Impact of Implant Size and Position on Subsidence Degree after Anterior Cervical Discectomy and Fusion: Radiological and Clinical Analysis

BACKGROUND

Implant subsidence is recognized as a complication of interbody stabilization, although its relevance remains ambiguous, particularly in terms of relating the effect of the position and depth of subsidence on the clinical outcome of the procedure. This study aimed to evaluate how implant positioning and size influence the incidence and degree of subsidence and to examine their implications for clinical outcomes.

METHODS

An observational study of 94 patients (157 levels) who underwent ACDF was conducted. Radiological parameters (implant position, implant height, vertebral body height, segmental height and intervertebral height) were assessed. Clinical outcomes were evaluated using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Subsidence was evaluated in groups according to its degree, and statistical analyses were performed.

RESULTS

The findings revealed that implant-to-endplate ratio and implant height were significant risk factors associated with the incidence and degree of subsidence. The incidence of subsidence varied as follows: 34 cases (41.5%) exhibited displacement of the implant into the adjacent endplate by 2-3 mm, 32 cases (39%) by 3-4 mm, 16 cases (19.5%) by ≥4 mm and 75 (47.8%) cases exhibited no subsidence.

CONCLUSIONS

The findings underscore that oversized or undersized implants relative to the disc space or endplate length elevate the risk and severity of subsidence.

Prosodic deficits and interpersonal difficulties in patients with schizophrenia

The present study examines the use of receptive emotional and linguistic prosody in patients with schizophrenia; particularly, its aim was to evaluate the type and number of errors made when comprehending the emotions and modes implied by meaningless utterances. Seventy-eight participants were enrolled to the study, i.e. two groups (patients with schizophrenia and healthy controls) consisting of 39 subjects. The severity of illness was evaluated with the Positive and Negative Syndrome Scale; comprehension of emotional and linguistic prosody was assessed by the subtests of the Polish Version of the Right Hemisphere Language Battery. Neither emotional nor linguistic prosody comprehension both correlated with schizophrenia symptoms. The study group experienced more difficulties in distinguishing between happiness and anger, and were more likely to misunderstand imperative utterances, confusing them with interrogative or affirmative ones. Such impairments are significant as they may affect the ability to form and sustain relationships with other people, achieve success in the work environment, and integrate in the community. They may also be a trait mark of the illness independent of psychotic symptoms. Further research is needed to translate this knowledge into meaningful and therapeutic interventions to improve quality of life, both for affected individuals and for their communication partners.

The correlation between white matter integrity and pragmatic language processing in first episode schizophrenia

Objective: Higher-order language disturbances could be the result of white matter tract abnormalities. The study explores the relationship between white matter and pragmatic skills in first-episode schizophrenia. Methods: Thirty-four first-episode patients with schizophrenia and 32 healthy subjects participated in a pragmatic language and Diffusion Tensor Imaging study, where fractional anisotropy of the arcuate fasciculus, corpus callosum and cingulum was correlated with the Polish version of the Right Hemisphere Language Battery. Results: The patients showed reduced fractional anisotropy in the right arcuate fasciculus, left anterior cingulum bundle and left forceps minor. Among the first episode patients, reduced understanding of written metaphors correlated with reduced fractional anisotropy of left forceps minor, and greater explanation of written and picture metaphors correlated with reduced fractional anisotropy of the left anterior cingulum. Conclusions: The white matter dysfunctions may underlie the pragmatic language impairment in schizophrenia. Our results shed further light on the functional neuroanatomical basis of pragmatic language use by patients with schizophrenia.

Higher order language impairments can predict the transition of ultrahigh risk state to psychosis-An empirical study

AIM

Higher order language skills, for example, non-literal language, humour, prosody deal with 'what is meant' and they are necessary for communicative exchange and relationships; No study has investigated their link with conversion to psychosis. The purpose of this study was to determine whether such skills could act as predictors of the onset of psychosis, and compare those of individuals converting and non-converting to psychosis with control of cognitive functions.

METHODS

Seventy-three patients, aged 15 to 32 years, fulfilling ultrahigh risk criteria took part: 14% of whom were receiving antipsychotic drugs. The study was observational, prospective and longitudinal in nature, and scheduled for 60 months. Pragmatic language skills were evaluated using the Polish version of the right hemisphere language battery. The ultrahigh risk (UHR) criteria were evaluated with Comprehensive Assessment of At-Risk Mental States; attention, intelligence and verbal fluency were controlled.

RESULTS

The conversion rate was 25%; converters demonstrated impaired humour comprehension and metaphor explanation abilities; composite score of pragmatic language was associated with a hazard ratio of 6.0 (95% CI 1.8-20.5) and AUC of .73. Verbal fluency was an independent predictor of conversion, but attention and intelligence were not; pragmatic language skills were associated with social function but not with prodromal symptoms.

CONCLUSIONS

The results suggest that deficits in humour comprehension and metaphor explanation could predict conversion to psychosis. These findings could improve diagnosis and create implications for speech and language therapy in UHR groups. Further studies on the mechanisms of pragmatic skills should analyze their relationship with abstract measures and semantic coherence.

Preliminary study of higher-order language and extralinguistic impairments in individuals with high clinical risk of psychosis and first episode of schizophrenia

AIM

Higher-order language functions are associated with understanding indirect speech acts, lexical-semantic processes, the understanding and production of prosody, discourse production and comprehension. Only a few studies imply that language abnormalities may be present in individuals at ultra-high risk for psychosis (UHR) and first-episode of schizophrenia (FE). The purpose of this study was to test the presence of higher-order language dysfunctions in UHR and FE subjects using a standardized comprehensive test battery.

METHODS

Twenty patients experiencing FE schizophrenia, 33 UHR individuals and 20 healthy controls (HC) took part in the study. Higher-order language and extralinguistic abilities were evaluated using the Right Hemisphere Language Battery (RHLB-PL). The battery consisted of tests covering the comprehension of implicit information, lexico-semantic processing, understanding humour, making inappropriate remarks and comments, understanding and explaining metaphors, understanding prosody and appropriateness of behaviour in communication settings.

RESULTS

The UHR patients scored lower than HC when comprehending implicit information, discourse and in areas associated with the effectiveness of interpersonal communication; however, they scored higher than the FE participants in explanation of metaphors and processing language information in the context of general knowledge. The FE participants scored lower than healthy controls in comprehension of implicit information, explanation of metaphors, discourse understanding, processing language information in the context of general knowledge and effectiveness of interpersonal communication.

CONCLUSIONS

The higher-order language dysfunctions mediated by the right hemisphere appear to be present in subjects at UHR of schizophrenia and those experiencing their FE. The results may play a crucial role in diagnostic processes.

An increase in plasma brain derived neurotrophic factor levels is related to n-3 polyunsaturated fatty acid efficacy in first episode schizophrenia: secondary outcome analysis of the OFFER randomized clinical trial

RATIONALE

N-3 polyunsaturated fatty acids (n-3 PUFA) influence multiple biochemical mechanisms postulated in the pathogenesis of schizophrenia that may influence BDNF synthesis.

OBJECTIVES

A randomized placebo-controlled study was designed to compare the efficacy of a 26-week intervention composed of either 2.2 g/day of n-3 PUFA or olive oil placebo, with regard to symptom severity in first-episode schizophrenia patients. The secondary outcome measure of the study was to describe the association between n-3 PUFA clinical effect and changes in peripheral BDNF levels.

METHODS

Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the following study arms: 36 to the EPA + DHA group and 35 to the placebo group. Plasma BDNF levels were assessed three times, at baseline and at weeks 8 and 26 of the intervention. BDNF levels were determined in plasma samples using Quantikine Human BDNF ELISA kit. Plasma BDNF level changes were further correlated with changes in the severity of symptoms in different clinical domains.

RESULTS

A significantly greater increase in plasma BDNF levels was observed in the intervention compared to the placebo group (Cohen's d = 1.54). Changes of BDNF levels inversely correlated with change in depressive symptoms assessed using the Calgary Depression Rating Scale in Schizophrenia (Pearson's r = - 0.195; p = 0.018).

CONCLUSIONS

The efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to an increase in BDNF levels, which may be triggered by the activation of intracellular signaling pathways including transcription factors such as cAMP-reactive element binding protein.

Higher-order language dysfunctions as a possible neurolinguistic endophenotype for schizophrenia: Evidence from patients and their unaffected first degree relatives

The purpose of the study was to examine the presence of pragmatic dysfunctions in first episode (FE) subjects and their healthy first degree relatives as a potential endophenotype for schizophrenia. Thirty-four FE patients, 34 parents of the patients (REL) and 32 healthy controls (HC) took part in the study. Pragmatic language functions were evaluated with the Right Hemisphere Language Battery, attention and executive functions were controlled, as well as age and education level. The parents differed from HC but not from their FE offspring with regard to overall level of language and communication and the general knowledge component of language processing. The FE participants differed from HC in comprehension of inferred meaning, emotional prosody, discourse dimensions, overall level of language and communication, language processing with regard to general knowledge and communication competences. The FE participants differed from REL regarding discourse dimensions. Our findings suggest that pragmatic dysfunctions may act as vulnerability markers of schizophrenia; their assessment may help in the diagnosis of early stages of the illness and in understanding its pathophysiology. In future research the adoptive and biological parents of schizophrenia patients should be compared to elucidate which language failures reflect genetic vulnerability and which ones environmental factors.

Polish individuals with an at-risk mental state: demographic and clinical characteristics

AIM

The aim of this study is to present sociodemographic and clinical characteristics of Polish individuals with an at-risk mental state (ARMS).

METHODS

A group of 99 individuals meeting the ARMS criteria were assessed in terms of sociodemographic data, psychopathological symptoms, psychosocial functioning and comorbidity.

RESULTS

The sample (mean age 19 years) was 54.55% women. At baseline, nearly 73% of the sample was educated, and 20.20% were employed. Approximately 87.88% of the participants lived with their families. Nearly 77% of the sample presented attenuated psychotic symptoms (APS), 17.17% demonstrated APS with accompanying vulnerability traits and 19.19% showed vulnerability features only. The mean Social and Occupational Functioning Assessment Scale score was 49.55 (±7.70). No effect of age, gender or level of functioning on psychopathological symptoms was observed. The most common comorbid diagnoses were depressive (44.44%) and anxiety disorders (19.19%), which coexisted in 5.05% of the individuals. Approximately 28.28% of the diagnoses met the criteria for personality disorders. The dropout rate from the study was 19.09%, with stigma as the most common reason.

CONCLUSIONS

Polish ARMS individuals are help-seeking young people most commonly presenting APS or vulnerability features. Despite a high level of psychosocial dysfunction, these individuals remain educationally active. Most individuals showed comorbid diagnoses (commonly depressive or anxiety disorders). Despite some differences resulting from the socioeconomic situation of the country or the specificity of the mental health services, the characteristics of the sample remain consistent with descriptions of ARMS populations worldwide. This study reaffirms the need for organizing early intervention services in non-stigmatizing settings.

Telomerase level increase is related to n-3 polyunsaturated fatty acid efficacy in first episode schizophrenia: Secondary outcome analysis of the OFFER randomized clinical trial

Schizophrenia is associated with shortening of the lifespan mainly due to cardiovascular events, cancer and chronic obstructive pulmonary disease. Both telomere attrition and decrease of telomerase levels were observed in schizophrenia. Polyunsaturated fatty acids (PUFA) influence multiple biochemical mechanisms which are postulated to accelerate telomere shortening and limit the longevity of patients with schizophrenia. Intervention studies based on add-on therapy with n-3 polyunsaturated fatty acids (n-3 PUFA) in patients with schizophrenia did not assess the changes in telomerase levels. A randomized placebo-controlled trial named OFFER was designed to compare the efficacy of a 26-week intervention composed of either 2.2g/day of n-3 PUFA or olive oil placebo with regard to symptom severity in first-episode schizophrenia patients. The secondary outcome measure of the study was to describe the association between the clinical effect of n-3 PUFA and changes in telomerase levels. Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the study arms. The Positive and Negative Syndrome Scale (PANSS) was used to assess the change in symptom severity. Telomerase levels of peripheral blood mononuclear cells (PBMC) were assessed at three points: at baseline and at weeks 8 and 26 of the intervention. A significantly greater increase in PBMC telomerase levels in the intervention group compared to placebo was observed (p<0.001). Changes in telomerase levels significantly and inversely correlated with improvement in depressive symptoms and severity of the illness. The efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to an increase in telomerase levels.

Schizophrenia patients have higher-order language and extralinguistic impairments

INTRODUCTION

The extralinguistic and paralinguistic aspects of the language refer to higher-order language functions such as lexical-semantic processes, prosody, indirect speech acts or discourse comprehension and production. Studies suggest that these processes are mediated by the Right Hemisphere (RH) and there is also some evidence of RH dysfunctions in schizophrenia. The aim of the paper is to investigate the extralinguistic and paralinguistic processing mediated by Right Hemisphere in schizophrenia patients using a validated and standardized battery of tests.

METHODS

Two groups of participants were examined: a schizophrenia sample (40 participants) and a control group (39 participants). Extralinguistic and paralinguistic processing was assessed in all subjects by the Polish version of the Right Hemisphere Language Battery (RHLB-PL), which measures comprehension of implicit information, naming, understanding humor, inappropriate remarks and comments, explanation and understanding of metaphors, understanding emotional and language prosody and discourse understanding.

RESULTS

Schizophrenia patients scored significantly lower than controls in subtests measuring comprehension of implicit information, interpretation of humor, explanation of metaphors, inappropriate remarks and comments, discernment of emotional and language prosody and comprehension of discourse. No differences were observed in naming, understanding metaphors or in processing visuo-spatial information.

CONCLUSIONS

Extralinguistic and paralinguistic dysfunctions appear to be present in schizophrenia patients and they suggest that RH processing may be disturbed in that group of patients. As the disturbances of higher-order language processes mediated by the RH may cause serious impairments in the social communication of patients, it is worth evaluating them during clinical examination.

Differences in omega-3 and omega-6 polyunsaturated fatty acid consumption in people at ultra-high risk of psychosis, first-episode schizophrenia, and in healthy controls

AIM

Supplementation with omega-3 PUFA showed efficacy in reducing the risk of transition into psychosis in UHR individuals. It is uncertain whether dietary patterns can be partly responsible for n-3 deficiencies observed in susceptible participants before the diagnosis of schizophrenia. The study was designed to assess differences in omega-3 and omega-6 PUFA consumption in healthy controls (HC), UHR participants and FES patients as well as to verify the hypothesis that dietary changes in PUFA consumption are present before active psychosis develops, that is, in UHR individuals.

METHODS

Dietary habits during the previous year were assessed in 34 patients at UHR of psychosis, 33 patients diagnosed with FES and 33 HC participants using a validated Food-Frequency Questionnaire and the Polish Food Composition Tables.

RESULTS

Significant differences in omega-3 and omega-6 PUFA intake were observed between study groups. UHR and FES groups reported significantly higher consumption of omega-6 PUFA in comparison with HC. FES patients also reported a higher consumption of alpha-linolenic acid (omega-3) in comparison with HC. No significant differences were seen in consumption of long-chain marine PUFA.

CONCLUSIONS

Differences in omega-6 and omega-3 PUFA consumption exist before development of psychotic symptoms, fulfilling the criteria of schizophrenia.

Evaluation of white matter structure changes, as assessed in tractography, and cognitive dysfunctions in patients with early onset schizophrenia and their first-degree relatives

OBJECTIVES

The aim of the project was to assess the differences in the white matter (WM) fiber structure between patients with early onset schizophrenia (EOS), their first degree relatives and controls using Fractional Anisotropy (FA), and an independent evaluation of the severity of working memory disturbances in the study groups.

METHODS

The study included 20 patients diagnosed with paranoid EOS (diagnosed before the age of 18), a group of 20 parents of patients, matched for gender, and 18 healthy controls. All study participants were examined with Diffusion Tensor Imaging (DTI,1.5 T) and selected neuropsychological tests to assess working memory, immediate memory and attention (Trail Making Test parts A and B: TMT-A and TMT-B, Digit Span Forward and Backward).

RESULTS

No significant differences in FA parameters were found between the analyzed groups. The group of patients took significantly longer to perform the TMT-A and TMT-B than the control group, and achieved worse outcomes in Digit Span tests. The relatives of the patients achieved lower scores in Digit Span tests and needed more time to perform TMT-B compared to controls. There were no significant differences between all groups in terms of the number of errors when performing TMT-A and TMT-B.

CONCLUSIONS

The results of our study indicate a reduction in the capacity of immediate memory, working memory, cognitive plasticity and divided attention, both in EOS patients and their first degree relatives compared to healthy subjects. The reported neuropsychological deficits were not reflected in WM integrity, as assessed with FA.

Oxidative stress reduction related to the efficacy of n-3 polyunsaturated fatty acids in first episode schizophrenia: Secondary outcome analysis of the OFFER randomized trial

Intervention studies of n-3 polyunsaturated fatty acids (n-3 PUFA) as add-on therapy in patients with schizophrenia have not examined changes in oxidative stress. A randomized placebo-controlled trial of a 26-week intervention composed of 2.2g/day of n-3 PUFA was found to reduce symptom severity in first-episode schizophrenia patients. The present study is an extension of our previous report, whose secondary aim was to assess the association between the clinical effect of n-3 PUFA and changes in oxidative stress indices. Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the study arms. Total plasma antioxidant capacity and 8-epi-isoprostane F_2α content were assessed at baseline and at weeks 8 and 26 of the study as secondary outcome measures. Significant changes in oxidative stress indices favouring the intervention group were observed: decreases in 8-isoprostane F_2α (p<0.001) and increases in total plasma antioxidant capacity (p<0.001). Significant correlations between changes in clinical scores relevant to symptom severity and changes in oxidative indices were observed. The results of the present study hence suggest that the efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to improvement in oxidative stress indices.

Deficits in the identification of pleasant odors predict the transition of an at-risk mental state to psychosis

OBJECTIVE

Existing knowledge of the relationship between olfactory identification (OI) ability and clinical risk of psychosis is inconsistent. To address this inconsistency, the aim of the present study was to identify the relationship between OI ability, with regard to the hedonic attributes of odors, and the risk of transition to psychosis in individuals with an ARMS.

METHODS

A group of 81 individuals meeting the ARMS criteria according to the Comprehensive Assessment of At Risk Mental State were at baseline administered with the University of Pennsylvania Smell Identification Test. The hedonic attributes of odorants were normatively established. Participants were followed up for transition to psychosis for a mean period of 36.1months (SD:27.5months).

RESULTS

The presence of deficits in the identification of pleasant odors was found to be a risk factor for conversion from an ARMS to schizophrenia. The hazard ratio for each point in deficit scores in the Cox regression model was 1.455 (95% CI: 1.211-1.747), p<0.0001. Significant deficits in the identification of pleasant odors were associated with a risk for conversion at both early and late time points from baseline.

CONCLUSIONS

The findings imply that the impaired identification of pleasant odorants may be a risk factor for the transition of an ARMS into a psychotic disorder, and highlights the need for further research of OI in "at-risk" cohorts, taking into account the hedonic attributes of odors.

The association between polyunsaturated fatty acid consumption and the transition to psychosis in ultra-high risk individuals

PUFA deficiencies in cellular membranes have been observed in ultra-high risk (HR) individuals and in early schizophrenia. It is uncertain whether dietary PUFA consumption can be associated with the risk of transition to psychosis in HR individuals. The aim of the study was to assess PUFA consumption and confirm whether dietary habits are related to the risk of transition to full-threshold psychosis in HR individuals during a 12-month follow-up. PUFA consumption during the previous year was analyzed in 62 h individuals and 33 healthy controls (HC) at the beginning of the follow-up period using a validated Food-Frequency Questionnaire and the Polish Food Composition Tables. Fifteen HR individuals converted into psychosis (C-HR) during the 12-month follow-up. C-HR individuals reported significantly higher consumption of n-6 fatty acids (linoleic acid, LA and arachidonic acid, AA) in comparison with individuals who did not develop psychosis (NC-HR). The C-HR group reported a significantly higher AA/(EPA+DHA) consumption ratio than the NC-HR group. HC reported significantly higher consumption of most n-3 PUFA and lower consumption of all n-6 PUFA than both groups of HR individuals. The results suggest that dietary patterns of PUFA consumption may play a role in the conversion to psychosis of HR individuals.

PORT (Programme of Recognition and Therapy): the first Polish recognition and treatment programme for patients with an at-risk mental state

AIM

To present the activities of the first early intervention centre in Poland and the Programme of Recognition and Therapy (PORT) run by the centre.

METHODS

An overview of the admission process, diagnostic procedures and therapeutic interventions offered to individuals with an at-risk mental state.

RESULTS

The PORT programme, developed in 2010, included 81 individuals, aged 15-29 years so far. The diagnostic procedures consists of evaluation of symptoms with the use of the Comprehensive Assessment of At-Risk Mental State (CAARMS), assessment of premorbid and current personality traits and the evaluation of cognitive functions. Therapeutic interventions include cognitive behavioural therapy, diet supplementation with omega-3 fatty acids and pharmacological treatment. Overall rate of conversion into psychosis within the years 2010-2103 was 18.5%. The programme has also been a source of research in the field of early psychosis.

CONCLUSIONS

The PORT programme enables young people with an ARMS an easy access to the specialized service offering treatment tailored to their specific needs.

Figural fluency and immediate visual memory in patients with at-risk mental state for psychosis: empirical study

AIM

Although a number of cognitive functions have been assessed in the ultra-high risk (UHR) population, only one study has reported on figural fluency. Visual memory was measured by different tests providing inconsistent results. The aim of the present study was to compare figural fluency and visual immediate memory performance in UHR patients and normal subjects.

METHODS

The UHR sample consisted of 55 help-seeking individuals meeting CAARMS criteria. The control group consisted of 65 subjects. They were matched as a group by age, gender and education level. Figural fluency (RFFT) and immediate visual memory (BVRT) were assessed within 2 weeks after inclusion in the study in the UHR patient group.

RESULTS

Significant differences were obtained in RFFT and BVRT results. In BVRT, UHR patients scored lower in number of correct designs (P < 0.001) and higher in number of errors (P < 0.0001), especially omissions (P < 0.001) and distortions (P < 0.0001). UHR subjects accurately recalled fewer designs, omitted and distorted more test figures. In RFFT, they scored lower in production of novel designs (P < 0.0001) and higher in the error ratio index (P < 0.008). They produced fewer novel designs and made more preservative errors.

CONCLUSIONS

The current study concerns non-verbal cognitive functions in UHR samples. Our results suggest that figural fluency and visual immediate memory are impaired in help-seeking UHR individuals as compared with matched controls.

Augmentation of antipsychotics with electroconvulsive therapy in treatment-resistant schizophrenia patients with dominant negative symptoms: a pilot study of effectiveness

OBJECTIVES

The aim of the study was to determine the effectiveness of the augmentation of antipsychotics (AP) with electroconvulsive therapy (ECT) in treatment-resistant schizophrenia (TRS) patients with dominant negative symptoms.

METHODS

The study encompassed 34 patients aged 21-55 years, 47.1% of whom were female, who were diagnosed with TRS. Each patient underwent a course of ECT sessions combined with AP medications which had previously been found to be ineffective. Prior to ECT and within 3 days after the final ECT session, the participants were evaluated on the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia and the Clinical Global Impression scales.

RESULTS

Augmentation of AP therapy with ECT led to a significant decrease in symptom severity in TRS patients with dominant negative symptoms, 58.8% of whom demonstrated at least a 25% decrease in the total PANSS score. The greatest reductions were observed in the general and positive PANSS subscales (mean ± SD: 11.35 ± 7.43 and 6.79 ± 5.23 patients), and the least significant in the negative symptoms subscale (5.03 ± 4.36 patients).

CONCLUSION

Augmentation of AP therapy with ECT in a group of TRS patients with dominant negative symptoms induced a significant decrease in symptom severity. The greatest reductions were obtained in general and positive symptoms and the least in negative symptoms.

Omega-3 fatty acids in first-episode schizophrenia - a randomized controlled study of efficacy and relapse prevention (OFFER): rationale, design, and methods

BACKGROUND

Polyunsaturated fatty acid (PUFA) metabolism abnormalities have been long implicated in the etiology of schizophrenia. Although several randomized clinical trials have been carried out to assess the efficacy of omega-3 PUFA as add-on therapy in reducing psychopathology in populations of chronic patients with schizophrenia, only a few concern first-episode schizophrenia. The majority of these studies used a 12-week intervention based on ethyl-eicosapentaenoic acid (ethyl-EPA), however, with conflicting results. An intervention based on docosahexaenoic acid plus EPA has not been used in first-episode schizophrenia studies so far. No add-on supplementation studies have been carried out in medicated first-episode schizophrenia patients to assess the efficacy of omega-3 PUFA in preventing relapses.

METHODS

A randomized placebo-controlled one-center trial will be used to compare the efficacy of 26-week intervention, composed of either 1320 mg/day of EPA and 880 mg/day of DHA, or olive oil placebo with regard to symptom severity and relapse rate in first-episode schizophrenia patients. Eighty-two patients (aged 16-35) will be recruited for the study. Eligible patients will be randomly allocated to one of two intervention arms: an active arm or a placebo arm (olive oil). The primary outcome measure of the clinical evaluation is schizophrenia symptom severity measured by the Positive and Negative Syndrome Scale (PANSS). Other outcomes include depressive symptoms, patient functioning and the level of insight. Correlates of change measured during the study will include structural brain changes, oxidative stress and defense, as well as neuroplasticity indicators. Metabolic syndrome components will also be assessed throughout the study.

DISCUSSION

By comparing 26-week administration of EPA + DHA or (placebo) olive oil as add-on therapy in reducing symptom severity and one-year relapse rate in patients with first episode schizophrenia, it is intended to provide new insights into the efficacy of omega-3 PUFA and correlates of change, and contribute to the improvement of mental health care for individuals suffering from schizophrenia.

TRIAL REGISTRATION

This study has been registered at Clinical Trials.gov with the following number: NCT02210962 .

Obstetrical complications and Apgar score in subjects at risk of psychosis

The objective of the study was to identify associations between a history of obstetrical complications (OCs) and the future development of symptoms indicating risk of psychosis (At Risk Mental State - ARMS). The frequency of OCs was assessed in 66 ARMS subjects, 50 subjects with the first episode of schizophrenia (FES) and 50 healthy controls. Obstetrical data was obtained from medical documentation and evaluated with the Lewis and Murray Scale. Definite OCs, according to the Lewis and Murray Scale, occurred significantly more frequently in the ARMS group compared to the controls (χ(2) = 7.79, p = 0.005; OR = 4.20, 95% CI = 1.46-12.11), as well as in the FES subjects compared to the controls (χ(2) = 8.39, p = 0.004; OR = 4.64, 95% CI = 1.56-13.20). Apgar scores in the first (Apgar 1) and the fifth minute after birth (Apgar 5) were significantly lower in the FES subjects compared to the controls (for Apgar 1 score Z = 4.439, p < 0.0001; for Apgar 5 score Z = 5.250, p < 0.0001). The ARMS subjects demonstrated significantly lower Apgar 5 scores compared to the healthy controls (Z = 3.458, p = 0.0016). The results indicate that OCs and low Apgar 5 score should be considered important factors in identifying subjects at risk of developing psychosis.

[Depression or apathy? A diagnostic trap: a huge right frontal lobe meningioma diagnosed and treated as mild atypical depression episode--a case study]

Neurobehavioral changes observed in patients with brain tumours may appear as cognitive deficits, mood disturbances, changes in behaviour or decreased adaptability (e.g., drowsiness, apathy, loss of spontaneity, fatigue). They are initially subtle, develop insidiously, and their severity often changes. Serious diagnostic problems can be caused by mood disorders, psychotic symptoms, personality changes, from disinhibition to apathy, observed in such patients. The problem in distinguishing them from organic psychiatric disorders, often poses a challenge for psychiatrists, neurologists and general practitioners. We describe a case difficult to diagnose because of apathy, due to a brain tumour in the right frontal lobe, diagnosed as depression. Another difficulty, rather suggesting mood disorder, was rheumatoid arthritis. Thorough and meticulous analysis of clinical data, neuropsychological assessment and neuroimaging diagnosis may help to assess aetiology of the observed disorders which can have similar clinical pictures but various causes.

[Risk factors of schizophrenia development in patients with amphetamines dependence and psychosis (amphetamine-induced psychosis and schizophrenia), and without psychosis]

AIM

Amphetamine and its derivates can induce, usually after many intoxications, schizophrenia-like psychosis. These disorders appeared only in part patients with amphetamine dependence. Aim of the study was to establish prevalence of selective risk factors of schizophrenia development in amphetamine users: 1) with amphetamine-induced schizophrenia-like psychosis, 2) with schizophrenia, and 2) without psychotic symptoms.

MATERIAL

In the study 3 groups of subjects were included: 30 amphetamine users with amphetamine induced schizophrenia-like psychosis, 30 amphetamine users with schizophrenia and 30 amphetamine users without psychotic symptoms (37 female and 53 male in mean age = 17.78 years).

METHODS

Amphetamine dependence, schizophrenia and schizophrenia-like psychosis induced amphetamine were diagnosed according to ICD-10 criteria after at least 1 year of amphetamine abstinence. The next procedure was used: 1) Structured interview with subjects and their mothers/caregivers regarding: a) amphetamines use (duration of abuse, doses of psychoactive substance) b) family history of psychosis (especially schizophrenia) 2) The Questionnaire of Child Development for assessment of prevalence of selected risk factors of schizophrenia development 3) The Premorbid Adjustment Scale (Cannon--Spoor) for assessment of premorbid psychosocial functioning in thelast year before psychosis.

CONCLUSIONS

Amphetamines users with amphetamine-induced psychosis were more similar in prevalence of selective risk factors of schizophrenia development to subjects with schizophrenia and amphetamine dependence than to amphetamine users without psychosis. Amphetamine-induced psychosis developed more frequently in amphetamine users who used higher amphetamine doses and with familial history of psychosis.

[Before you diagnose a patient with a conversion disorder, perform a thorough general medical and neurological examination. Case study]

INTRODUCTION

Dissociative and conversion disorders are classified together according to ICD-10 as states that are not confirmed by the presence of somatic diseases, which they suggest. According to the DSM-IV, both disorders are classified separately. Conversion disorders are a group of psychiatric disorders whose symptoms mimic the presence of malfunction or loss of motor or sensory function, whereas the nature and dynamics of the observed symptoms is not fully explained by the results of objective assessments and consultations, nor is the direct effect of a psychoactive substance. Impaired mental integration of different functions which normally interact simultaneously in the perception of reality and inner experience of the individual is found in dissociative disorders.

AIM

The article describes the case of 25-year old man, in whom after initial suspicion of myasthenia gravis and its exclusion, a diagnosis of conversion disorder was made on the basis of the clinical picture and treatment with an SSRI antidepressant and individual psychotherapy were recommended. No improvement in mental and neurological status after six month therapy resulted in an in-depth diagnostics in a clinical setting and diagnosis of brain stem tumor (aastrocytoma fibrillare).

CONCLUSIONS

(a) Neuroimaging is a source of important clinical data and in many cases should constitute an inherent element of a psychiatric diagnosis. (b) Diagnosis of conversion (dissociative) disorders requires a precise differential diagnosis, excluding the somatic causes of observed neurological ailments. (c) A late diagnosis of neurological or somatic causes of symptoms which arouse a suspicion of conversion (dissociative) disorders may make a radical treatment impossible or may considerably aggravate the remote prognosis and quality of the patients' life.

Acetyl-CoA metabolism in amprolium-evoked thiamine pyrophosphate deficits in cholinergic SN56 neuroblastoma cells

Inhibition of pyruvate (PDHC) and ketoglutarate (KDHC) dehydrogenase complexes induced by thiamine pyrophosphate deficits is known cause of disturbances of cholinergic transmission in the brain, yielding clinical symptoms of cognitive, vegetative and motor deficits. However, particular alterations in distribution of key acetylcholine precursor, acetyl-CoA, in the cholinergic neuron compartment of thiamine pyrophosphate-deficient brain remain unknown. Therefore, the aim of our work was to find out how amprolium-induced thiamine pyrophosphate deficits (TD) affect distribution of acetyl-CoA in the compartment of pure cholinergic neuroblastoma SN56 cells originating from murine septum. Amprolium caused similar concentration-dependent decreases in thiamine pyrophosphate levels in nondifferentiated (NC) and differentiated (DC) cells cultured in low thiamine medium. In such conditions DC displayed significantly greater loss of viability than the NC ones, despite of lesser suppressions of PDHC activities and tetrazolium salt reduction rates in the former. On the other hand, intramitochondrial acetyl-CoA levels in DC were 73% lower than in NC, which explains their greater susceptibility to TD. Choline acetyltransferase activity and acetylcholine content in DC were two times higher than in NC. TD caused 50% decrease of cytoplasmic acetyl-CoA levels that correlated with losses of acetylcholine pool in DC but not in NC. These data indicate that particular sensitivity of DC to TD may result from relative shortage of acetyl-CoA due to its higher utilization in acetylcholine synthesis.

[Declared management methods used by the Polish psychiatrists among a group of people with a high risk syndrome of psychosis development: results of the National Polish Questionnaire]

AIM

The aim of the study was to assess the declared management methods used byPolish psychiatrists among a group of people at high risk of psychosis development.

METHOD

Management methods used among two kinds of UHR persons, i.e., (A) attenuated or brief, limited psychotic symptoms group and (B) state and trait risk factors group, were assessed during nationwide psychiatric conferences held in 2009, which gathered Polish psychiatrists practicing throughout the whole country.

RESULTS

(A) For those experiencing attenuated or brief, limited psychotic symptoms (APS or BLIPS), the vast majority of respondents (88%) declared using pharmacological intervention. Moreover, all doctors choosing pharmacotherapy declared using antipsychotic drugs (AP). Second generation antipsychotics (SGA) (84%), i.e., risperidone (48%) and olanzapine (32%) were medications to be selected as the first choice. Most doctors declared that they use medium doses ofAP (46%) for minimum 6-12 months (31%). (B) Among the group of people with state and trait risk factors, the vast majority of respondents (81%) also declared using AP: mostly SGA (75%) and typical AP (20%). Medications used as the first choice in this group were also mostly risperidone and olanzapine (44% and 28% respectively). 65% of the doctors declared using low doses of antipsychotics for the minimum of 6-12 months (39%).

CONCLUSIONS

A high percentage of Polish psychiatrists state that they use pharmacological intervention in persons at high risk of developing psychosis. Preferred medications are mainly SGA (risperidone and olanzapine), prescribed in medium and low doses for a minimum of 6-12 months.

[The structure of temperament sixth year students of the medical faculty of the medical university]

THE AIM OF THIS STUDY

To assess differences in temperament traits in accordance with the regulatory theory of temperament J. Strelau in medical students compared to the general population matched for age and sex derived from the standardization sample of the questionnaire FCZ-KT.

MATERIAL AND METHODS

The study was conducted among 202 sixth year students of the Faculty of Medicine, Medical University of Łódź in the academic year 2008/2009. Among those respondents were 140 women (69%) and 62 men (31%). The average age of students enrolled was 24.7 years (range: 23-29). They were asked to complete a survey on demographic variables and temperament questionnaire FCZ-KT developed and standardized by B. Zawadzki and J. Strelau.

RESULTS

There were no significant differences in the severity of the four temperament traits consistent with the theory of regulatory J. Strelau temperament: Lively, Sensory Sensitivity, Strength, and Activity. Significant differences were observed in the Perseverance (p < 0.0001) and Reactivity emotional (p < 0.0001), with a significantly lower severity of these characteristics were observed among the students of sixth year medical faculty in comparison with the general population. The strength of the effects observed, expressed as standardized difference in mean belongs to the moderate and significant (coefficient of Cohen's d > 0.6).

CONCLUSIONS

Students of the Medical Faculty are substantially different from the temperamental traits of people in the same age range and same-sex couples in the general population. Students of the Medical Faculty are characterized by lower emotional reactivity and perseverance. Characterized by their weaker tendency to respond to intense emotions and the harmful stimuli associated with the greater resistance and less sensitivity and a weaker trend to continue their behavior and emotional experience after discontinuation of the situation which caused this behavior. Conduct a study of sixth year students of one medical school is likely to result in restrictions on the relevance of external applications and the ability to generalize the entire population of medical students in Poland.

[Cognitive disturbances observed in chronic hepatitis C patients during pegylated interferon alpha and ribavirin therapy]

Chronic hepatitis C (CHC) patients treated with peg-interferon alpha and ribavirin (peg-IFNalpha/RBV) complain of irritability, attention and memory disturbances which may indicate cognitive impairment associated with treatment.

AIM

Assessment of the probable connection between peg-IFNalpha/RBV treatment and the development of cognitive disturbances in CHC patients.

METHOD

47 CHC patients were divided into two groups: experimental (n=26) and control (n=21). The experimental group patients were given peg-IFNalpha2a (n=18) or peg-IFNalpha2b (n=8) plus RBV in standard doses as recommended by the manufacturers. Control group patients did not receive the above treatment. Both groups underwent a neuropsychological examination consisting of R. Brickenkamp d2 test, Auditory Verbal Learning Test and Hooper Visual Organization Test at the beginning (t=0) and after 12 weeks of treatment or observation (t=1).

RESULTS

The experimental group patients showed significant deterioration in all the measured cognitive functions in t=1 comparing to t=0. Cognitive decline was not seen in the control group. The observed cognitive performance changes could not be correlated sufficiently enough with the presence of organic affective disorders diagnosed according to ICD-10 criteria.

CONCLUSIONS

The findings suggest that peg-IFNalpha/RBV therapy of CHC patients is connected with the deterioration in cognitive functioning including attention, auditory verbal memory and visuo-spatial skills. These changes may be the effect of peg-IFNalpha-induced neurotransmission abnormalities in the dorso-lateral prefrontal cortex, anterior cingulate cortex, hippocampus and parieto-orbital cortical regions and can impair patients' ability to drive a motor vehicle, operate machinery, or their engagement in hazardous activities requiring attention and coordination. Medical professionals should thoroughly inform patients about the possibility of cognitive decline associated with peg-IFNalpha/RBV therapy.

[Attention abnormalities in patients with chronic hepatitis C after pegylated interferon alpha and ribavirin treatment]

THE AIM OF THE STUDY

To (a) describe the influence of peg-IFNalpha 2a and 2b on attention processes and (b) to assess whether attention abnormalities induced by peg-IFNalpha/RBW resolve 8 weeks after treatment discontinuation in chronic hepatitis C patients.

MATERIAL AND METHODS

26 chronic hepatitis C patients treated with peg-IFNalpha2a (n=18) or 2b (n=8) and RBV were enrolled in the study. Attention processes were tested three times: before the beginning (t=0), after 12 weeks of medication (t=1) and 8 weeks after treatment discontinuation (t=2). Attention was assessed with Brickenkamp d2 test and the results were compared in groups of patients treated with different kinds of peg-IFNalpha.

RESULTS

The two kinds of peg-IFNalpha did not differ significantly regarding the influence on attention processes. 8 weeks after treatment discontinuation (t=2) there was observed a significant decrease all aspects of attention measured by d2 test, i.e. work accuracy, speed of processing and ability to focus attention comparing with t=0 and t=1.

CONCLUSIONS

Peg-IFNalpha/RBW therapy is connected with a decrease in attention processes performance and the two kinds of peg-interferon alpha (2a and 2b) may exert a similar influence. Attention dysfunction did not resolve 8 weeks after treatment discontinuation and may be the irreversible effect of the dorso-lateral prefrontal cortex or anterior cingulate cortex damage.

[Self-harm done by young patients during their psychiatric hospitalization in relation to the presence of specific mental disorders and chosen environmental factors]

AIM

The objective of the study was to assess the relation between the occurrence of deliberate self-harm (DSH) in young patients during their psychiatric treatment and the presence of specific mental disorders, or the history of suicide attempts, the exposure to abuse and their family situation.

METHOD

The studied group consisted of 187 in-patients aged 13-19 years, hospitalized at the Adolescent Ward of the Central Clinical Hospital, Medical University of Łódź, during the 2 quarters on the turn of 2005 and 2006. All patients were examined psychiatrically, and on discharge they were also assessed with the "Questionnaire for the Assessment of Self-Harm" designed for the purpose of this study.

RESULTS

Forty-seven percent of the psychiatrically treated in-patients had performed DSH acts. A strong relationship (p < 0.001) was found between the occurrence of SH and the previous history of suicidal attempts, the presence of an alcohol problem in the family, the exposure to sexual and physical abuse and the lack of support from close family members.

CONCLUSIONS

There was no relation between the occurrence of deliberate self-harm in young in-patients and the presence of a specific psychiatric disorder.

[Depressive disorders and symptoms accompanying pegylated interferon alpha and ribavirin treatment of chronic hepatitis C patients]

The aim of the study was to describe describe the frequency of depressive symptoms and episodes accompanying peg-interferon alpha and ribavirin (peg-IFN-alpha/RBV) treatment of chronic hepatitis C patients (CHC).

MATERIAL METHODS

47 CHC patients were enrolled in the study. They were divided into two groups: experimental and control consisting of 26 and 21 participants, respectively. Experimental group patients were given peg-IFN-alpha/RBV2a (n = 18) or 2b (n = 9) and ribavirin treatment in doses recommended by manufacturers. Control group patients did not receive the above treatment. Both groups underwent psychiatric examination using semi-structured clinical interview (MINI) at the beginning (t0) and after 12 weeks of treatment or observation (t12). Depressive episodes were diagnosed according to ICD-10 criteria. Hamilton Rating Scale for Depression (HRSD) was used to assess depressive symptoms intensity at the same time points.

RESULTS

Three and two participants in the control and experimental group were diagnosed with depression in t0. Six new patients developed depression in t12 twelve weeks after peg-IFN-alpha/RBV treatment. No new cases were seen in the control group. There was also observed a significant increase in depressive symptoms intensity during peg-IFN-alpha/RBV treatment. No significant changes in the frequency of depressive episodes and their intensity were seen in the control group over the period of observation.

CONCLUSIONS

The findings suggest a connection between peg-IFN-alpha/RBV therapy and the development of depressive symptoms and episodes. The above changes may be the effect of IFN-alpha-induced neurotransmission abnormalities in limbic system and basal ganglia. The above findings necessitate a routine psychiatrist involvement in the management of CHC.

[The metabolic syndrome and its components in participants of EUFEST]

AIM

The objective of the article is the evaluation of prevalence of the metabolic syndrome--MS and its components in EUFEST research amongst subjects with Polish nationality.

MATERIAL

The studied group consisted of 94 patients, aged from 18-40, with the first episode of schizophrenia, schizophreniform or schizoaffective disorders (DSM-IV) never treated with antipsychotics or not longer than for 2 weeks in the last year and/or for 6 weeks in a lifetime.

METHODS

Determination of fasting glucose level, HDL-C and TG levels, waist circumference, blood pressure measurement before starting pharmacotherapy. The results were compared with the NATPOL PLUS research results.

RESULTS

MS was found in 1% of the subjects, elevated blood pressure in more than 50% of the subjects, decreased level of HDL-C (33%) and elevated TG level (15%), in almost 50% of the subjects, waist circumference was elevated in 6.4%, elevated GLUC level in 3% subjects. 31% of the subjects had no risk factors of MS, 34.3% presented one risk factor, 27.7 % -two, 5.3%- three, 1%- four risk factors. Elevated blood pressure and decreased level of HDL-C or elevated TG level- were the most frequent risk factors in a group with 2 risk factors. Decreased level of HDL-C was always observed in groups with more than 3 risk factors. There were no significant correlation between risk factors and sex, socioeconomic status, demographic data, neuropsychological tests and clinical state examination results. Comparing EUFEST research results with NATPOL PLUS research results, no significant difference in prevalence of MS, while using the same criteria of diagnosis (NCEPATP III 2001) was found. Occurrence of the MS and more than 2 risk factors found in more than 1/3rd of the subjects, indicates a necessity of evaluation of MS risk factors before starting treatment, careful selection of adequate antipsychotics, as well as waist circumference and laboratory parameters monitoring during pharmacotherapy.

[Grapefruit juice interactions with psychotropic drugs: advantages and potential risk]

Clinicians perceive psycho-farmacotherapy as a real challenge mainly because of numerous adverse effects and drug interacions that may lead to potential life threatening consequences. The amount information that must be taken into account while prescribing psychotropic drugs grows day by day and it is really difficult to stay well informed. Food, like grapefruit juice (GJ), is also a significant source of interactions, which is sometimes forgotten. Grapefruit contains active bioflavonoids that may change bioavailability of many medications and raise its concentrations above toxic levels. The mechanism of interaction is complex and connected with the influence of GJ active ingredients on prehepatic metabolism and enteric absorption pathways using p-glicoprotein (PGP) and organic anion transporting polipeptide (OATP). The main direction of GJ action is inhibition of cytochrome P450 1A2 and 3A4 isoforms. A wide range of medicines used in daily psychiatric practice undergoes phase I oxidation with CYP 3A4 and 1A2 i.e.: anxiolytics, antidepressants, mood stabilizers, antipsychotics and procognitive compounds. It raises the potential risk of dangerous interactions with grapefruit juice. GJ is generally contraindicated to patients taking psychotropics and it is advised to inform patients about described interaction.

[Differences in medical specialty choice and in personality factors among female and male medical students]

This study was designed to investigate the connection between medical students' gender and their medical specialty preference, empathy and personal values.

MATERIALS AND METHODS

The sample of 199 students was obtained from Medical University of Łódz, 124 were female and 75 were male. Distribution by class was 45.23% fifth year and 54.77% sixth year. The mean age of the students was 24.07 years (SD = 0.92). They had demographic survey and reliable tests performed. Empathy was examined with Empathy Questionnaire by A. Weglinski and personal values by Allport-Vernon-Lindzey Study of Values and Scheler's Personal Values Scale by P. Brzozowski.

RESULTS

In the research medical students' gender was associated with medical students' specialty preference (p < 0.001). Men favoured surgery whereas women preferred gynaecology and internal medicine. In this study female students scored higher in empathy (p < 0.001) and in the Religious Values (p < 0.01). Male students scored higher in the Economic Values (p < 0.05). There was no significant association between medical students' gender and other personal values.

CONCLUSIONS

There is the connection between medical students' gender and their medical specialty preference. Medical students gender is associated with their empathy, religious values and economic values.

[Female and male medical students differences in self-concept and aspirations]

This study was designed to investigate the connection between medical students' gender and their self-concept and aspirations.

MATERIAL AND METHODS

The sample of 199 students was obtained from Medical University of Lódź, 124 were female and 75 were male. Distribution by class was 45.23% fifth year and 54.77% sixth year. They had demographic survey and reliable tests performed: Aspirations Questionnaire by B. Galas and G. H. Gough and A. B. Heilbrun Adjective Check List.

RESULTS

In the research medical students' gender was associated with medical students' aspirations and self-concept. Man scored higher in material aspirations (p = 0.002) and lower in familiar aspirations (p = 0.026) and religious aspirations (p = 0.007). Women scored higher (ACL) in endurance (p = 0.024), self-control (p = 0.030) and military leadership (p = 0.032). Whereas men scored higher (ACL): in affiliation (p = 0.006), heterosexuality (p = 0.034), personal adjustment (p = 0.008), feminine attributes (p = 0.021), free child (p = 0.006), high origence-low intelligence (p = 0.008) and in high origence-high intelligence (p = 0.004).

CONCLUSION

Medical students gender is associated with their aspirations and self-concept.

[The effect of some factors on medical student specialty choice of non-primary care--a synthesis of the literature]

The paper analyses the literature on non-primary care specialty choice. The motives for studying medicine and influences on medical student career choice have been presented. The stability of this selection has also been examined. Several predictors of specialty choice such as: demographics, academic performance, income, social status and personality attributes have been identified. Moreover, the influence of prestige, intellectual content, ability to provide sophisticated technology on preferences of non-primary care specialty has been analyzed. Association between empathy and medical specialty choice has been evaluated. What is more, it is presented that internal medicine residents are more likely to be introverted, attentive, to have deeper intellectual curiosity, higher aspiration levels and to be interested in mental stimulations. Furthermore, the surgery residents are more likely to be interested in modern technology, prestige, higher income and to be assertive and extroversive. In addition, students attracted to gynecology like contact with (mostly healthy) patients and express strong believes on reproductive issues. Besides, psychiatry students seem to be sensitive, unstable and impulsive. The analyses of Polish students' attitudes to non-primary care specialties are also presented. There is a positive perception of non-primary care and hospital medicine specialties. The specialties are more attractive because of foreseeable higher income, prestige, opportunities for research and possibilities for mastering skills and knowledge.

[Determinants of primary care specialty choice]

This paper analyzes and synthesizes the literature on primary care specialty choice. Motivation for choosing medicine and its impact on recruitment to different types of medical work has been presented. Factors that influence medical students and young doctors to change specialty preference have also been explored. Variables, such as gender, martial status, age, income expectations and prestige, that affect medical students' specialty selection decisions for primary care, have been examined. Personality profiles of primary care physician have been evaluated and the influence of communication skills and knowledge of social psychology on his/her work have been analyzed. It is presented that other traits, such as patient-centeredness, needs to serve society and value orientation, is also associated with increases in numbers of students choosing primary care. The analyze shows that the preference for primary care is connected with being interested in diverse patients and health problems and also with being people-orientated. A survey conducted into Polish medical students' attitudes to primary care and family medicine is presented. There is a negative perception of family medicine among Polish students and doctors because of its long work hours and less time for family, insufficient diagnostic possibilities and monotony It is chosen because of lack of other possibilities, difficulties in employment and opportunity to become 'a specialist' in short time.

Phenotype-dependent susceptibility of cholinergic neuroblastoma cells to neurotoxic inputs

A preferential loss of brain cholinergic neurons in the course of Alzheimer's disease and other encephalopathies is accompanied by a proportional impairment of acetyl-CoA synthesizing capacity in affected brains. Particular susceptibility of cholinergic neurons to neurodegeneration might results from insufficient supply of acetyl-CoA for energy production and acetylcholine synthesis in these conditions. Exposure of SN56 cholinergic neuroblastoma cells to dibutyryl cAMP and retinoic acid for 3 days caused their morphologic differentiation along with the increase in choline acetyltransferase activity, acetylcholine content and release, calcium content, and the expression of p75 neurotrophin receptors. Acetyl-CoA content correlated inversely with choline acetyltransferase activity in different lines of SN56 cells. In differentiated cells, aluminum (1 mM), amyloid beta(25-35) (0.001 mM), and sodium nitroprusside (1 mM), caused much greater decrease of pyruvate dehydrogenase and choline acetyltransferase activities and cell viability than in nondifferentiated ones. Aluminum (1 mM) aggravated suppressory effects of amyloid beta on choline acetyltransferase and pyruvate dehydrogenase activities and viability of differentiated cells. Similar additive inhibitory effects were observed upon combined exposure of differentiated cells to sodium nitroprusside and amyloid beta(25-35). None or much smaller suppressory effects of these neurotoxins were observed in nondifferentiated cells. Increase in the fraction of nonviable differentiated cells positively correlated with losses of choline acetyltransferase, pyruvate dehydrogenase activities, and cytoplasmic cytochrome c content in different neurotoxic conditions. These data indicate that highly differentiated cholinergic neurons may be more susceptible to aluminum and other neurotoxins than the nondifferentiated ones due to relative shortage of acetyl-CoA, increased content of Ca(2+), and expression of p75 receptors, yielding increase in cytoplasmic cytochrome c and subsequently grater rate of death of the former ones.

Altered expression of adenosine receptors in heart of diabetic rat

Diabetes results in functional, biochemical, and morphological abnormalities in the heart. Some of these changes may be attributed to altered adenosine action. This study aimed to examine the expression level of adenosine receptors (AR) in heart of streptozotocin-induced diabetic rat. Performed analyses revealed detectable levels of A1-AR, A2a-AR, A2b-AR, A3-AR mRNA and protein in whole heart and isolated cardiac myocytes. An increase in A1-AR protein content with no changes in mRNA level was observed in isolated cardiac myocytes. Diabetes resulted in an increase of A3-AR mRNA and protein levels in heart and in cardiac myocytes. The level of A2a-AR mRNA was increased in whole diabetic heart, but it decreased in cardiac myocytes with no detectable changes in protein content. We did not observe any changes in expression level of A2b-AR in diabetic heart and isolated cardiac myocytes. Administration of insulin to diabetic rat for four days resulted in returning of the ARs mRNA and protein to the levels observed in heart of normal rat. These changes in ARs genes expression, and receptors protein content correspond to some abnormalities characteristic of the diabetic heart, suggesting involvement in pathogenesis of diabetic cardiomyopathy.

[Statins--"21st century aspirin"?]

Doctors prescribe patients more and more medications. This predominantly affects elderly people. Polypharmacy is more and more frequent and predominantly affects elderly people. It may lead to many harmful and virtually life threatening drug interactions. There is pressing need to investigate new remedies, which would be applied in many different and coexisting medical conditions. It is vital particularly in case of elderly people who usually suffer from many different diseases which have numerous common pathogenetic pathways. 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, also known as statins, are a widely prescribed drug class for treatment of dyslipidemias and their complications such as coronary artery disease, stroke and peripheral arteriosclerosis. Now, there is accumulating evidence that statins also have beneficial pleiotropic effects that may make them useful in treatment of such diseases as dementia, osteoporosis, some forms of cancer, diabetes mellitus and its microangiopathic complications, hypertension and prevent deep vein thrombosis. Should we call statins "21st century aspirin?" This paper reviews recent data concerning the possibility of using statins in new indications; particularly in dementia (including Alzheimer's disease), osteoporosis, cardiovascular accidents and some forms of neoplasms.

Responsiveness of renal glomeruli to adenosine in streptozotocin-induced diabetic rats dependent on hyperglycaemia level

Glomerular filtration rate (GFR) in response to adenosine precursor, NAD, and glomeruli contractility in response to adenosine were evaluated in streptozotocin-induced diabetic rats with severe (blood glucose 27.8 +/- 1.2 mmol/L) and moderate hyperglycaemia (18.2 +/- 0.9 mmol/L) compared with nondiabetic (ND)-rats. In anaesthetised rats, basal GFR was greater in moderately diabetic rats compared with severely diabetic rats (p < 0.05) and ND-rats (p < 0.02). Intravenous infusion of 5 nmol x min(-1) x kg(-1) NAD reduced GFR and renal plasma flow (RPF) in diabetic rats but had no effect on these parameters in ND-rats. Moreover, NAD-induced reduction of GFR and RPF was greater in rats with severe diabetes (41% and 30%, respectively) than in with moderate diabetes (25% and 26%, respectively). Theophylline (0.2 micromol x min(-1) x kg(-1) ) abolished renal response to NAD. Isolated glomeruli contraction in response to adenosine, assessed by glomerular 3H-inulin space reduction, was lowered in moderately diabetic-group and enhanced in severely diabetic-group. compared with ND-group (p < 0.05). Adenosine A1-receptor antagonist DPCPX inhibited adenosine-induced glomeruli contraction. This differential response of diabetic renal glomeruli to adenosine suggests that impaired glomerular contractility in response to adenosine could be responsible for hyperfiltration in moderate diabets, whereas, the increased adenosine-dependent contractility of glomeruli in severe diabetes may increase the risk of acute renal failure in this condition.

Expression level of adenosine kinase in rat tissues. Lack of phosphate effect on the enzyme activity

In this report we describe cloning and expression of rat adenosine kinase (AK) in Esccherichaia coli cells as a fusion protein with 6xHis. The recombinant protein was purified and polyclonal antibodies to AK were generated in rabbits. Immunoblot analysis of extracts obtained from various rat tissues revealed two protein bands reactive with anti-AK IgG. The apparent molecular mass of these bands was 48 and 38 kDa in rat kidney, liver, spleen, brain, and lung. In heart and muscle the proteins that react with AK antibodies have the molecular masses of 48 and 40.5 kDa. In order to assess the relative AK mRNA level in rat tissues we used the multiplex PCR technique with beta-actin mRNA as a reference. We found the highest level of AK mRNA in the liver, which decreased in the order kidney > spleen > lung > heart > brain > muscle. Measurement of AK activity in cytosolic fractions of rat tissues showed the highest activity in the liver (0.58 U/g), which decreased in the order kidney > spleen > lung > brain > heart > skeletal muscle. Kinetic studies on recombinant AK as well as on AK in the cytosolic fraction of various rat tissues showed that this enzyme is not affected by phosphate ions. The data presented indicate that in the rat tissues investigated at least two isoforms of adenosine kinase are expressed, and that the expression of the AK gene appears to have some degree of tissue specificity.

Expression level of adenosine kinase in rat tissues. Lack of phosphate effect on the enzyme activity

In this report we describe cloning and expression of rat adenosine kinase (AK) in Esccherichaia coli cells as a fusion protein with 6xHis. The recombinant protein was purified and polyclonal antibodies to AK were generated in rabbits. Immunoblot analysis of extracts obtained from various rat tissues revealed two protein bands reactive with anti-AK IgG. The apparent molecular mass of these bands was 48 and 38 kDa in rat kidney, liver, spleen, brain, and lung. In heart and muscle the proteins that react with AK antibodies have the molecular masses of 48 and 40.5 kDa. In order to assess the relative AK mRNA level in rat tissues we used the multiplex PCR technique with beta-actin mRNA as a reference. We found the highest level of AK mRNA in the liver, which decreased in the order kidney > spleen > lung > heart > brain > muscle. Measurement of AK activity in cytosolic fractions of rat tissues showed the highest activity in the liver (0.58 U/g), which decreased in the order kidney > spleen > lung > brain > heart > skeletal muscle. Kinetic studies on recombinant AK as well as on AK in the cytosolic fraction of various rat tissues showed that this enzyme is not affected by phosphate ions. The data presented indicate that in the rat tissues investigated at least two isoforms of adenosine kinase are expressed, and that the expression of the AK gene appears to have some degree of tissue specificity.

Isozymes delta of phosphoinositide-specific phospholipase C

Phospholipase C (PLC, EC 3.1.4.11) is the major starting point in the phosphatidylinositol pathway, which generates intracellular signals that regulate protein kinase C and intracellular calcium concentration. To date, three major types of phosphoinositide-specific PLC species named beta, gamma and delta, have been characterized. This article reviews recent studies on isozymes delta of PLC. Four such isozymes have been cloned and termed delta1-4. Their structural organization, regulation of activity and the interaction with membrane lipid are considered. The intracellular localization of delta isozymes and distribution in various tissues are presented. Attention is given to the pathological conditions in which an abnormal protein level of PLC delta or its activity have been observed.

[Signal transduction in the cell by phosphoinositide-specific phospholipase C isozymes]

This article reviews recent studies on phosphoinositide-specific phospholipase C species named beta, gamma and delta. The localization of PLC isozymes in the cell, structural organization, regulation of PLC activity and the interaction with various receptors is presented.

Isozymes delta of phosphoinositide-specific phospholipase C

Phospholipase C (PLC, EC 3.1.4.11) is the major starting point in the phosphatidylinositol pathway, which generates intracellular signals that regulate protein kinase C and intracellular calcium concentration. To date, three major types of phosphoinositide-specific PLC species named beta, gamma and delta, have been characterized. This article reviews recent studies on isozymes delta of PLC. Four such isozymes have been cloned and termed delta1-4. Their structural organization, regulation of activity and the interaction with membrane lipid are considered. The intracellular localization of delta isozymes and distribution in various tissues are presented. Attention is given to the pathological conditions in which an abnormal protein level of PLC delta or its activity have been observed.

Myoid cells and neuroendocrine markers in myasthenic thymuses

We have studied myoid cells in normal and myasthenic thymuses as well as in thymomas. For the presence of neuroendocrine markers-producing cells and identification of synaptophysin (Syn) the immunohistochemical method and immunoblot analysis were used. Myoid cells can be demonstrated in the thymus of myasthenic patients in high number. These cells occur in the vicinity of Hassall's bodies but also within them. Some regenerated Hassall's bodies displayed majority of myoid cells with their concentric arrangement around the centrally situated lacunar-like cell with nuclei of monocytogenic origin. Such phenomenon may suggest cooperation of myoid cells and their epithelial transitional forms with monocytogenic cells in various thymic hormone production. It is likely that myoid cells are the source of some thymic epithelial cells. According to some authors, thymomatous epithelial cells and skeletal muscle share a common epitope defined by a monoclonal antibody (mAb), whereas thymic epithelial cells possess acetylocholine receptor (AChR) on their surface. The epithelial cells of some thymomas express also desmin. In normal thymuses of children, Syn and chromogranin A (Chg A) were demonstrated in some cells of Hassall's bodies by immunohistochemical method. In addition, antibodies to Syn stained nerve structures surrounding the thymic blood vessels. In myasthenic thymuses, Syn expression was in cortical and medullary epithelial cells, in myoid cells and only scanty and focal in keratinized epithelial cells of Hassall's bodies. The epithelial cells of some thymomas also express Syn. In some thymuses of all groups investigated in this study Chg A was seen in single cells of Hassall's bodies and focally in cortical epithelial cells. Our results show that in normal thymuses of cardiac surgery patients and in the adult myasthenic thymuses antibody raised against Syn recognized protein with molecular weight of 48,000 but not normal (38,000) Syn. It remains to be elucidated if the overexpression of synaptophysin-like protein in myasthenic thymuses is a compensatory phenomenon to the defect in normal synaptic function.

Expression, purification and kinetic properties of human recombinant phospholipase C delta 3

To obtain sufficient quantities of pure phospholipase C delta 3 (PLC delta 3) necessary for structural and kinetic studies, cDNA of human fibroblast PLC delta 3 was cloned in the pPROEX-1 vector, expressed in E. coli cells as a (6 x His) fusion protein and purified to homogeneity. From 1 L of E. coli culture 8 mg of pure PLC delta 3 was obtained by a two step purification procedure, which includes phosphocellulose and Mono S cation exchange chromatography. The presence of His tag did not affect the catalytic and regulatory properties of PLC delta 3. The K(app) for PIP2 was 142 +/- 11 and 156 +/- 12 microM for His.PLC delta 3 and PLC delta 3, respectively. Recombinant PLC delta 3 showed an absolute requirement for Ca2+. Increasing the free Ca2+ concentration from 0.2 to 0.5 microM resulted in a sharp increase in enzyme activity. In comparison with human recombinant PLC delta 1 the delta 3 isoenzyme was more sensitive to low Ca2+ concentration. The Ca2+ concentration yielding maximal activation of PLC delta 1 and PLC delta 3 was 10 and 1 microM, respectively. The activity of PLC delta 3 was stimulated by polyamines and by basic proteins such as protamine, histone and mellitin. PLC delta 3 was activated most effectively by spermine and histone but the extent of this activation was lower than for PLC delta 1. The data presented indicate that the expression of PLC delta 3 in E. coli cells permits to obtain active enzyme. The catalytic and regulatory properties of PLC delta 3 are similar to those of PLC delta 1.

Expression, purification and kinetic properties of human recombinant phospholipase C delta 3

To obtain sufficient quantities of pure phospholipase C delta 3 (PLC delta 3) necessary for structural and kinetic studies, cDNA of human fibroblast PLC delta 3 was cloned in the pPROEX-1 vector, expressed in E. coli cells as a (6 x His) fusion protein and purified to homogeneity. From 1 L of E. coli culture 8 mg of pure PLC delta 3 was obtained by a two step purification procedure, which includes phosphocellulose and Mono S cation exchange chromatography. The presence of His tag did not affect the catalytic and regulatory properties of PLC delta 3. The K(app) for PIP2 was 142 +/- 11 and 156 +/- 12 microM for His.PLC delta 3 and PLC delta 3, respectively. Recombinant PLC delta 3 showed an absolute requirement for Ca2+. Increasing the free Ca2+ concentration from 0.2 to 0.5 microM resulted in a sharp increase in enzyme activity. In comparison with human recombinant PLC delta 1 the delta 3 isoenzyme was more sensitive to low Ca2+ concentration. The Ca2+ concentration yielding maximal activation of PLC delta 1 and PLC delta 3 was 10 and 1 microM, respectively. The activity of PLC delta 3 was stimulated by polyamines and by basic proteins such as protamine, histone and mellitin. PLC delta 3 was activated most effectively by spermine and histone but the extent of this activation was lower than for PLC delta 1. The data presented indicate that the expression of PLC delta 3 in E. coli cells permits to obtain active enzyme. The catalytic and regulatory properties of PLC delta 3 are similar to those of PLC delta 1.

Effects of TRH, prolactin and TSH on cell proliferation in the intermediate lobe of the rat pituitary gland

The effect of TRH on cell proliferation in the anterior lobe of the pituitary is well known and documented. On the other hand, there are no data on the effects of TRH on the intermediate lobe of the pituitary gland. The aim of this study was to investigate the effect of TRH and its analogues (pGlu-HIs-Gly, pGlu-His-Gly-NH2) on cell proliferation in the intermediate pituitary lobe. The bromodeoxyuridine technique was used to detect the proliferating cells. It was found that TRH stimulated cell proliferation 24 h after a single injection at a dose of 100 micrograms/kg body weight. The TRH analogues did not exert any significant stimulatory effect either 12 h or 24 h after the injection. The second experiment was carried out to distinguish the probable mechanism of the action of TRH. The effects of TSH and prolactin (PRL) on intermediate lobe cell proliferation were examined. It was found that both PRL and TSH exerted a significant stimulatory effect 24 h after a single s.c. injection of PRL at a dose of 150 IU/kg body weight or TSH at a dose 20 IU/kg body weight. It therefore appears that the stimulatory effect of TRH on intermediate pituitary lobe cell proliferation is mediated by PRL and TSH.