Correction to: Abstracts : 29th European Congress of Pathology

Due to an error with the registration system, the following abstract was regrettably omitted from the Poster Sessions. The abstract should have been included as PS-10-021 and displayed on page S166.

Olanzapine vs. other antipsychotics in actual out-patient settings: six months tolerability results from the European Schizophrenia Out-patient Health Outcomes study

OBJECTIVE

The European Schizophrenia Out-patient Health Outcomes study is an observational study investigating treatment in schizophrenia. We report treatment-emergent adverse events during the first 6 months of treatment.

METHOD

The rate of extrapyramidal symptoms (EPS), anticholinergic use, weight gain and sexual related dysfunctions were assessed in 8,400 out-patients.

RESULTS

Patients typical antipsychotics and risperidone experienced significantly more EPS and anticholinergic use than patients in the clozapine, olanzapine, and quetiapine cohorts. Patients treated with amisulpride, typical antipsychotics and risperidone were significantly more likely to have sexual related dysfunctions and/or amenorrhea. Increases in weight and body mass index occurred in all cohorts, but were significantly greater in the olanzapine and clozapine cohorts.

CONCLUSION

Patients treated with olanzapine, quetiapine and clozapine had better tolerability outcomes regarding EPS and sexual related dysfunctions compared with patients receiving risperidone, amisulpride and typicals. Patients treated with olanzapine and clozapine had higher weight increases than patients treated with risperidone, quetiapine and typicals.

Effectiveness of antipsychotic treatment for schizophrenia: 6-month results of the Pan-European Schizophrenia Outpatient Health Outcomes (SOHO) study

OBJECTIVE

To present the 6-month outcomes associated with antipsychotic treatment of patients participating in the Schizophrenia Outpatient Health Outcomes (SOHO) study.

METHOD

SOHO is a 3-year, prospective, observational study of the health outcomes associated with antipsychotic treatment in 10 European countries. The study included over 10,000 out-patients who were initiating or changing their antipsychotic medication.

RESULTS

Clinical Global Impression (CGI)-severity and quality of life (QOL) scores improved in all treatment cohorts. There was a higher response in the CGI-overall symptoms and in the CGI-schizophrenia positive, negative, cognitive and depressive symptom scales in the olanzapine (Olz) and clozapine (Cloz) cohorts compared with other treatment cohorts. Changes were associated with an improvement in QOL.

CONCLUSION

Patients starting Olz and Cloz tend to have better outcomes at 6 months than patients who start other antipsychotics in actual out-patient clinical practice. The results should be interpreted conservatively because of the non-randomized study design.

What parents of children with asthma tell us

INTRODUCTION

The family's contribution to effective asthma management is increasingly being recognized. This study gathered and analyzed information from parents about their greatest fears relative to having a child with asthma and identified information that parents believed was critical for providers to acknowledge. The methodology serves as a model for possible practitioner-directed action research with their care population.

METHODS

Written information from 52 parents who attended focus groups comprise the data. Data were analyzed using constant comparative strategies.

RESULTS

Common parental fears included uncertainty, long-term effects of medication, and concern that the condition would not go away or improve. Common themes parents wanted providers to know included the following: parents need more information; parents are scared and fearful; living with asthma is difficult, and this stress affects the parents' behavior; and parents know what is best for their child. Age trends were identified for fear themes only.

DISCUSSION

Findings suggest parents can and should be asked about their greatest fears and concerns. Although developmental patterns may be used to initiate discussion, providers need to identify parents' unique concerns so they can integrate them in refining the child's asthma action plan.

Thrombosis, markers of thrombotic risk, indwelling central venous catheters and antithrombotic prophylaxis using low-dose warfarin in subjects with malignant disease

Markers of thrombotic risk--fibrinogen, factor VIII and immunoglobulin G (IgG) anticardiolipin titres--were measured, and the presence of lupus anticoagulant and factor V Leiden were assessed in 84 patients with a solid or haematological malignancy. These patients were monitored, following the insertion of an indwelling venous catheter, for thrombosis. Fifty-five were given prophylactic low-dose warfarin. Over a mean of 15 weeks there were 10 (12%) thrombotic events in 10 patients. Seven were on warfarin. Haemorrhagic problems occurred in three (5%), all on warfarin. Of the 84 patients, 86% had raised fibrinogen levels, 37% elevated factor VIII and 44% raised anticardiolipin levels. Lupus anticoagulant was present in five and three were heterozygous for factor V Leiden. A high prevalence of a range of prothrombotic changes was confirmed and the frequent presence of low-titre anticardiolipin antibody in subjects with malignancy demonstrated. However, none of these parameters predicted the development of thrombosis (P > 0.05).

Working together toward the issue of conjugal violence: the work of an interdisciplinary task force

In 1995 each of the Professional Councils at the Royal Victoria Hospital endorsed the creation of an Interdisciplinary Task Force on Conjugal Violence. Task force members were drawn from Medicine, Nursing and Social Work. The overall goal was to increase the quality of care that the interdisciplinary team could provide to their patients. This mandate encompassed three major tasks. First, to study the extent of awareness about the issue among health care professionals; second, to assess their needs for resources and education; and finally, to recommend and implement means of increasing the level of awareness of this health concern among professionals and patients. The task force members educated themselves about conjugal violence and developed a questionnaire that was distributed to health care professionals within the hospital. The number of individuals from each discipline who received the survey was proportionate to their actual number in the center and selected at random. Results of the survey indicated that all groups desired more information and education about the scope of the problem as well as means for assessing and intervening with patients who are abused. The task force developed a Conjugal Abuse Information Package, an Abuse Assessment Screen, a Public Awareness Program and an Ongoing Teaching Program for Health Care Professionals. This project provides an example of how an interdisciplinary health care team can successfully work together for the benefit of patients.

Protein phosphorylation and the regulation of cell-cell junctions in brain endothelial cells

Endothelial cells lining the capillaries of the brain have two properties that distinguish them from their peripheral counterparts: (1) tight junctions of extremely low permeability; and (2) low rates of fluid-phase endocytosis. In combination, these features limit the nonspecific flux of ions, proteins, and other substances into the central nervous system environment, creating the blood-brain barrier. This barrier is not immutable. Tight junction permeability can be rapidly increased, which may play a role in the development of a variety of brain pathologies. We have therefore been interested in mechanisms regulating junctional permeability and strategies for interfering with this regulation. What is becoming increasingly apparent is that junctions are not passive mechanical entities; rather, they are targets for a variety of signaling pathways.

Hospital services for stroke care. A European Perspective. European Study of Stroke Care

BACKGROUND AND PURPOSE

Stroke is a common cause of mortality and morbidity in Europe and a major consumer of healthcare costs. However, outcomes from stroke vary significantly across Europe, raising the issue of the extent to which the delivery of care varies across Europe.

METHODS

A multicenter, multinational study collected data on hospital admission for stroke. These included patient baseline characteristics, clinical status, and use of inpatient services.

RESULTS

Initial results examined inpatient services in nine hospitals in six countries. Statistically significant differences existed between hospitals in key processes of care, most notably in the areas of (1) mean length of stay (11 to 39 days) and median length of stay (8 to 21 days), (2) percentage of admissions receiving brain imaging (30% to 98%) and neurosurgery (0% to 31%), and (3) percentage of admissions with an identified "need" who received physiotherapy (44% to 90%) and occupational (0% to 65%) and speech (0% to 59%) therapy. Although there were significant hospital differences (P < .001) in the case mix of admissions in terms of level of consciousness, presence of incontinence, prestroke Rankin Scale score, and age, these did not explain the differences in care across sites.

CONCLUSIONS

There is geographic inequity across Europe in the care a stroke patient can expect to receive. Ongoing analysis will examine the link between European variations in service use and outcomes, in terms of mortality, handicap, and functional ability, as a means of indicating which patterns of care are the most effective.

Stroke care in Europe. Can we learn lessons from the different ways stroke is managed in different countries?

Stroke is a major health care problem in the European Union and consumes significant resources. The mortality rates from stroke and treatment strategies vary significantly between member states. Only by comparison between centres in different member states with differing health care delivery can the effect of these varying approaches to the management of stroke on outcome be assessed. Conducting a study on a European wide basis in centres which are known to differ in terms of treatment strategies and outcomes allows an immediate analysis of the effectiveness, resource requirements and cost of different methods of managing stroke patients. This paper addresses the current burden of stroke and strategies for its management. An outline of a European Union project, assessing how stroke is managed in different countries, is provided with the aim of indicating a strategy for discovering and promoting more cost-effective services for stroke care in the future.

A novel sialyl LewisX analog attenuates neutrophil accumulation and myocardial necrosis after ischemia and reperfusion

BACKGROUND

Polymorphonuclear leukocytes (PMNs) have been shown to mediate coronary vascular and myocardial tissue injury after coronary artery ischemia and reperfusion. Previous studies using specific monoclonal antibodies directed against P-selectin and L-selectin have demonstrated the involvement of the selectin family of glycoproteins in the early phase of PMN-induced myocardial ischemia-reperfusion injury. We examined the effects of a novel oligosaccharide analog of sialyl LewisX (SLeX), which blocks both P-selectin and E-selectin in an acute canine model of myocardial ischemia and reperfusion.

METHODS AND RESULTS

Anesthetized, open-chest dogs were subjected to 1.5 hours of left circumflex coronary artery (LCx) occlusion followed by 4.5 hours of reperfusion and randomly received the SLeX analog CY-1503 (5 mg/kg IV), the nonfucosylated analog of CY-1503, SLN (5 mg/kg IV), or saline 5 minutes before reperfusion. The investigators were blinded to the treatment until all the data analysis was completed. All three groups of dogs exhibited similar and severe reductions in transmural myocardial blood flow in the LCx region as well as pronounced myocardial contractile dysfunction during occlusion, suggesting comparable degrees of myocardial ischemia. After reperfusion, dogs receiving saline (n = 6) displayed an enhanced degree of myocardial injury that was evidenced by a dramatic elevation in plasma creatine kinase (CK) activity, PMN accumulation, and myocardial necrosis. Plasma CK activity increased from 1.9 +/- 0.5 IU/microgram protein at baseline to 73.0 +/- 11.0 IU/micrograms protein (P < .001) at 4.5 hours of reperfusion and myocardial PMN accumulation, as measured by cardiac myeloperoxidase (MPO) activity, and was significantly enhanced (P < .01) within the necrotic zone compared with the nonischemic zone (4.3 +/- 0.6 versus 0.7 +/- 0.1 U/100 mg tissue). After 4.5 hours of reperfusion, 36% of the myocardium within the ischemic zone and 17% of the left ventricle became necrotic in the dogs receiving saline. Treatment with CY-1503 (n = 6) significantly (P < .05) blunted plasma CK activity by more than 50% throughout the reperfusion period, reduced necrotic zone PMN accumulation by 63% (P < .05), and reduced myocardial necrosis in the area at risk by 65% (P < .01) and by 72% within the left ventricle (P < .01). In contrast, administration of the nonfucosylated analog of CY-1503, SLN (n = 6), failed to exert any detectable cardioprotective effects after myocardial ischemia and reperfusion.

CONCLUSIONS

Our results provide strong evidence that treatment with a unique carbohydrate analog of SLeX, CY-1503, significantly reduces the degree of myocardial injury associated with coronary artery ischemia and reperfusion. The profound cardioprotection appears to be related to a reduction in PMN accumulation within the ischemic-reperfused myocardium. Additional studies investigating more-prolonged periods of reperfusion are required to determine whether CY-1503 treatment merely delays the onset or actually reduces the full extent of myocardial necrosis after ischemia and reperfusion.

Treatment of ABO hemolytic disease with synthetic blood group trisaccharides

Thirteen infants, 10 with A-O and 3 with B-O hemolytic disease of the newborn (ABO-HDN), were treated with synthetic A or B blood group trisaccharides (ATS, BTS) which cause dissociation of maternal antibody bound to infant red cells. The clinical outcome was compared with that of a control group of 21 infants treated with phototherapy during the preceding year. Exchange transfusion was required in 2 out of 13 infants in the experimental group and in 7 in the control group. A randomized prospective controlled study is necessary to confirm these results.

A comparison of epanolol and nifedipine in stable angina patients: results of a multicentre trial

Epanolol (200 mg once daily) was compared with nifedipine (20 mg twice daily) in a multicentre, double-blind, randomised, crossover study in which 571 patients with stable angina pectoris were entered. Efficacy was assessed by anginal attack rate and short-acting nitrate consumption. Symptoms and treatment preference of the patients were assessed by questionnaires. Assessments were made at baseline and after each 4-week treatment period. Both treatments were equally efficacious as demonstrated by weekly anginal attack rates and nitrate usage. Of those patients who expressed a preference for treatment, 61% expressed a preference for epanolol compared with 39% for nifedipine. Significantly fewer patients reported experiencing flushing, pedal oedema or feeling generally unwell (p less than 0.01) during the epanolol treatment period. Patients withdrew from nifedipine treatment more often than from epanolol because of adverse effects. Hence, epanolol was found to be as efficacious as nifedipine in patients with stable angina pectoris, but exhibited a superior tolerability profile and was preferred by more patients.

Acceptor specificity and tissue distribution of three human alpha-3-fucosyltransferases

Based on the capacity to transfer alpha-L-fucose onto type-1 and type-2 synthetic blood group H and sialylated acceptors, a comparison of the alpha-3-fucosyltransferase activities of different human tissues is shown. Three distinct acceptor specificity patterns are described: (I) myeloid alpha-3-fucosyltransferase pattern, in which leukocytes and brain enzymes transfer fucose actively onto H type-2 acceptor and poorly onto sialylated N-acetyllactosamine: (II) plasma alpha-3-fucosyltransferase (EC 2.4.1.152), in which plasma and hepatocyte enzymes transfer, in addition, onto the sialylated N-acetyllactosamine; (III) Lewis alpha-3 4-fucosyltransferase (EC 2.4.1.65), in which gall-bladder kidney and milk enzymes transfer, in addition, onto type-1 acceptors. The small amount (less than 10%) of alpha-3-fucosyltransferase activity found in the plasma of an alpha-3-fucosyltransferase-deficient individual had a myeloid-type acceptor pattern, suggesting that this small proportion of the plasma enzyme is derived from leukocytes. In addition to the three acceptor specificity patterns, these enzyme activities can be differentiated by their optimum pH: 8.0-8.7 for the enzymes from myeloid cells and brain. 7.2-8.0 for liver enzymes and 6.0-7.2 for gallbladder enzymes. Milk samples had two alpha-3-fucosyltransferase activities, the Lewis or alpha-3/4-fucosyltransferase under control of the Lewis gene and an alpha-3-fucosyltransferase with plasma acceptor pattern which was independent of the control of the Lewis gene. The apparent affinity for GDP-fucose of the myeloid-like enzyme was weaker than those of the plasma and Lewis-like enzymes. The apparent affinities for H type 2 and sialylated N-acetyllactosamine were stronger for exocrine secretions as compared to the plasma and myeloid enzymes. The plasma type of alpha-3-fucosyltransferase activity was more sensitive to N-ethylmaleimide and heat inactivation than the samples with myeloid-like alpha-3-fucosyltransferase activity.

C4'-Branched-chain surgar nucleosides: synthesis of isomers of psicofuranine

Photoamidation of 3-O-acetyl-1,2:5,6-di-O-isopropylidene-alpha-D-erythro-hex-3-enofuranose (1) afforded 3-O-acetyl-4-C-carbamoyl-1,2:5,6-di-O-isopropylidene-alpha-D-gulofuranose (2) and 3-O-acetyl-3-C-carbamoyl-1,2:5,6-di-O-isopropylidene-D-alpha-allofuranose (3) in 65 and 26% yields, respectively (based on consumed 1). Treatment of 2 and 5% hydrochloric acid in methanol yielded the spiro lactone 5, which was deacetylated to yield 7. Reduction of 5 with sodium borohydride afforded 4-C-(hydroxymethyl)-1,2-O-isopropylidene-alpha-D-gulofuranose (9) in 79% yield. Oxidation of 9 with sodium metaperiodate afforded a dialdose that was reduced with sodium borohydride to give 4-C-(hydroxymethyl)-1,2-O-isopropylidene-alpha-D-erythro-pentofuranose (11) in 88% yield. Treatment of the acetate 12, derived from 11, with trifluoroacetic acid, followed by acetylation, afforded the branched-chain sugar acetate 14. Condensation of the glycosyl halide derived from 14 with N6-benzoyl-N6,9-bis-(trimethylsilyl)adenine yielded an equimolar anomeric mixture of protected nucleosides 15 and 16 in 40% yield. Treatment of the latter compounds with sodium methoxide in methanol afforded 9-[4-C-(hydroxymethyl)-beta-D-erythro-pentofuranosyl] adenine (17) and the alpha-D anomer 18. The structure of 3 was determined by correlation with the known 5,3'-hemiacetal of 3-C-(hydroxymethyl)-1,2-O-isopropylidene-alpha,alpha'-D-ribo-pentodialdose (25).

Photoamidation of 2,3,4,6-tetra-O-acetyl-1-deoxy-D-arabino-hex-1-enopyranose and of (Z)-3-deoxy-3-C-(methoxycarbonyl)methylene-1,2:5,6-di-O-isopropylidene-α-D-ribo-hexofuranose

The acetone-initiated photochemical addition of formamide to 2,3,4,6-tetra-O-acetyl-1-deoxy-D-arabino-hex-1-enopyranose (1) afforded 3,4,5,7-tetra-O-acetyl-2,6-anhydro-D-glycero-D-ido-heptonamide (2), 3,4,5,7-tetra-O-acetyl-2,6-anhydro-D-glycero-D-talo-heptonamide (3), and 4,5,6,8-tetra-O-acetyl-3,7-anhydro-1-deoxy-2-methyl-D-glycero-D-talo-octitol (4), in 55, 7, and 23% yields, respectively. Reduction of 2 with diborane followed by acetylation yielded 1-acetamido-3,4,5,7-tetra-O-acetyl-2,6-anhydro-1-deoxy-D-glycero-D-ido-heptitol (7) in 70% yield. Deacetylation of 2 and 3 with sodium methoxide yielded the unsubstituted heptonamides 5 and 6.Photoamidation of (Z)-3-deoxy-3-C-(methoxycarbonyl)methylene-1,2:5,6,-di-O-isopropylidene-α-D-ribo-hexofuranose (8) yielded 3-C-[R and S-carbamoyl(methoxycarbonyl)methyl]-3-deoxy-1,2:5,6-di-O-isopropylidene- α-D-allofuranose (9) and (10).

Photoamidation of unsaturated carbohydrates. Synthesis of 1-(3-C-carbamoyl-3-deoxy-beta-D-glucopyranosyl)-thymine and -cytosine

The acetone-initiated photochemical addition of formamide to 1,2,4,6-tetra-O-acetyl-3-deoxy-alpha-D-erythro-hex-2-enopyranose (1) afforded 1,2,4,6-tetra-O-acetyl-3-C-carbamoyl-3-deoxy-alpha-D-glucopyransoe (2), 1,2,4,6-tetra-O-acetyl-3-C-carbamoyl-3-deoxy-alpha-D-allopyranose (3), 1,2,4,6-tetra-O-acetyl-3-C-carbamoyl-3-deoxy-alpha-D-altropyranose (4), and 1,2,4,6-tetra-O-acetyl-3-deoxy-3-C-(1-hydroxy-1-methylethyl)-alpha-D-mannopyranose (5), in 46, 13, 1, and 7% yields, respectively. Condensation of 2,4,6-tri-O-acetyl-3-C-carbamoyl-3-deoxy-alpha-D-glucopyranosyl bromide (produced from 2 with hydrogen bromide) with 2,4-bis(trimethylsilyl)thymine afforded 1-(2,4,6-tri-O-acetyl-3-C-carbamoyl-3-deoxy-beta-D-glucopyranosyl)thymine (6) in 40% yield. Deacetylation of 6 with sodium methoxide in methanol yielded the pure unprotected nucleoside 7. Similar condensation of the bromide from 2 with 2,4-bis(trimethylsilyl)-N4-acetylcytosine afforded the protected cytosine nucleoside 8 in 55% yield, which was converted into 1-(3-C-carbamoyl-3-deoxy-beta-D-glucopyranosyl)cytosine (9).