Identifying gene-environment interactions in schizophrenia: contemporary challenges for integrated, large-scale investigations

Recent years have seen considerable progress in epidemiological and molecular genetic research into environmental and genetic factors in schizophrenia, but methodological uncertainties remain with regard to validating environmental exposures, and the population risk conferred by individual molecular genetic variants is small. There are now also a limited number of studies that have investigated molecular genetic candidate gene-environment interactions (G × E), however, so far, thorough replication of findings is rare and G × E research still faces several conceptual and methodological challenges. In this article, we aim to review these recent developments and illustrate how integrated, large-scale investigations may overcome contemporary challenges in G × E research, drawing on the example of a large, international, multi-center study into the identification and translational application of G × E in schizophrenia. While such investigations are now well underway, new challenges emerge for G × E research from late-breaking evidence that genetic variation and environmental exposures are, to a significant degree, shared across a range of psychiatric disorders, with potential overlap in phenotype.

Serum leptin levels in patients with nonalcoholic steatohepatitis

OBJECTIVE

Leptin is a peptide hormone that mainly regulates food intake and energy expenditure of human body. A close correlation between serum leptin levels and the percentage of body fat stores is well known. Nonalcoholic steatohepatitis (NASH) is a common disorder which causes serum liver enzyme elevation. In this study, the serum leptin levels were investigated in patients with NASH to determine a possible role in the pathogenesis and in patients with chronic viral hepatitis to ascertain the effect of hepatic inflammation on serum leptin level.

METHODS

Forty-nine patients (38 men, 11 women) with NASH diagnosed by biopsy, 32 patients with biopsy-proven chronic viral hepatitis (21 men and 11 women), and 30 healthy adults (17 men, 13 women) enrolled in the study. Fasting blood samples were obtained, and serum leptin levels were measured by ELISA. Body mass index (BMI) was calculated for all subjects, and serum insulin, C-peptide, and lipoprotein levels were also detected.

RESULTS

The mean serum leptin levels (+/-SEM) were 6.62 +/- 0.71, 4.24 +/- 1.0, and 4.02 +/- 0.46 ng/ml in NASH, chronic hepatitis, and the control group, respectively. Mean serum leptin level in the NASH group was significantly higher than those in the other groups tested. BMI was also slightly higher in the NASH group when compared to the other groups (26.7 +/- 0.3, 23.7 +/- 0.6, and 24.6 +/- 0.3, respectively). There was a significant correlation between BMI and serum leptin levels when all the subjects were evaluated together (NASH, hepatitis, and control groups, r = 0.337, p = 0.012) but not in the NASH group when evaluated alone (r = 0.238, p = 0.1). Of the predisposing factors for NASH, obesity was observed in 24% of patients and hyperlipidemia in 67%. Serum cholesterol and triglyceride levels were significantly higher in the NASH group than those in controls (p < 0.05). It has been detected that most of these patients consumed high amounts of fat in their dietary habits.

CONCLUSIONS

The serum leptin levels were significantly higher in patients with NASH, while they were not affected by chronic hepatitis. This elevation is out of proportion to BMI of these patients and may be related to hyperlipidemia in most. Elevated serum leptin levels, therefore, may promote hepatic steatosis and steatohepatitis.

Early expression of negative/disorganized symptoms predicting psychotic experiences and subsequent clinical psychosis: a 10-year study

OBJECTIVE

The cognitive and motivational impairments observed in psychotic disorders may reflect early developmental alterations that, when combined with later environmental exposures, may drive the onset of positive psychotic symptoms. The epidemiological predictions of this model were tested.

METHOD

A longitudinal prospective cohort study (the Early Developmental Stages of Psychopathology Study) was conducted with a representative general population sample of adolescents and young adults from Munich (N=3,021), who were 14-24 years of age at baseline. Sociodemographic factors, environmental exposures, and measures of psychopathology and associated clinical relevance were assessed across three waves, covering a period of up to 10 years, by clinical psychologists using the Composite International Diagnostic Interview.

RESULTS

Both negative/disorganized and positive psychotic symptoms were frequent (5-year cumulative prevalence rates of around 12%) and occurred in combination more often than predicted by chance. Negative/disorganized symptoms revealed a pattern of sociodemographic associations indicative of developmental impairment, whereas the positive symptoms were associated with environmental exposures such as trauma, cannabis use, and urbanicity. Negative/disorganized symptoms predicted positive symptoms over time, and co-occurrence of positive and negative/disorganized symptoms was predictive of clinical relevance in terms of secondary functional impairment and help-seeking behavior.

CONCLUSION

The results suggest that the negative/disorganized features associated with psychotic disorder are distributed at the population level and drive the ontogenesis of positive psychotic experiences after exposure to environmental risks, increasing the likelihood of impairment and need for care.

Examining the independent and joint effects of molecular genetic liability and environmental exposures in schizophrenia: results from the EUGEI study

Schizophrenia is a heritable complex phenotype associated with a background risk involving multiple common genetic variants of small effect and a multitude of environmental exposures. Early twin and family studies using proxy-genetic liability measures suggest gene-environment interaction in the etiology of schizophrenia spectrum disorders, but the molecular evidence is scarce. Here, by analyzing the main and joint associations of polygenic risk score for schizophrenia (PRS-SCZ) and environmental exposures in 1,699 patients with a diagnosis of schizophrenia spectrum disorders and 1,542 unrelated controls with no lifetime history of a diagnosis of those disorders, we provide further evidence for gene-environment interaction in schizophrenia. Evidence was found for additive interaction of molecular genetic risk state for schizophrenia (binary mode of PRS-SCZ above 75% of the control distribution) with the presence of lifetime regular cannabis use and exposure to early-life adversities (sexual abuse, emotional abuse, emotional neglect, and bullying), but not with the presence of hearing impairment, season of birth (winter birth), and exposure to physical abuse or physical neglect in childhood. The sensitivity analyses replacing the a priori PRS-SCZ at 75% with alternative cut-points (50% and 25%) confirmed the additive interaction. Our results suggest that the etiopathogenesis of schizophrenia involves genetic underpinnings that act by making individuals more sensitive to the effects of some environmental exposures.

Medicinal foodstuffs. V. Moroheiya. (1): Absolute stereostructures of corchoionosides A, B, and C, histamine release inhibitors from the leaves of Vietnamese Corchorus olitorius L. (Tiliaceae)

Three new ionone glucosides named corchoionosides A, B, and C were isolated from the leaves of Corchorus olitorius, commonly called "moroheiya" in Japanese, together with seven known compounds, an ionone glucoside (6S,9R)-roseoside, a monoterpene glucoside betulalbuside A, two flavonol glucosides astragalin and isoquercitrin, two coumarin glucosides scopolin and cichoriine, and chlorogenic acid. The absolute stereostructures of corchoionosides A, B, and C were determined by chemical and physiochemical evidence, which included the result of application of a modified Mosher's method, the CD helicity rule, and chemical correlation with (6S,9R)-roseoside. Corchoionosides A and B and (6S,9R)-roseoside were found to inhibit the histamine release from rat peritoneal exudate cells induced by antigen-antibody reaction.

Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach

Background

Proximal gastrectomy was introduced as a function-preserving operation for early gastric cancer (EGC). The aim of this study was to investigate long-term outcomes after this procedure.

Methods

Between 1993 and 2005, patients with suspected EGC in the upper third of the stomach underwent proximal gastrectomy. The long-term oncological and surgical outcomes were assessed.

Results

Of 128 patients thought to have EGC, 14 had advanced disease. Nodal involvement was seen in 13 patients (10·2 per cent). Postoperative complications developed in 20 (15·6 per cent). Anastomotic stricture was the most frequent complication, occurring in 13 patients (10·2 per cent). There were no postoperative deaths. During follow-up, nine patients (7·0 per cent) were hospitalized owing to bowel obstruction. Eight (6·3 per cent) developed a second primary gastric carcinoma. The overall 5-year survival rate was 90·5 per cent.

Conclusion

Proximal gastrectomy is well tolerated, with excellent outcomes in patients with suspected EGC. It is recommended as a standard procedure for the treatment of EGC in the upper third of the stomach.

Outcome of pylorus-preserving gastrectomy for early gastric cancer

Background

Pylorus-preserving gastrectomy has been introduced as a function-preserving operation for early gastric cancer in Japan. The aim of this study was to investigate the safety and radicality of the procedure.

Methods

Between 1995 and 2004, 611 patients with apparent early gastric cancer in the middle third of the stomach had pylorus-preserving gastrectomy. The short-term surgical and long-term oncological outcomes of these operations were assessed.

Results

The accuracy of preoperative diagnosis of early gastric cancer was 94·3 per cent. Nodal involvement was seen in 62 patients (10·1 per cent). There were no postoperative deaths. Complications developed in 102 patients (16·7 per cent). Major complications, such as leakage and abscess, were observed in 19 (3·1 per cent). The most common complication was gastric stasis, occurring in 49 (8·0 per cent). The overall 5-year survival rate in patients with early gastric cancer was 96·3 per cent.

Conclusion

Pylorus-preserving gastrectomy is a safe operation with an excellent prognosis in patients with early gastric cancer. It is recommended as the standard procedure for early gastric cancer in the middle third of the stomach.

Cytokine upregulation of proteinase-activated-receptors 2 and 4 expression mediated by p38 MAP kinase and inhibitory kappa B kinase beta in human endothelial cells

BACKGROUND AND PURPOSE

Up-regulation of proteinase-activated receptor-2 (PAR2) is a factor in a number of disease states and we have therefore examined the signalling pathways involved in the expression of the receptor.

EXPERIMENTAL APPROACH

We investigated the effects of tumour necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), trypsin and the PAR2 activating peptide, 2-furoyl(2f)-LIGKV-OH on both mRNA and functional expression of PAR2 in human umbilical vein endothelial cells (HUVECs). The effect of specific chemical inhibitors and dominant negative adenovirus constructs of the mitogen-activated protein kinase (MAPK) cascade and the nuclear factor kappa B (NF-kappaB) signalling pathway was assessed. Methods included semi-quantitative and quantitative RT-PCR, [(3)H]inositol phosphate (IP) accumulation and Ca(2+)-dependent fluorescence.

KEY RESULTS

The above agonists induced both mRNA and functional expression of PAR2; PAR4 mRNA, but not that for PAR1 or PAR-3, also increased following TNFalpha treatment. Inhibition of p38 MAP kinase reduced PAR2 and PAR4 expression, whilst inhibition of MEK1/ERK/JNK was without effect. A similar dependency upon p38 MAP kinase was observed for the expression of PAR4. TNFalpha -induced enhancement of PAR2 stimulated [(3)H]-inositol phosphate accumulation (IP) and Ca(2+) signalling was abolished following SB203580 pre-treatment. Infection with adenovirus encoding dominant-negative IKKbeta (Ad.IKKbeta(+/-)) and to a lesser extent dominant-negative IKKalpha (Ad.IKKalpha(+/-)), substantially reduced both control and IL-1beta- induced expression of both PAR2 and PAR4 mRNA and enhancement of PAR2-stimulated IP accumulation and Ca(2+) mobilisation.

CONCLUSIONS AND IMPLICATIONS

These data reveal for the first time the signalling events involved in the upregulation of both PAR2 and PAR4 during pro-inflammatory challenge.

Surgical treatment of advanced gastric cancer: Japanese perspective

The results of clinical trials regarding surgery of curable advanced gastric cancer and esophagogastric junction (EGJ) tumors are reviewed and summarized. Four clinical trials have evaluated D2 dissection for curable gastric cancer in the West. Two large trials in the UK and the Netherlands failed to prove the efficacy of D2 dissection. However, these trials had critical weak points. As they were carried out in a number of hospitals where there was no experience with this surgery, the quality of surgery and postoperative care were very poor making the hospital mortality unacceptably high. After these trials, an Italian group started a phase II study in 8 hospitals with a relatively high volume to confirm the safety of this procedure for Caucasians. They achieved 3% mortality, which was much smaller than that of even D1 in the former trials. These results first highlighted the importance of learning and hospital volume in D2 dissection. Survival results of the Dutch trial showed some difference between D1 and D2, but the difference was not statistically significant. This was attributed to the high hospital mortality and poor quality of surgery, especially low compliance of D2 and the high rate of extension of D1, making this comparison similar to that between D1.3 and D1.7. The results of the phase III study by the Italian group are awaited. Recently a Taiwanese trial proved the benefit of D2 dissection over D1 in a phase III trial. This was a single institutional trial with a sample size of 221 patients. The 5-year survival rate of D2 and D1 was 59.5 and 53.6%, respectively (p = 0.04). The Dutch trials for EGJ tumors showed a large difference in overall survival between the transthoracic and transhiatal approach for Siewert type 1 and 2 tumors, but this was not statistically significant, most likely due to the small sample size. In the subgroup analysis, they demonstrated that there was no survival difference in Siewert type 2 but a large difference in Siewert type 1. A Japanese study showed that there is no benefit to the thoraco-abdominal approach over the transhiatal approach for EGJ tumors whose invasion in the esophagus is 3 cm or less. These two trials clearly demonstrated that mediastinal dissection through a right thoracotomy is recommendable for Siewert type 1, while the transhiatal approach should be considered as standard for Siewert type 2.

Medicinal foodstuffs. XIV. On the bioactive constituents of moroheiya. (2): New fatty acids, corchorifatty acids A, B, C, D, E, and F, from the leaves of Corchorus olitorius L. (Tiliaceae): structures and inhibitory effect on NO production in mouse peritoneal macrophages

Following the characterization of the glycosidic constituents in a medical foodstuff "moroheiya," the leaves of Corchorus olitorius L., four higher fatty acids with a trienone function, corchorifatty acids, A, B, C, and D, an undecanoic acid, corchorifatty acid E, and a trihydroxyfatty acid, corchorifatty acid F, were isolated from the less polar fraction of "moroheiya". The structures and optical purity of corchorifatty acids were determined on the basis of chemical and physicochemical evidence. Corchorifatty acids A, B, and C showed an inhibitory effect on lipopolysaccharide-induced NO production in cultured mouse peritoneal macrophages.

Novel antagonists for proteinase-activated receptor 2: inhibition of cellular and vascular responses in vitro and in vivo

BACKGROUND AND PURPOSE

Proteinase-activated receptor 2 (PAR(2)) is a G-protein coupled receptor associated with many pathophysiological functions. To date, the development of PAR(2) antagonists has been limited. Here, we identify a number of novel peptide-mimetic PAR(2) antagonists and demonstrate inhibitory effects on PAR(2)-mediated intracellular signalling pathways and vascular responses.

EXPERIMENTAL APPROACH

The peptide-mimetic compound library based on the structures of PAR(2) agonist peptides were screened for inhibition of PAR(2)-induced calcium mobilisation in human keratinocytes. Representative compounds were further evaluated by radioligand binding and inhibition of NFkappaB transcriptional activity and IL-8 production. The vascular effects of the antagonists were assessed using in vitro and in vivo models.

KEY RESULTS

Two compounds, K-12940 and K-14585, significantly reduced SLIGKV-induced Ca(2+) mobilisation in primary human keratinocytes. Both K-12940 and K-14585 exhibited competitive inhibition for the binding of a high-affinity radiolabelled PAR(2)-ligand, [(3)H]-2-furoyl-LIGRL-NH(2), to human PAR(2) with K(i) values of 1.94 and 0.627 microM respectively. NFkappaB reporter activity and IL-8 production were also significantly reduced. Furthermore, relaxation of rat-isolated aorta induced by SLIGRL-NH(2) was inhibited competitively by K-14585. K-14585 also significantly lowered plasma extravasation in the dorsal skin of guinea pigs and reduced salivation in mice.

CONCLUSIONS AND IMPLICATIONS

K-12940 and K-14585 antagonized PAR(2) competitively, resulting in inhibition of PAR(2)-mediated signalling and physiological responses both in vitro and in vivo. These peptide-mimetic PAR(2) antagonists could be useful in evaluating PAR(2)-mediated biological events and might lead to a new generation of therapeutically useful antagonists.

Estimating Exposome Score for Schizophrenia Using Predictive Modeling Approach in Two Independent Samples: The Results From the EUGEI Study

Exposures constitute a dense network of the environment: exposome. Here, we argue for embracing the exposome paradigm to investigate the sum of nongenetic "risk" and show how predictive modeling approaches can be used to construct an exposome score (ES; an aggregated score of exposures) for schizophrenia. The training dataset consisted of patients with schizophrenia and controls, whereas the independent validation dataset consisted of patients, their unaffected siblings, and controls. Binary exposures were cannabis use, hearing impairment, winter birth, bullying, and emotional, physical, and sexual abuse along with physical and emotional neglect. We applied logistic regression (LR), Gaussian Naive Bayes (GNB), the least absolute shrinkage and selection operator (LASSO), and Ridge penalized classification models to the training dataset. ESs, the sum of weighted exposures based on coefficients from each model, were calculated in the validation dataset. In addition, we estimated ES based on meta-analyses and a simple sum score of exposures. Accuracy, sensitivity, specificity, area under the receiver operating characteristic, and Nagelkerke's R2 were compared. The ESMeta-analyses performed the worst, whereas the sum score and the ESGNB were worse than the ESLR that performed similar to the ESLASSO and ESRIDGE. The ESLR distinguished patients from controls (odds ratio [OR] = 1.94, P < .001), patients from siblings (OR = 1.58, P < .001), and siblings from controls (OR = 1.21, P = .001). An increase in ESLR was associated with a gradient increase of schizophrenia risk. In reference to the remaining fractions, the ESLR at top 30%, 20%, and 10% of the control distribution yielded ORs of 3.72, 3.74, and 4.77, respectively. Our findings demonstrate that predictive modeling approaches can be harnessed to evaluate the exposome.

New bioactive monoterpene glycosides from Paeoniae Radix

Bioassay-guided separation of MeOH extract of Japanese Paeoniae Radix inhibiting contractile responses of guinea pig ileum stimulated with electric field disclosed a new monoterpene glycoside, 6-O-beta-D-glucopyranosyl-lactinolide (1), as an active constituent together with two new monoterpene glycosides (3 and 4) and two new monoterpenes (2 and 5). Furthermore, 1-O-beta-D-glucopyranosyl-paeonisuffrone (2) was found to inhibit histamine release from rat peritoneal exudate cells induced by antigen-antibody reaction.

Distribution and significance of the oesophageal and gastric cardiac mucosae: a study of 131 operation specimens

AIMS

To clarify the distribution and significance of the oesophageal and gastric cardiac mucosae at the oesophago-gastric junction (EGJ).

METHODS AND RESULTS

Oesophagectomy specimens from 131 consecutive patients with middle and upper thoracic oesophageal cancer were examined. The surgically resected specimens including the EGJ were cut into 5 mm thick serial sections and examined histopathologically for the length of the oesophageal and gastric cardiac mucosae and the incidence of columnar epithelial islands (CEIs). We also determined the presence of short-segment Barrett's oesophagus (SSBE) and goblet cell metaplasia in SSBE. Oesophageal cardiac mucosa was found in 125 cases (95%) and gastric cardiac mucosa was found in all cases. The mean length of the oesophageal and gastric cardiac mucosa was 4 mm (range 1-26 mm) and 13 mm (range 2-64 mm), respectively. CEIs were found in 75 cases (57%). SSBE was found in 70 cases (53%), among which goblet cell metaplasia was found in 28 cases (21%). No long-segment Barrett's oesophagus was found. The mean length of oesophageal cardiac mucosa (6 mm) and gastric cardiac mucosa (17 mm) in SSBE was significantly greater than that (3 mm and 8 mm, respectively) in non-SSBE cases (P < 0.0001 and P < 0.0001). The incidence (69%) of CEIs in SSBE was significantly higher than that (44%) in non-SSBE cases (P = 0.005).

CONCLUSIONS

Oesophageal and gastric cardiac mucosae were found frequently. Oesophageal cardiac glands and CEIs might play an important role in the development of SSBE.

Replicated evidence that endophenotypic expression of schizophrenia polygenic risk is greater in healthy siblings of patients compared to controls, suggesting gene-environment interaction. The EUGEI study

BACKGROUND

First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.

METHODS

We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.

RESULTS

In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.

CONCLUSIONS

The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene-environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.

Outcome measures of interepisode bipolar patients in a Turkish sample

BACKGROUND

We aimed to study the correlations of several outcome measures in bipolar patients with the clinical features of interepisode period.

METHODS

Bipolar patients who were diagnosed according to DSM-III-R or IV were contacted and asked for a further evaluation. Interepisode bipolar patients (n = 100) were interviewed with the Schedule for Affective Disorders and Schizophrenia (SADS). In addition the Brief Disability Questionnaire (BDQ), the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Global Assessment Scale (GAS) were administered to assess outcome. They were also asked to check the List of Life Events (LLE) for the last six months.

RESULTS

Our results can be summarised as follows: (1) quality of life was predicted by current subthreshold depressive symptoms; (2) the number of previous depressive episodes, current subthreshold depressive and manic symptoms predicted disability; (3) the number of previous depressive episodes and the duration of hospitalisation as well as current subthreshold depressive and manic symptoms predicted overall functioning; (4) the number and distress level of life events were correlated with suicidal symptoms.

CONCLUSIONS

Our findings suggest that outcome measures were correlated with subsyndromal disorder, the number of previous depressive episodes and the duration of hospitalisation.

Cognitive functioning throughout adulthood and illness stages in individuals with psychotic disorders and their unaffected siblings

Important questions remain about the profile of cognitive impairment in psychotic disorders across adulthood and illness stages. The age-associated profile of familial impairments also remains unclear, as well as the effect of factors, such as symptoms, functioning, and medication. Using cross-sectional data from the EU-GEI and GROUP studies, comprising 8455 participants aged 18 to 65, we examined cognitive functioning across adulthood in patients with psychotic disorders (n = 2883), and their unaffected siblings (n = 2271), compared to controls (n = 3301). An abbreviated WAIS-III measured verbal knowledge, working memory, visuospatial processing, processing speed, and IQ. Patients showed medium to large deficits across all functions (ES range = -0.45 to -0.73, p < 0.001), while siblings showed small deficits on IQ, verbal knowledge, and working memory (ES = -0.14 to -0.33, p < 0.001). Magnitude of impairment was not associated with participant age, such that the size of impairment in older and younger patients did not significantly differ. However, first-episode patients performed worse than prodromal patients (ES range = -0.88 to -0.60, p < 0.001). Adjusting for cannabis use, symptom severity, and global functioning attenuated impairments in siblings, while deficits in patients remained statistically significant, albeit reduced by half (ES range = -0.13 to -0.38, p < 0.01). Antipsychotic medication also accounted for around half of the impairment in patients (ES range = -0.21 to -0.43, p < 0.01). Deficits in verbal knowledge, and working memory may specifically index familial, i.e., shared genetic and/or shared environmental, liability for psychotic disorders. Nevertheless, potentially modifiable illness-related factors account for a significant portion of the cognitive impairment in psychotic disorders.

Comparative analyses of serum vitellogenin levels in male and female Reeves' pond turtles ( Chinemys reevesii ) by an immunological assay

A quantitative immunological method was developed for measuring serum vitellogenin levels of Reeves' pond turtles (Chinemys reevesii) to investigate the effects of endocrine disruptors on the freshwater ecosystem. Vitellogenin was induced by injecting estradiol-17beta into C. reevesii turtles (adult females, juvenile females, and males) and was purified from the turtle serum by EDTA-MgCl2 precipitation followed by gel filtration. Using a polyclonal antibody raised against C. reevesii vitellogenin, an enzyme-linked immunosorbant assay was established. The detectable range, recovery of vitellogenin, and coefficient of variation in this assay were 0.0040-1.0 microg.ml(-1), 85.3-109% and 3.4-11.5%, respectively. This assay was also applicable for measurement of the concentrations of vitellogenins from other species, Japanese pond turtles (Mauremys japonica) and red-eared turtles (Trachemys scripta). The serum vitellogenin concentration of 131 C. reevesii turtles captured at a Japanese local river was measured by the assay. In females, vitellogenin ranged from 0.10 microg.ml(-1) to 15,000 microg.ml(-1) with two peaks, 0.10-1.0 microg.ml(-1) (juveniles) and 1,000-10,000 microg.ml(-1) (adults). However, in males, it ranged from 0.10 microg.ml(-1) to 0.60 microg.ml(-1), showing one peak, 0.10-0.20 microg.ml(-1). Therefore, if relatively high concentrations of vitellogenin are detected in males or juvenile females, it is suggested that they would have been exposed to xenobiotic estrogens.

Immunohistochemical observations on binding of monoclonal antibody to epithelial membrane antigen in epithelial tumors of the oral cavity and skin

A total of 211 cases of benign and malignant tumors of epithelial origin were studied by the immunoperoxidase method to determine the distribution profile of epithelial membrane antigen (EMA) with the use of monoclonal antibody. Normal epithelial cells in the oral mucosa and skin were usually negative for EMA staining, as were epithelial cells in hyperplastic lesions and papillomas. Paget cells and tumor cells of Bowen's disease (carcinoma in situ) demonstrated a high incidence of EMA positivity, whereas the frequency in basal cell carcinoma was unexpectedly low. Squamous cell carcinomas revealed positive EMA staining of cytoplasmic membranes, and the antigen was also present in keratinized areas. EMA expression in squamous cell carcinoma generally showed a high incidence (85%) and was higher in keratinized lesions than in unkeratinized or less well-differentiated neoplasms. EMA distribution could be classified into two forms: one in which the cytoplasmic membranes demonstrate positivity and in which a positive cytoplasmic pattern is found in parakeratinized cells in malignant foci.

Reasons for clozapine discontinuation in patients with treatment-resistant schizophrenia

Although clozapine is more effective than other antipsychotics in the treatment of schizophrenia, the rate of its discontinuation is also high. The aim of this retrospective chart-review study was to investigate the causes of clozapine discontinuation in patients with treatment-resistant schizophrenia. This study included a total of 396 patients with schizophrenia, 240 still on clozapine therapy and 156 who discontinued clozapine, and compared their clinical characteristics. Those who discontinued clozapine had a longer history of illness and more hospitalizations before clozapine and tended to be older. Inadequate response was more common among clozapine discontinuers compared to continuers. The most common reason for discontinuation was the side-effects associated with clozapine (49%). Discontinuation from patient decision or by the psychiatrist due to noncompliance was the second (29.7%) and discontinuation due to lack of efficacy was the third most frequent reason (21.3%). The patients who discontinued clozapine because of cardiac side effects were younger, had shorter duration of clozapine use, and had lower maximum clozapine dose compared to the other discontinuers. Our findings point out the importance of enhancing psychiatrists' ability to handle manageable side effects to minimize discontinuations and maximize the benefits of clozapine in patients with treatment-resistant schizophrenia.

Abnormal cellular property of fibroblasts from congenital gingival fibromatosis

Two strains of cultured cells were isolated and characterized from the gingiva of two siblings with congenital gingival fibromatosis. The growth rate of both fibroblast strains was slower than that of comparable cells obtained from the normal gingiva of control individuals. The amounts of substances, including collagen and glycosaminoglycans, biosynthesized by the diseased cells were much greater than those by the control cells from normal gingivae. Namely, 11.7-13.7% of the protein synthesized by diseased cells was collagen, whereas collagen accounted for only 6.1-8.5% of the total protein produced by normal cells. Moreover, the production of a large amount of extracellular substances by the diseased cells was confirmed by electron microscopic examination. These observations suggest that the fibromatosis tissues contain affected fibroblasts which have low growth activity but are active in the production of much greater amounts of collagen and other extracellular substances compared to normal fibroblasts.

The effectiveness of intramuscular biperiden in acute akathisia: a double-blind, randomized, placebo-controlled study

Neuroleptic-induced acute akathisia (NIA) is a distressing condition and an important clinical problem because it is associated with treatment noncompliance and suicidal or impulsive behavior. Anticholinergics are among the treatment options; however, a review of the literature fails to identify a double-blind, randomized, placebo-controlled study of these medications in NIA. In a randomized, double-blind, placebo-controlled design, we studied the effectiveness of intramuscular biperiden (n = 15) or isotonic saline (n = 15) in the treatment of NIA diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Injections were repeated up to 3 times unless akathisia was completely treated (scored 0 for global akathisia with the Barnes Akathisia Rating Scale). Patients were assessed for akathisia, other movement disorders, and psychiatric symptoms at baseline and 3 times after the first injection at 2-hour intervals. Response was defined as at least a 2-point decline in the global akathisia score. The numbers of responders in the 2 groups were not significantly different (7 and 5 in the biperiden and placebo groups, respectively). The courses of individual items on the Barnes Akathisia Rating Scale were also similar. Our results suggest that intramuscular biperiden should not be considered as a first-line treatment of NIA.

The prognostic impact of isolated tumor cells in lymph nodes of T2N0 gastric cancer: comparison of American and Japanese gastric cancer patients

BACKGROUND

The clinical significance of immunohistochemically detected isolated tumor cells (ITC) in lymph nodes of gastric cancer patients is controversial. This study examined the prognostic impact of ITC on patients with early-stage gastric cancer in two large volume centers in the United States and Japan.

METHODS

Fifty-seven patients with T2N0M0 gastric carcinoma who underwent gastric resection between January 1987 and January 1997 at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York and 107 patients resected at National Cancer Center Hospital (NCCH) in Tokyo between January 1984 and December 1990 were studied. The sections were newly prepared from each lymph node for immunohistochemical staining for cytokeratin. Lymph nodes and original specimens from MSKCC were examined by pathologists in NCCH. The prognostic significance of the presence of ITC in lymph nodes was investigated in patients of both institutions.

RESULTS

ITC were identified in 30 of 57 patients (52.6%) at MSKCC and in 38 of 107 patients (35.5%) at NCCH. In both institutions, there was no significant difference in the prognosis of the studied patients with or without ITC (P= .22, .86 respectively).

CONCLUSIONS

The presence of ITC detected by immunohistochemistry in the regional lymph nodes did not affect the prognosis of American and Japanese patients with T2N0M0 gastric carcinoma who underwent gastrectomy with D2 lymph node dissection.

Infiltrating lipoma of the tongue

A case of an infiltrating lipoma, occurring in the tongue of a 56-year-old Japanese woman, is presented. The relevant literature is discussed.