Development of a Non-Contact Sensor System for Converting 2D Images into 3D Body Data: A Deep Learning Approach to Monitor Obesity and Body Shape in Individuals in Their 20s and 30s

This study demonstrates how to generate a three-dimensional (3D) body model through a small number of images and derive body values similar to the actual values using generated 3D body data. In this study, a 3D body model that can be used for body type diagnosis was developed using two full-body pictures of the front and side taken with a mobile phone. For data training, 400 3D body datasets (male: 200, female: 200) provided by Size Korea were used, and four models, i.e., 3D recurrent reconstruction neural network, point cloud generative adversarial network, skinned multi-person linear model, and pixel-aligned impact function for high-resolution 3D human digitization, were used. The models proposed in this study were analyzed and compared. A total of 10 men and women were analyzed, and their corresponding 3D models were verified by comparing 3D body data derived from 2D image inputs with those obtained using a body scanner. The model was verified through the difference between 3D data derived from the 2D image and those derived using an actual body scanner. Unlike the 3D generation models that could not be used to derive the body values in this study, the proposed model was successfully used to derive various body values, indicating that this model can be implemented to identify various body types and monitor obesity in the future.

On Weather Data-Based Prediction of Gamma Exposure Rates Using Gradient Boosting Learning for Environmental Radiation Monitoring

Gamma radiation has been classified by the International Agency for Research on Cancer (IARC) as a carcinogenic agent with sufficient evidence in humans. Previous studies show that some weather data are cross-correlated with gamma exposure rates; hence, we hypothesize that the gamma exposure rate could be predicted with certain weather data. In this study, we collected various weather and radiation data from an automatic weather system (AWS) and environmental radiation monitoring system (ERMS) during a specific period and trained and tested two time-series learning algorithms-namely, long short-term memory (LSTM) and light gradient boosting machine (LightGBM)-with two preprocessing methods, namely, standardization and normalization. The experimental results illustrate that standardization is superior to normalization for data preprocessing with smaller deviations, and LightGBM outperforms LSTM in terms of prediction accuracy and running time. The prediction capability of LightGBM makes it possible to determine whether the increase in the gamma exposure rate is caused by a change in the weather or an actual gamma ray for environmental radiation monitoring.

Demirjian method and Willems method to study the dental age of adolescents in Shanghai before and after 10 years

BACKGROUND

The aim of this study is to assess the validity of whether the difference in dental age between 2009 to 2011 and 2021 is affected by environmental factors such as environmental pollution, floating population, and dietary habits. Demirjian and Willems dental age estimation methods were conducted for a Han population of children aged 8 to 14 in Shanghai, China. A total of 1,259 digital panorama radiographs of children aged 8.00-14.99 was estimated. All digital panorama radiographs were estimated using the Demirjian and Willems methods.

MATERIALS AND METHODS

Both 2009 to 2011 and 2021 were statistically analyzed by paired t-tests. The results show that the Demirjian method overestimates 2009 to 2011 and underestimates 2021 than children's chronological age. According to the Willms method, males are overestimated and females are underestimated from 2009 to 2011, and both genders were underestimated in 2021.

CONCLUSIONS

In conclusion, the difference in dental age between 2009 to 2011 and 2021 was statistically significant. Factors such as environment and dietary habits have been found to be affected by dental development. However, there are disputes among some researchers about the exact factors, so it is suggested to further study the effects of environmental factors on tooth development.

Spontaneous Formation of Star-Shaped Surface Patterns in a Driven Bose-Einstein Condensate

We observe experimentally the spontaneous formation of star-shaped surface patterns in driven Bose-Einstein condensates. Two-dimensional star-shaped patterns with l-fold symmetry, ranging from quadrupole (l=2) to heptagon modes (l=7), are parametrically excited by modulating the scattering length near the Feshbach resonance. An effective Mathieu equation and Floquet analysis are utilized, relating the instability conditions to the dispersion of the surface modes in a trapped superfluid. Identifying the resonant frequencies of the patterns, we precisely measure the dispersion relation of the collective excitations. The oscillation amplitude of the surface excitations increases exponentially during the modulation. We find that only the l=6 mode is unstable due to its emergent coupling with the dipole motion of the cloud. Our experimental results are in excellent agreement with the mean-field framework. Our work opens a new pathway for generating higher-lying collective excitations with applications, such as the probing of exotic properties of quantum fluids and providing a generation mechanism of quantum turbulence.

Peeled volume models of a whole body to enhance comprehension of anthropological bone landmarks

BACKGROUND

In physical anthropology, bone landmarks are palpated in living humans for the identification of corresponding skin landmarks and exact biometry. The purpose of this study is to help comprehend the locations and depths of representative bone landmarks all over the body.

MATERIALS AND METHODS

The sectioned images of a male cadaver's whole body were used to build a volume model, which was continuously peeled at 1 mm thicknesses to disclose 27 selected landmarks in the anterior, lateral, or posterior views.

RESULTS

The captured views of peeled volume models along with the labels of the bone landmarks were loaded to browsing software that was distributed for free. The browsing software containing the peeled volume models will enhance convenient studying of the bone landmarks.

CONCLUSIONS

With the knowledge of bone landmarks, investigators would be able to attain more accurate measurements between skin landmarks.

Regional myocardial blood flow in regions of prior myocardial infarction before and after revascularization

In 30 patients who received 102 saphenous vein bypass grafts, 91 were patent. Preoperative intracoronary injection of 99mTc-labeled albumin particles suspended in contrast revealed 81 regions of perfusion deficit which subsequently received successful revascularization. With postoperative graft injection of isotope, 48 of these regions no longer showed a perfusion deficit (59%), while 33 showed no change (41%). In these 30 patients, 16 of 17 (94%) revealed perfusion defects in regions of prior transmural myocardial infarction. Conversely, only 55 of 96 regions distal to coronary artery stenosis of greater than 50% revealed perfusion defects (57%). Thus, 99mTc-labeled microsphere studies seem to be valuable in detecting regions of prior infarction. After angiographically documented revascularization, the method continued to reveal perfusion deficits in 41% of abnormal regions noted preoperatively, even though almost half of these same specific regions showed improved postoperative regional contractility after postextrasystolic potentiation.

Effects of Palonosetron on Perioperative Cardiovascular Complications in Patients Undergoing Noncardiac Surgery With General Anesthesia: A Retrospective Cohort Study

We retrospectively investigated whether palonosetron administered during the induction of general anesthesia is associated with an increased risk of perioperative cardiovascular complications in a single tertiary center cohort consisting of 4,517 palonosetron-exposed patients and 4,517 propensity score-matched patients without palonosetron exposure. The primary endpoint was a composite of perioperative cardiovascular complications, including intraoperative cardiac arrhythmia, intraoperative cardiac death, and myocardial injury within the first postoperative week, and there was no significant difference between the groups (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 0.92-1.19). As secondary endpoints, intraoperative cardioversion, cardiac compression, use of cardiovascular drugs, postoperative hospital stay, and in-hospital mortality showed no differences between the groups. However, the palonosetron group showed decreased intraoperative hypotension (OR = 0.88; 95% CI = 0.79-0.97) and length of postoperative intensive care unit (ICU) stay (4.26 ± 9.86 vs. 6.14 ± 16.75; P = 0.026). Palonosetron did not increase the rate of perioperative cardiovascular complications, and can therefore be used safely during anesthetic induction.

A randomized phase II trial of weekly docetaxel plus either cisplatin or oxaliplatin in patients with previously untreated advanced gastric cancer: Preliminary results

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Background: Docetaxel, in combination with cisplatin or oxaliplatin, has demonstrated efficacy against AGC. This randomized phase II trial evaluated two weekly docetaxel-based regimens to see which would be most promising according to objective response rate (ORR) as first-line therapy in AGC. Methods: Chemotherapy-naïve patients with measurable unresectable and/or metastatic gastric adenocarcinoma and a performance status ≤2 were randomly assigned to receive docetaxel (35 mg/m2) weekly on days 1 and 8 of a 21-day cycle plus either cisplatin (60 mg/m2 on day 1) (arm A) or oxaliplatin (120 mg/m2 on day 1) (arm B). Toxicity was assessed on days 1, 8, and 21 of each cycle, and response was evaluated every 2 cycles. Results: Between March 2007 and December 2008, 61 eligible patients entered. In Arm A, 29 patients were evaluable for objective response and 31 for safety. In Arm B, 28 patients were evaluable for objective response and 30 for safety. Median age was 52 years and disease status was comparable for both arms. Ten of 29 (34.5%) patients had a confirmed objective response in the arm A (95% confidence interval [CI] 17.1–51.8%) and 11 of 28 (39.2%) patients had a confirmed objective response in the arm B (95% CI 21.1- 57.2%). No significant difference was noted between the arms both for ORR (p=0.202) or for disease control (58.6% and 82.1%, respectively, p=0.082). Median progression free survival time was 4.4 month in the arm A and 4.3 months in the arm B (Hazard ratio = 0.936; 95% CI, 0.503–1.744; p = 0.836). There was no relevant difference in the occurrence of overall grade ¾ toxicity between the two arms (51.6% vs. 46.6%, respectively; p=0.800). Neutropenia was the most common grade 3/4 toxicity (32.3% vs. 36.6%, respectively). There was one treatment related death in Arm B. Conclusions: The preliminary results showed that both treatment arms have similar clinical efficacy as front-line treatment in AGC. Each regimen has a manageable tolerability profile. The accrual is ongoing.

No significant financial relationships to disclose.

Overexpression of the osteopontin correlates with the aggressiveness of endometrial cancer

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Background: To test the hypothesis that expression of osteopontin (OPN), an integrin-binding glycoprotein, can independently predict the potential aggressiveness of endometrial cancer. We studied OPN expression in endometrial cell carcinomas and correlated OPN expression levels with clinicopathologic tumor features. Methods: The status of OPN expression in benign and malignant endometrial cancer cell lines and tissues was analyzed by Western blot and immunohistochemistry. Nonparametric Spearman’s correlation coefficient method was used to assess the statistical significance of the correlation between clinicopathologic characteristics of tumor and OPN expression. Results: An increased expression of OPN was observed in the endometrial cancer compared to normal endometrial tissue samples. When the level of OPN in normal tissue was set at 1, its level in benign endometrial hyperplasia was slightly increased at 1.2, whereas the OPN level in the highly malignant endometrial carcinoma tissue was greatly increased by nearly 3- 5 folds. Amongst the 70 cases examined immunocytochemically, of the 23 grade 1 endometrial carcinomas, 6 were unstained and 12 stained weakly positive (+). For the 20 grade 3 or serous type endometrial carcinomas analyzed, 8 (40%) stained strongly positive (+++), 8 (40%) stained moderately positive (++) and 1 stained weakly positive (+). These results showed that the level of OPN expressed between grade 1 and grde 3 or more was significantly different (Spearman’s correlation coefficient method, p = 0.001). Kaplan-Meier survival analysis showed that the increased level of OPN expression was significantly associated with reduced survival time of the patients. Conclusions: The results suggest that the increased OPN level may be involved in the malignant transformation of endometrial adenocarcinoma cells and OPN expression level is an important determinant for patient survival.

No significant financial relationships to disclose.

Simulation and Experimental Verification of Crystallization and Birefringence in Melt Spinning of PET

A novel approach for the numerical simulation of the development of crystallinity and birefringence on the spinline was proposed. The approach was based on the calculation of elastic recovery and crystalline and amorphous orientation functions without making any assumption about freezing. To model crystallization, the amorphous orientation function and the flow effect on the equilibrium melting temperature elevation due to the entropy reduction between the oriented and unoriented melts were incorporated. The crystalline orientation function was calculated from the frozen-in elastic recovery. The entropy change and frozen-in elastic recovery calculation were based on a nonlinear viscoelastic constitutive Eq. with the crystallinity and temperature dependent viscosity and relaxation time. The crystalline and amorphous contributions to the overall birefringence were obtained from the crystalline orientation function and the flow birefringence, respectively. The temperature, diameter, density, and birefringence profile in both low- and high-speed spun PET fibers were predicted and compared with the experimental data from literature. Theoretical predictions were found to be in agreement with the published experimental data.

Decreased insulin sensitivity is associated with the extent of coronary artery disease in patients with angina

BACKGROUND

Insulin resistance has been proposed as an important risk factor in the development of atherosclerosis.

AIM

To evaluate the association of insulin resistance and coronary atherosclerosis, we investigated the correlation between insulin sensitivity and the degree of coronary stenosis in patients with angina pectoris.

METHODS

The study population consisted of 74 subjects with angina (54 men and 20 women) aged from 31 to 73 years. Coronary angiograms were evaluated by three semiquantitative scoring systems (vessel score, stenosis score and extent score) to estimate the extent of focal and diffuse coronary artery disease (CAD). Insulin sensitivity (K(ITT)) was determined by the insulin tolerance test.

RESULTS

There were significant correlations existed between K(ITT) and all three coronary scores. Multivariate analysis revealed significant and independent correlations of all three coronary scores with K(ITT) (vessel score: beta = -0.349, p = 0.004; stenosis score: beta = -0.487, p < 0.001; extent score: beta = -0.481, p < 0.001), even in patients without diabetes mellitus (vessel score: beta = -0.387, p = 0.008; stenosis score: beta = -0.469, p < 0.001; extent score: beta = -0.559, p < 0.001). K(ITT) was significantly lower in patient with diffuse CAD than without diffuse CAD (2.13 +/- 0.66 vs. 2.57 +/- 0.79%/min, p < 0.05). However, K(ITT) was not different between patients with and without focal CAD.

CONCLUSIONS

Insulin sensitivity has statistically significant and independent associations with the extent of coronary stenosis. These results suggest that insulin resistance may play a major role in the development of diffuse coronary artery stenosis.

Competing protein:protein interactions are proposed to control the biological switch of the E coli biotin repressor

A model is suggested for the complex between the biotin repressor of Escherichia coli, BirA, and BCCP, the biotin carboxyl carrier protein to which BirA transfers biotin. The model is consistent with prior physical and biochemical studies. Measurement of transfer rates for variants of BirA with single-site mutations in the proposed BirA:BCCP interface region also provides support. The unique feature of the proposed interaction between BirA and BCCP is that it uses the same beta-sheet region on the surface of BirA that the protein uses for homodimerization into a form competent to bind DNA. The resulting mutually exclusive protein:protein interfaces explain the novel feature of the BirA regulatory system, namely, that transcription of the genes involved in biotin synthesis is not determined by the level of biotin, per se, but by the level of unmodified BCCP. The model also provides a role for the C-terminal domain of BirA that is structurally similar to an SH3 domain.

Turning On uracil-DNA glycosylase using a pyrene nucleotide switch

Base flipping is a highly conserved process by which enzymes swivel an entire nucleotide from the DNA base stack into their active site pockets. Uracil DNA glycosylase (UDG) is a paradigm enzyme that uses a base flipping mechanism to catalyze the hydrolysis of the N-glycosidic bond of 2'-deoxyuridine (2'-dUrd) in DNA as the first step in uracil base excision repair. Flipping of 2'-dUrd by UDG has been proposed to follow a "pushing" mechanism in which a completely conserved leucine side chain (Leu-191) is inserted into the DNA minor groove to expel the uracil. Here we report a novel implementation of the "chemical rescue" approach to show that the weak binding affinity and low catalytic activity of L191A or L191G can be completely or partially restored by substitution of a pyrene (Y) nucleotide wedge on the DNA strand opposite to the uracil base (U/A to U/Y). These results indicate that pyrene acts both as a wedge to push the uracil from the base stack in the free DNA and as a "plug" to hinder its reinsertion after base flipping. Pyrene rescue should serve as a useful and novel tool to diagnose the functional roles of other amino acid side chains involved in base flipping.

Corepressor-induced organization and assembly of the biotin repressor: a model for allosteric activation of a transcriptional regulator

The Escherichia coli biotin repressor binds to the biotin operator to repress transcription of the biotin biosynthetic operon. In this work, a structure determined by x-ray crystallography of a complex of the repressor bound to biotin, which also functions as an activator of DNA binding by the biotin repressor (BirA), is described. In contrast to the monomeric aporepressor, the complex is dimeric with an interface composed in part of an extended beta-sheet. Model building, coupled with biochemical data, suggests that this is the dimeric form of BirA that binds DNA. Segments of three surface loops that are disordered in the aporepressor structure are located in the interface region of the dimer and exhibit greater order than was observed in the aporepressor structure. The results suggest that the corepressor of BirA causes a disorder-to-order transition that is a prerequisite to repressor dimerization and DNA binding.

Multiple disordered loops function in corepressor-induced dimerization of the biotin repressor

Cooperative association of the Escherichia coli biotin repressor with the biotin operator is allosterically activated by binding of the corepressor, bio-5'-AMP. The corepressor function of the adenylate is due, in part, to its ability to induce repressor dimerization. Since a high-resolution structure of only the apo or unliganded repressor is currently available, the location of the dimerization interface on the protein structure is not known. Here, five mutants in the corepressor-binding domain of the repressor have been analyzed with respect to their DNA-binding and self-assembly properties. Results of these studies reveal that four of the mutant proteins exhibit defects in DNA binding. These same proteins are compromised in self-assembly. Furthermore, in the three-dimensional structure of the apo protein the mutations all lie in partially disordered surface loops, one of which is known to participate directly in corepressor binding. These results suggest that multiple disordered surface loops function in the corepressor-induced dimerization required for sequence-specific DNA binding by the biotin repressor.

Expression of osteopontin in calcified coronary atherosclerotic plaques

Advanced atherosclerosis is often associated with dystrophic calcification and remodeling of extracellular matrix of vascular wall. Recently many studies have documented a general relationship between calcification and severity of coronary disease, and discussed the feasibility of electron beam computed tomography for detecting and quantifying the coronary artery calcification in the patients. The present study investigated the expression and the localization of osteopontin, one of noncollagenous bone matrix protein, within the calcified coronary arteries. Autopsy-derived coronary artery specimens were scanned and reconstructed to visualize the pattern of coronary calcification using a novel microscopic computed tomography technique. The localization of the osteopontin were evaluated by immunohistochemial stain with LF7. The present study showed that the pattern of coronary calcification is variable and the expression of osteopontin is localized mainly to calcified lesion. The smooth muscle cells in addition to macrophage expressed osteopontin protein in human coronary atherosclerotic plaques. Soluble osteopontin released near to the sites of vascular calcification may represent an adaptive mechanism aimed at regulating the process of vascular calcification.

Function of a conserved sequence motif in biotin holoenzyme synthetases

The biotin holoenzyme synthetases (BHS) are essential enzymes in all organisms that catalyze post-translational linkage of biotin to biotin-dependent carboxylases. The primary sequences of a large number of these enzymes are now available and homologies are found among all. The glycine-rich sequence, GRGRXG, constitutes one of the homologous regions in these enzymes and, based on its similarity to sequences found in a number of mononucleotide binding enzymes, has been proposed to function in ATP binding in the BHSs. In the Escherichia coli enzyme, the only member of the family for which a three-dimensional structure has been determined, the conserved sequence is found in a partially disordered surface loop. Mutations in the sequence have previously been isolated and characterized in vivo. In this work these single-site mutants, G115S, R118G, and R119W, of the E. coli BHS have been purified and biochemically characterized with respect to binding of small molecule substrates and the intermediate in the biotinylation reaction. Results of this characterization indicate that, rather than functioning in ATP binding, this glycine-rich sequence is required for binding the substrate biotin and the intermediate in the biotinylation reaction, biotinyl-5'-AMP. These results are of general significance for understanding structure-function relationships in biotin holoenzyme synthetases.

Complete myocardial revascularization on the beating heart

BACKGROUND

Complete myocardial revascularization with excellent visualization, exposure, and stabilization can be accomplished on the beating heart without cardiopulmonary bypass (CPB).

METHODS

Three hundred patients were totally revascularized via median sternotomy with myocardial stabilization using the CardioThoracic System. All patients who underwent coronary artery bypass grafting were considered for the off-pump procedure. Pericardial sutures were placed at the level of the left atrial appendage and were pulled upwards to the right. The stabilizer was applied sequentially from circumflex, obtuse marginal, intermediate, diagonal, left anterior descending, and right coronary artery. Coronaries were occluded using the Calafiore technique, and multiple arterial grafts were inserted.

RESULTS

The average number of grafts was 3.4 per patient. Six percent had to be converted to standard CPB. Comorbidity was not a limiting factor with 8% redos, 48% having diabetes, and acute myocardial infarctions in 28%. The unadjusted mortality was 2.3%, and stroke rate was 0.7%.

CONCLUSIONS

These results indicate that complete revascularization can safely be accomplished without CPB.

Mutation of the type II transforming growth factor-beta receptor is coincident with the transformation of human colon adenomas to malignant carcinomas

The transforming growth factor-beta (TGF-beta) type II receptor (RII) is a colon cancer suppressor gene that is inactivated by mutation in 90% of human colon cancers arising via the microsatellite instability (MSI) pathway of carcinogenesis. To determine the pathophysiological consequence of RII mutations, we have determined the timing of their onset among 22 MSI human colon adenomas of varying stages. No RII mutations were detected in any early MSI adenoma, including all those with simple tubular or villous histology. The earliest RII mutation detected was in a region of high-grade dysplasia but was absent from the surrounding simple adenoma. Six additional RII mutations were all found in highly progressed adenomas that contained regions of frankly invasive adenocarcinoma. These RII mutations were detected in both the advanced adenomas and their adjacent regions of carcinoma. RII mutation is a late event in MSI adenomas and correlates tightly with progression of these adenomas to cancer.

Analysis of the gene encoding cyclomaltodextrinase from alkalophilic Bacillus sp. I-5 and characterization of enzymatic properties

The gene encoding cyclomaltodextrinase (CDase) was cloned from alkalophilic Bacillus sp. I-5. The nucleotide sequence of the gene was determined and the physicochemical properties of the enzyme were investigated. The gene had an open reading frame of 559 amino acids with a predicted molecular weight of 64,884. The enzyme was purified to near homogeneity from Escherichia coli cells carrying a recombinant plasmid that contained the CDase gene. The enzyme hydrolyzed cyclomaltoheptaose (beta-CD) 13 times better than starch and 33 times better than pullulan, and it had transglycosylation activity. The enzyme also hydrolyzed acarbose, a pseudotetrasaccharide inhibitor of glucosidases. The enzyme was stabilized by Ca2+ and the activity was increased more than twofold in the presence of 5 mM EDTA. The optimum temperature of the enzyme was elevated from 40 to 50 degrees C by Ca2+ ion and the thermal activity was maintained more than 80% at 60 degrees C in the presence of Ca2+. Comparison of known amino acid sequences of several amylolytic enzymes with cyclomaltodextrinase activity, site-directed mutagenesis of the enzyme, and substrate specificity of the enzyme imply that the region between the third and the fourth conserved regions of the enzyme may play an important role in binding and degradation of cyclomaltodextrin.

Detection of a dup(17q) and inv(16) by fluorescence in situ hybridization in acute myelomonocytic leukemia

Two cases of acute myelomonocytic leukemia (AMMoL) of FAB type M4Eo are described in which a primary subclone containing a dup(17)(q21q25) and a subclone containing dup(17)(q21q25), inv(16)(p13q22) were seen in one patient, and -7, dup(17)(q21q25) in another. Fluorescence in situ hybridization (FISH) was carried out for the confirmation of the duplicated segment and breakpoint of inv(16). Inv(16) is a well known anomaly in AMMoL, whereas dup(17q) is rare though as not yet confirmed, this anomaly could be a nonrandom or novel change in AMMoL.

Outcome of clozapine therapy for elderly patients with refractory primary psychosis

OBJECTIVE

The objective was to analyze outcome of clozapine therapy in elderly patients with treatment refractory primary psychosis.

DESIGN

This was an open-label clozapine trial in elderly patients. Patient psychopathology was assessed before and after clozapine therapy.

SETTING

A psychiatry service at a large urban/suburban Veterans Administration Medical Center.

PATIENTS

Inpatients and outpatients age 65 years or older with primary psychotic disorders established to be resistant to conventional antipsychotic therapy (Kane et al., 1988). Ten patients met study inclusion criteria out of a total of 134 patients receiving clozapine at the Cleveland VAMC (7.5%). Mean age of the group was 70.6 years.

MEASURES

Patients were rated with the Brief Psychiatric Rating Scale (BPRS; Overall and Gorham, 1962). Additional data on patient demographics, comorbid non-psychiatric diagnoses and concurrent psychotropic medication were collected via chart review.

RESULTS

Mean clozapine dosage was 204 mg/day for a mean duration of 430 days. 7/10 patients had some degree of clinical improvement and 3/10 patients had significant improvement documented by BPRS change of 20% or greater. Patients had a mean of 1.4 comorbid physical illnesses, which were not worsened by clozapine therapy. 4/10 patients discontinued clozapine therapy due to adverse effects or inability to comply with bloodwork; however; only 2/10 were truly treatment intolerant.

CONCLUSIONS

Clozapine is a useful alternative treatment option for elderly individuals with refractory primary psychosis. As in younger patients, inability to tolerate drug-related adverse effects or weekly bloodwork may lead to drug discontinuation.

Clozapine-induced urinary incontinence: incidence and treatment with ephedrine

BACKGROUND

Treatment with the atypical antipsychotic drug clozapine appears to be associated with an increased incidence of urinary incontinence (UI). We posited that the potent anti-alpha-adrenergic effects of clozapine were involved, and hence that an alpha-adrenergic agonist would reduce UI. We tested this hypothesis by using ephedrine, an approved alpha-adrenergic agonist.

METHOD

Fifty-seven inpatients with schizophrenia or schizoaffective disorder (DSM-IV) who met the Kane criteria for being treatment refractory were treated with clozapine (75-900 mg/day). Patients who developed UI were then openly treated with ephedrine in increasing doses until UI was attenuated or a dose of 150 mg/day was attained.

RESULTS

Seventeen patients developed UI as evidenced by either urine-stained sheets/clothing or direct patient reports. In 2 cases, the UI was sufficiently severe that adult diapers had to be used. Comparison of patients who developed UI and those who did not showed that UI was associated with female gender and with concomitant treatment with typical antipsychotic drugs. One patient was treated with a behavioral program, but the remaining 16 patients were treated with ephedrine. Ephedrine treatment was very effective, with 15/16 patients showing improvement within 24 hours after reaching maximum ephedrine dosage. Twelve of 16 (including the 2 most severe) eventually had a complete remission of their UI. In the remaining 4 patients, 3 had a reduction in the frequency of UI and 1 showed no response. These benefits have been maintained over the course of 12 months of subsequent treatment for several patients. There were no side effects associated with the use of ephedrine nor were there any changes in neuropsychiatric status.

CONCLUSION

Ephedrine appears to be a safe and effective treatment clozapine-associated UI. By inference, it is likely that clozapine may cause UI via its anti-alpha-adrenergic properties.

Clozapine reduces water-drinking behavior in schizophrenic patients with polydipsia

Disordered water balance, or polydipsia, is an underassessed and underreported phenomenon present in the severely psychiatrically disabled population. Prevalence rates for polydipsia range from 6.2 to 20%. We followed up five male patients (mean age 43) with chronic schizophrenia who met the Kane criteria for being treatment nonresponders and who, in addition, had marked polydipsia. Three patients had previously received medical care for hyponatremia and had to be placed on fluid restriction when admitted to the hospital. All patients exhibited polydipsia despite high doses of typical antipsychotic drugs. Each patient was treated openly with clozapine (range 450-800 mg/day) for at least 6 months. In each case, there was a decline in the Brief Psychiatric Rating Scale score (preclozapine mean, 63; postclozapine mean, 46), and a marked reduction in fluid-seeking behavior. All fluid restrictions could be lifted, and the patients were discharged from the hospital. During a mean follow-up period of 17 months, during which patients were evaluated weekly, polydipsic behavior that required intervention had not been noted. We conclude that clozapine may be a highly effective treatment for polydipsia in patients with treatment-refractory schizophrenia. Future studies may aim to delineate neurobiologic mechanisms.