination revealed neither stenosis nor adhesions in the area surrounding the neointestine. The regenerated small bowel showed a mean shrinkage of 30.7% (range 20%-40%). Histologic and immunohistochemical evaluation showed a well-developed three layers of mucosa and smooth muscle and serosa in the regenerated bowel wall that were similar to those of the normal bowel with evident neovascularization. Also, the regeneration of smooth muscle fibers and innervation were evident. The preliminary results of this study showed that Surgisis allowed rapid regeneration of mucosa and smooth muscle and therefore may be a promising material for the creation of a neointestine.

Lichtenstein repair of inguinal hernia with Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients

While polypropylene mesh remains the preferred prosthesis material for hernioplasties, there are some problems with infections, intestinal obstruction and fistulization, and migration particularly in immunodepressed patients. A new degradable and reabsorbable material, the porcine small intestinal submucosa (Surgisis) has been developed for hernia repairs in humans. This prospective study evaluated the safety and efficacy of Lichtenstein hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft as a mesh in ten immunodepressed subjects. Six subjects were HIV-positive in the immunodepressive phase, and the other four had undergone transplantation (three kidney, one liver). There were no intraoperative or postoperative complications, recurrences, or wound infections. Thus Lichtenstein's hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients promises safety and efficacy.

Induction of tetraploid gynogenesis in the European sea bass (Dicentrarchus labrax L.)

A preliminary study on tetraploid gynogenetic induction in the European sea bass was performed by pressure-blocking the second polar body release and the first cleavage in eggs fertilized with ultraviolet-irradiated sperm. Fertilization of eggs with genetically inactivated sperm produced only haploid development that terminated around hatching. Pressure treatments (8.500 psi for 2 min) applied at 6 and 65 min after fertilization (a.f.) produced variable levels (7-95%) of tetraploid larvae at hatching. A small proportion of mosaics (3.8n/4.2n) was also recorded.

[Treatment of complicated peptic ulcer: personal experience]

BACKGROUND

The availability of drugs which can effectively inhibit gastric secretion allowed the control of the peptic disease in almost all the patients, but the incidence of complications is substantially unchanged.

METHODS

In the present study, we performed a retrospective evaluation of 153 patients treated for complicated peptic ulcer (hemorrhage and perforation) in the last 6 years. Hemor-rhage is a common onset of the peptic disease and it rarely requires a surgical treatment, because medical and endoscopic therapies are successful in a high number of patients.

RESULTS

Surgery was necessary in 17.2% of the cases in the group of patients studied.

CONCLUSIONS

Our experience confirms the high operative mortality in the patients who underwent surgery for hemorrhage related to complicated peptic ulcer because of the frequent presence of several risk factors. Surgical therapy is the main procedure of treatment of perforated peptic ulcer and in the group of patient examined all the cases of perforation underwent surgical operation. In conclusion, despite the progress of pharmacological and endoscopic therapies, surgical treatment is the best therapy of complicated peptic ulcer.

[Contribution of glutathione to detoxification in alcoholism. Biochemical-clinical studies]

The effects of reduced glutathione (GSH) administration (1.2 g/day and 2.4 g/day intravenously) on erythrocyte glutathione levels, serum gamma-glutamyl transpeptidase activity (GGTP) and urinary glucaric acid elimination were studied in a population of 24 chronic alcoholics voluntarily admitted to a 30 day detoxification protocol in comparison to a 12 patient control group treated only with chlordiazepoxide (initial dose 75-100 mg/day). Glutathione treatment increases dose-dependently and in a significant way erythrocyte glutathione levels and hastens the recovery of serum GGTP and urinary glucaric acid elimination. The relationship between glutathione, GGTP and glucaric acid is discussed, suggesting the possible role of GSH against the oxidative damage of alcohol.

HBV and HCV infection in i.v. drug addicts; coinfection with HIV

A group of 122 drug addict patients were studied to evaluate the incidence of HIV, HBV, HCV infections and of laboratory findings of hepatic damage. Our data show that hepatic damage is more frequent in patients affected by HBV-HCV coinfection than those with HBV or HCV infection alone and that HIV positivity supports HBV-HCV coinfection.

[Acute toxicity of trichloroethylene. Description of a case series at the Autonomous Service of Toxicology of Florence during the 1977-1988 period]

The authors report the number of acute trichloroethylene intoxications admitted to the Toxicological Unit of Florence University from January 1977 to December 1988. The identification of the solvent metabolic pathway allowed to clarify the pathogenesis of hepatorenal dysfunction observed during acute intoxications. Together with gastrointestinal decontamination and cardiac arrhythmia control we have studied the effect of drugs supposed to act as blockers of trichloroethylene metabolism or as inactivators of the hepatotoxic free radical metabolite 2-2(1)-3 trichloroxirane. The prognostic modification related to new therapeutic protocols is reported and discussed.

Pyrrolidone carboxylic acid in acute and chronic alcoholism. Preclinical and clinical studies

2-Pyrrolidone-5-carboxylic acid (PCA) is a cyclic derivative of glutamic acid, physiologically present in mammalian tissues. We herein report preclinical pharmacology experiments showing that PCA releases GABA from the cerebral cortex of freely-moving guinea-pigs and displays anti-anxiety effects in a simple approach-avoidance conflict situation in the rat. In clinical pharmacology experiments, PCA significantly shortens the plasma half-life of ethanol during acute intoxication. In chronic alcoholics a treatment with PCA (2g/day per 30 days) significantly hastens the recovery to physiological values of plasma gamma-glutamyl transferase activity and of the urinary excretion of glucaric acid, which are considered suitable markers of the trend of the alcoholic disease. The evidence emerging from preclinical and clinical studies strongly suggests that, by combining central anxiolytic actions with the peripheral recovery of the antioxidant defense system in the liver, PCA should be further investigated as an interesting endogenous molecule possibly helpful in the therapy of alcoholism.

Clinical experiences with Ro 15-1788 (anexate) in benzodiazepine and mixed-drug overdoses

Benzodiazepine overdose is the most common of admission to the Toxicological Unit of the University of Florence. The aim of this study has been to evaluate the efficiency of Ro 15-1788 in benzodiazepine and mixed drug overdoses. The administration of Ro 15-1788 was followed by a quick reversal of central nervous system depression and was more effective in benzodiazepine overdoses than in mixed drug overdoses. The dose was titrated individually and the range 2-10 mg was effective according to the conditions of the patient. In some cases, the comatose state relapsed; further administration of Ro 15-1788 again promptly reversed the condition. On awakening, two patients displayed anxiety and restlessness.

Biological markers and therapeutic outcome in alcoholic disease: a twelve-year survey

The early diagnosis and evaluation of the biological consequences of alcohol abuse are reviewed in a population of 401 chronic alcoholics admitted to our Toxicological Unit from January 1973 to the end of December 1984; selected cases were treated with disulfiram implantation. The results of the study indicate that anemia with increased globular volume of erythrocytes, elevated serum gamma-glutamyl-transferase activity, increased postprandial cholalemia, and increased elimination of pentane in the breath can be considered suitable markers for the early diagnosis of alcohol abuse. Disulfiram implantation significantly prolonged the abstinence duration in the treated patients.

Clinical findings and follow-up evaluation of an outbreak of mushroom poisoning--survey of Amanita phalloides poisoning

One hundred and sixty cases of mushroom poisoning during the period July-November 1981 are reported. The survey details 116 observations of short incubation syndromes and 44 cases of delayed syndrome, identified as Amanita Phalloides poisoning. Of the latter, 40 patients were adult (mean age 46 years, range 20-77; 18 females and 22 males) and 4 were children (less than or equal to 12 years old; 3 females and 1 male). All the patients with Amanita Phalloides poisoning were treated according to a therapeutic protocol, based on the infusion of high doses of penicillin G, administration of dexamethasone and thioctic acid, careful correction of water and electrolyte unbalance. The severity of the disease varied in the population of 44 patients: 4 patients died (2 females, 10 and 77 years old; 2 males, 56 and 64 years old); 26 patients were discharged from the hospital as clinically cured; 14 were discharged with persistently abnormal levels of transaminases and they were advised of a follow-up evaluation. The average length of stay in hospital was 2 weeks. Of the patients followed-up, 6 were symptom-free after 6 months, with normal transaminase values and a normal histopathological picture of liver biopsy specimens. In the remaining patients, there was no normalization of transaminase values and liver biopsy specimens showed a picture of chronic active hepatitis. These patients displayed abnormal immunological tests, with presence of immune complexes and of anti-smooth muscle autoantibodies. The results indicate that Amanita Phalloides poisoning represents a threat not only in the high mortality acute phase, but also in the development of chronic active hepatitis in some survivors.

Amanita poisoning: a clinical-histopathological study of 64 cases of intoxication

In the last few years new and effective therapeutic schedules have been employed in the treatment of patients intoxicated by mushrooms of the genus Amanita. As a result, the survival rate has considerably increased and clinical-histopathological correlation studies, such as the present one, have become feasible. The fate of these patients was once wrongly considered to be either complete recovery (rarely) or death (frequently). According to the results of the present study, Amanita intoxication can also progress to chronic liver damage. This latter evolution of the disease seems to depend on the severity of the acute phase of the intoxication, as clinical, laboratory and biopsy findings of liver alteration testify. The correct evaluation of evolving liver damage involves histopathological investigations, which should be performed 6 months after the acute episode, in those patients who overcome a moderate to severe acute intoxication.