Identification of a biological signature for schizophrenia in serum

Biomarkers are now used in many areas of medicine but are still lacking for psychiatric conditions such as schizophrenia (SCZ). We have used a multiplex molecular profiling approach to measure serum concentrations of 181 proteins and small molecules in 250 first and recent onset SCZ, 35 major depressive disorder (MDD), 32 euthymic bipolar disorder (BPD), 45 Asperger syndrome and 280 control subjects. Preliminary analysis resulted in identification of a signature comprised of 34 analytes in a cohort of closely matched SCZ (n=71) and control (n=59) subjects. Partial least squares discriminant analysis using this signature gave a separation of 60-75% of SCZ subjects from controls across five independent cohorts. The same analysis also gave a separation of ~50% of MDD patients and 10-20% of BPD and Asperger syndrome subjects from controls. These results demonstrate for the first time that a biological signature for SCZ can be identified in blood serum. This study lays the groundwork for development of a diagnostic test that can be used as an aid for distinguishing SCZ subjects from healthy controls and from those affected by related psychiatric illnesses with overlapping symptoms.

Ethanol production from Eucalyptus plantation thinnings

Conditions for optimal pretreatment of eucalypt (Eucalyptus dunnii) and spotted gum (Corymbia citriodora) forestry thinning residues for bioethanol production were empirically determined using a 3(3) factorial design. Up to 161mg/g xylose (93% theoretical) was achieved at moderate combined severity factors (CSF) of 1.0-1.6. At CSF>2.0, xylose levels declined, owing to degradation. Moreover at high CSF, depolymerisation of cellulose was evident and corresponded to glucose (155mg/g, ∼33% cellulose) recovery in prehydrolysate. Likewise, efficient saccharification with Cellic® CTec 2 cellulase correlated well with increasing process severity. The best condition yielded 74% of the theoretical conversion and was attained at the height of severity (CSF of 2.48). Saccharomyces cerevisiae efficiently fermented crude E. dunnii hydrolysate within 30h, yielding 18g/L ethanol, representing a glucose to ethanol conversion rate of 0.475g/g (92%). Based on our findings, eucalyptus forest thinnings represent a potential feedstock option for the emerging Australian biofuel industry.

Safety and cost-effectiveness of early discharge after primary angioplasty in low risk patients with acute myocardial infarction. PAMI-II Investigators. Primary Angioplasty in Myocardial Infarction

OBJECTIVES

The second Primary Angioplasty in Myocardial Infarction (PAMI-II) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty (PTCA), with subsequent discharge from the hospital 3 days later, is safe and cost-effective in low risk patients.

BACKGROUND

In low risk patients with myocardial infarction (MI), few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay.

METHODS

Patients with acute MI underwent emergency catheterization with primary PTCA when appropriate. Low risk patients (age <70 years, left ventricular ejection fraction >45%, one- or two-vessel disease, successful PTCA, no persistent arrhythmias) were randomized to receive accelerated care (admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [n = 237] or traditional care [n = 234]).

RESULTS

Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier (4.2+/-2.3 vs. 7.1+/-4.7 days, p = 0.0001) and had lower hospital costs ($9,658+/-5,287 vs. $11,604+/-6,125 p = 0.002) than the patients who received traditional care. At 6 months, accelerated and traditional care groups had a similar rate of mortality (0.8% vs. 0.4%, p = 1.00), unstable ischemia (10.1% vs. 12.0%, p = 0.52), reinfarction (0.8% vs. 0.4%, p = 1.00), stroke (0.4% vs. 2.6%, p = 0.07), congestive heart failure (4.6% vs. 4.3%, p = 0.85) or their combined occurrence (15.2% vs. 17.5%, p = 0.49). The study was designed to detect a 10% difference in event rates; at 6 months, only a 2.3% difference was measured between groups, indicating an actual power of 0.19.

CONCLUSIONS

Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing, and a day 3 hospital discharge strategy, resulting in substantial cost savings.

A prospective, randomized evaluation of prophylactic intraaortic balloon counterpulsation in high risk patients with acute myocardial infarction treated with primary angioplasty. Second Primary Angioplasty in Myocardial Infarction (PAMI-II) Trial Investigators

OBJECTIVES

A large, international, multicenter, prospective, randomized trial was performed to determine the role of prophylactic intraaortic balloon pump (IABP) counterpulsation after primary percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (AMI).

BACKGROUND

Previous studies have suggested that routine IABP use after primary PTCA reduces infarct-related artery reocclusion, augments myocardial recovery and improves clinical outcomes.

METHODS

Cardiac catheterization was performed in 1,100 patients within 12 h of onset of AMI at 34 clinical centers. Clinical and angiographic variables were used to stratify patients undergoing primary PTCA into high and low risk groups. High risk patients were then randomized to 36 to 48 h of IABP (n = 211) or traditional care (n = 226). The study had 80% power to detect a reduction in the primary end point from 30% to 20%.

RESULTS

There was no significant difference in the predefined primary combined end point of death, reinfarction, infarct-related artery reocclusion, stroke or new-onset heart failure or sustained hypotension in patients treated with an IABP versus those treated conservatively (28.9% vs. 29.2%, p = 0.95). The IABP strategy conferred modest benefits in reduction of recurrent ischemia (13.3% vs. 19.6%, p = 0.08) and subsequent unscheduled repeat catheterization (7.6% vs. 13.3%, p = 0.05) but did not reduce the rate of infarct-related artery reocclusion (6.7% vs. 5.5%, p = 0.64), reinfarction (6.2% vs. 8.0%, p = 0.46) or mortality (4.3% vs. 3.1%) and was associated with a higher incidence of stroke (2.4% vs. 0%, p = 0.03). IABP use did not result in enhanced myocardial recovery as assessed by paired admission to predischarge and 6-week rest and exercise left ventricular ejection fraction.

CONCLUSIONS

In contrast to previous studies, a prophylactic IABP strategy after primary PTCA in hemodynamically stable high risk patients with AMI does not decrease the rates of infarct-related artery reocclusion or reinfarction, promote myocardial recovery or improve overall clinical outcome.

Acute myocardial infarction in Oklahoma: are we different?

Data regarding 787 patients admitted to Saint Francis Hospital in Tulsa, Oklahoma, with acute myocardial infarction (MI) were analyzed to determine circadian variation and to assess demographic and anatomic characteristics. The study population consisted of 634 men (81%) and 153 women (19%). This cohort displayed a circadian rhythm that nearly duplicated a previously published national data base. As was seen nationally, our patients had a peak incidence between 6 AM and noon. Of the total population, 448 patients had acute cardiac catheterization allowing definition of the infarct vessel. The majority of myocardial infarctions were from right coronary artery occlusions. Men were more likely than women to have an anterior MI. Both men and women were more likely to have an inferior MI if they were less than 65 years of age, though this was more pronounced for women. As the population aged, they were more likely to have an anterior myocardial infarction.

Intravascular platelet aggregation and spontaneous contrast

The purpose of this study was to determine why spontaneous contrast developed after general anesthesia in dogs. Twenty-seven dogs underwent echocardiography before and after pentobarbital or chloralose-urethane general anesthesia. The results showed that none of the 12 dogs receiving pentobarbital and 10 of 15 dogs receiving chloralose-urethane anesthesia developed contrast, in association with large platelet and platelet-neutrophil aggregates (P < 0.01); this effect could also be reproduced in vitro. The administration of adenosine diphosphate or antiplatelet antibody to nine dogs confirmed that intravascular platelet aggregation can cause ultrasonic contrast. The implications of these findings for patients with spontaneous contrast are discussed.

Confirmation of 11-nor-delta 9-tetrahydrocannabinol in urine as its t-butyldimethylsilyl derivative using GC/MS

A procedure for the detection and quantitation of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid, the major metabolite of delta 9-tetrahydrocannabinol, in urine is presented. Because a significant portion of the metabolite is present as a conjugated form, the urine was hydrolyzed by the addition of strong base. The solution was then acidified and the metabolite extracted into an organic solvent. It was subsequently converted to the t-butyldimethylsilyl ether and t-butyldimethylsilyl ester, and analyzed by GC/MS utilizing electron ionization (EI). Confirmation of the product was carried out by using selected ion monitoring (SIM) for three ions which represent logical demonstrable fragmentation pathways for the molecule and by comparing their relative abundances to a reference standard. A deuterated analog was carried through the entire process as an internal standard. The method provides excellent linearity and the derivatives are stable for more than 10 days at room temperature.

5-Fluorouracil-induced angina

5-Fluorouracil-induced cardiac ischemia is rare and poorly understood. We present the second known case of catheterization data and provide new information regarding possible mechanisms.

Standardization of a commercial (Boehringer Mannheim diagnostics) enzymic method for cholesterol

The Laboratory Standardization Panel of the National Cholesterol Education Program recommends that cholesterol method accuracy ideally be within 3% of the true value determined by the Abell-Kendall Reference Method, a component of the National Reference System for Cholesterol. As one of the Abell-Kendall network laboratories established to facilitate cholesterol standardization, the approach we recommend for determining accuracy involves a comparison analysis on patients' specimens by the method in question and by the Abell-Kendall method. Use of fresh specimens precludes matrix interactions that may influence enzymic measurement. Using this approach, we assessed an enzymic method for cholesterol with two instruments (Boehringer Mannheim/Hitachi 717 and 737), with BMD reagent, controls, and calibrator. Fresh and frozen sera were analyzed with both instruments over three days. The Abell-Kendall method was used at the Northwest Lipid Research Center on frozen aliquots of the same sera. Both instruments demonstrated good agreement with the Reference Method, as determined by linear regression; overall bias averaged less than -2% for the Hitachi 717 and -1% for the Hitachi 737 at 2000 mg/L--i.e., within the accuracy recommendation. We observed a difference in bias for fresh and frozen specimens; with the Hitachi 717, fresh specimens exhibited -3% bias at 2000 mg/L, but there was virtually no bias of determinations of frozen specimens.

Standardization of a commercial (Boehringer Mannheim diagnostics) enzymic method for cholesterol

The Laboratory Standardization Panel of the National Cholesterol Education Program recommends that cholesterol method accuracy ideally be within 3% of the true value determined by the Abell-Kendall Reference Method, a component of the National Reference System for Cholesterol. As one of the Abell-Kendall network laboratories established to facilitate cholesterol standardization, the approach we recommend for determining accuracy involves a comparison analysis on patients' specimens by the method in question and by the Abell-Kendall method. Use of fresh specimens precludes matrix interactions that may influence enzymic measurement. Using this approach, we assessed an enzymic method for cholesterol with two instruments (Boehringer Mannheim/Hitachi 717 and 737), with BMD reagent, controls, and calibrator. Fresh and frozen sera were analyzed with both instruments over three days. The Abell-Kendall method was used at the Northwest Lipid Research Center on frozen aliquots of the same sera. Both instruments demonstrated good agreement with the Reference Method, as determined by linear regression; overall bias averaged less than -2% for the Hitachi 717 and -1% for the Hitachi 737 at 2000 mg/L--i.e., within the accuracy recommendation. We observed a difference in bias for fresh and frozen specimens; with the Hitachi 717, fresh specimens exhibited -3% bias at 2000 mg/L, but there was virtually no bias of determinations of frozen specimens.

Sensitive high-performance liquid chromatographic method for the determination of etodolac in serum

A sensitive high-performance liquid chromatographic method for the determination of etodolac in serum was developed. The limit of detection was 0.2 microgram/ml. The specificity of the method was demonstrated by the lack of response obtained with a variety of control sera, sera spiked with etodolac congeners, and sera obtained from rats treated with a variety of other drugs.

Composition of serum very-low-density and high-density lipoproteins in diabetes

We examined the cholesterol/protein ratio and the apoprotein composition of serum lipoproteins in a randomly selected population of maturity-onset diabetics and in a group of nondiabetics of similar age. We found no differences in cholesterol distribution between the groups as a whole, but diabetics with above-normal low-density lipoproteins (LDL) had decreased concentrations of high-density lipoprotein (HDL) cholesterol. In the diabetics as a whole, there was an increase in the cholesterol/protein ratio in HDL, a negative correlation between the amounts of LDL cholesterol and HDL cholesterol, an increase in the proportion of apolipoprotein C in very-low-density lipoprotein (VLDL), and a decrease in the proportion of the apolipoprotein AI component of HDL. In diabetic subjects with increased VLDL, there was an increase in the relative amount of apolipoprotein CIII, and a consequent decrease in the ratio of apolipoprotein CII/apolipoprotein CIII in the VLDL. In both diabetic and control subjects, apolipoprotein E and cholesterol content of VLDL were linearly related.

Composition of serum very-low-density and high-density lipoproteins in diabetes

We examined the cholesterol/protein ratio and the apoprotein composition of serum lipoproteins in a randomly selected population of maturity-onset diabetics and in a group of nondiabetics of similar age. We found no differences in cholesterol distribution between the groups as a whole, but diabetics with above-normal low-density lipoproteins (LDL) had decreased concentrations of high-density lipoprotein (HDL) cholesterol. In the diabetics as a whole, there was an increase in the cholesterol/protein ratio in HDL, a negative correlation between the amounts of LDL cholesterol and HDL cholesterol, an increase in the proportion of apolipoprotein C in very-low-density lipoprotein (VLDL), and a decrease in the proportion of the apolipoprotein AI component of HDL. In diabetic subjects with increased VLDL, there was an increase in the relative amount of apolipoprotein CIII, and a consequent decrease in the ratio of apolipoprotein CII/apolipoprotein CIII in the VLDL. In both diabetic and control subjects, apolipoprotein E and cholesterol content of VLDL were linearly related.