Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia

Borderline personality disorder (BOR) is determined by environmental and genetic factors, and characterized by affective instability and impulsivity, diagnostic symptoms also observed in manic phases of bipolar disorder (BIP). Up to 20% of BIP patients show comorbidity with BOR. This report describes the first case-control genome-wide association study (GWAS) of BOR, performed in one of the largest BOR patient samples worldwide. The focus of our analysis was (i) to detect genes and gene sets involved in BOR and (ii) to investigate the genetic overlap with BIP. As there is considerable genetic overlap between BIP, major depression (MDD) and schizophrenia (SCZ) and a high comorbidity of BOR and MDD, we also analyzed the genetic overlap of BOR with SCZ and MDD. GWAS, gene-based tests and gene-set analyses were performed in 998 BOR patients and 1545 controls. Linkage disequilibrium score regression was used to detect the genetic overlap between BOR and these disorders. Single marker analysis revealed no significant association after correction for multiple testing. Gene-based analysis yielded two significant genes: DPYD (P=4.42 × 10-7) and PKP4 (P=8.67 × 10-7); and gene-set analysis yielded a significant finding for exocytosis (GO:0006887, PFDR=0.019; FDR, false discovery rate). Prior studies have implicated DPYD, PKP4 and exocytosis in BIP and SCZ. The most notable finding of the present study was the genetic overlap of BOR with BIP (rg=0.28 [P=2.99 × 10-3]), SCZ (rg=0.34 [P=4.37 × 10-5]) and MDD (rg=0.57 [P=1.04 × 10-3]). We believe our study is the first to demonstrate that BOR overlaps with BIP, MDD and SCZ on the genetic level. Whether this is confined to transdiagnostic clinical symptoms should be examined in future studies.

A comparison of stress levels, coping styles and psychological morbidity between graduate-entry and traditional undergraduate medical students during the first 2 years at a UK medical school

BACKGROUND

Stress levels and psychological morbidity are high among undergraduate medical students (UGs), but there is a lack of research into the psychological health of UK graduate-entry medical students (GEs). GEs are likely to experience different (perhaps more severe) stressors and to cope with stress differently. We compared stress levels, psychological morbidity and coping styles in GE versus UG medical students studying at the same UK medical school in the same academic year. A cross-sectional self-rated questionnaire study of all first- and second-year GE and UG medical students was conducted. Perceived stress, psychological morbidity, recent adverse life events, stress-related personality traits and coping styles were assessed using standard questionnaires.

RESULTS

75% GEs and 46% UGs responded to the questionnaire. Both groups reported equally high levels, and similar profiles of, perceived stress and psychological morbidity. Levels of recent adverse life events and stress-related personality traits were similar in both groups. Compared to UGs, GEs were more likely to use active coping (p = 0.02) and positive reframing (p = 0.03), but were also more likely to use substances (alcohol and other drugs; p < 0.001) to help them cope. Unlike UGs, second-year GEs showed less perceived stress (p = 0.007) and psychological morbidity (p = 0.006) than first-year GEs although levels of both were still high.

CONCLUSION

Our results show that both GE students and their younger UG counterparts on a traditional medical course have similar profiles of stress symptoms. They do, however, cope with stress differently. GEs are more likely to use active problem-focused coping strategies, and they are also more likely to cope by using substances (alcohol or other drugs). GE students need interventions to prevent maladaptive coping styles and encourage adaptive coping that are tailored to their needs. Such interventions should be targeted at first-year students. It is vital that these students develop positive coping skills to benefit them during training and in a future career that is inherently stressful.

Evidence for genetic heterogeneity between clinical subtypes of bipolar disorder

We performed a genome-wide association study of 6447 bipolar disorder (BD) cases and 12 639 controls from the International Cohort Collection for Bipolar Disorder (ICCBD). Meta-analysis was performed with prior results from the Psychiatric Genomics Consortium Bipolar Disorder Working Group for a combined sample of 13 902 cases and 19 279 controls. We identified eight genome-wide significant, associated regions, including a novel associated region on chromosome 10 (rs10884920; P=3.28 × 10-8) that includes the brain-enriched cytoskeleton protein adducin 3 (ADD3), a non-coding RNA, and a neuropeptide-specific aminopeptidase P (XPNPEP1). Our large sample size allowed us to test the heritability and genetic correlation of BD subtypes and investigate their genetic overlap with schizophrenia and major depressive disorder. We found a significant difference in heritability of the two most common forms of BD (BD I SNP-h2=0.35; BD II SNP-h2=0.25; P=0.02). The genetic correlation between BD I and BD II was 0.78, whereas the genetic correlation was 0.97 when BD cohorts containing both types were compared. In addition, we demonstrated a significantly greater load of polygenic risk alleles for schizophrenia and BD in patients with BD I compared with patients with BD II, and a greater load of schizophrenia risk alleles in patients with the bipolar type of schizoaffective disorder compared with patients with either BD I or BD II. These results point to a partial difference in the genetic architecture of BD subtypes as currently defined.

Adjunctive Medications in Patients Receiving Thrombolytic Therapy: A Multicenter Prospective Assessment

OBJECTIVE:

To describe the use of adjunctive therapies in patients with acute myocardial infarction receiving thrombolytic agents.

DESIGN:

Data were collected prospectively by the study-site investigator or the emergency department physician caring for the patient. Study participation did not influence thrombolytic regimen selection or the adjunctive therapies ordered.

SETTING:

Thirteen Virginia hospitals representing a cross-section of hospitals in the state. Eleven are urban medical centers; four have graduate medical education programs.

PARTICIPANTS:

Patients were included in the study if the decision to administer thrombolytic therapy was made in the emergency department.

MAIN OUTCOME MEASURES:

Concomitant medications administered during the first six hours after initiation of thrombolytic therapy.

RESULTS:

Two hundred ten patients (aged 57 ± 14.1 y) were evaluated. Ninety-five percent of these patients were treated with tissue plasminogen activator, 3 percent received anisoylated plasminogen streptokinase activator complex, and 2 percent received streptokinase. Ninety-one percent of the patients also received heparin, the most commonly used adjunctive medication; 77 percent concomitantly received lidocaine; 62 percent received aspirin; and only 19 percent received a beta-blocker.

CONCLUSIONS:

Our data provide a reference point for future studies to determine factors that influence the selection of adjunctive agents for treating patients with acute myocardial infarction receiving thrombolytics.

5′Prime;-Ester Prodrugs of the Varicella-Zoster Antiviral Agent, 6-Methoxypurine Arabinoside

The potent and selective activity of 6-methoxypurine arabinoside (9-[β-D-arabinofuranosyl]-6-methoxy-9H-purine; 1) and its pharmacokinetic limitations have been described previously. In an attempt to circumvent first-pass catabolism following oral administration, a series of 5′-esters (2a-t) was prepared by dicyclohexyl-carbodiimide-promoted condensation with formic acid in the case of 2a, or by direct acylation of the parent nucleoside with the corresponding acyl chloride. These compounds were evaluated in rats for efficacy as oral prodrugs of 1 by measuring the amount of 1 excreted in the urine. Both aliphatic and aromatic esters exhibited a range of systemic availabilities. The substituted benzoate esters showed a correlation between the amount of 1 excreted and the electron-donating properties of the substituent. A similar relationship was observed for the relative stabilities of this series of esters to non-enzymatic hydrolysis at neutral pH. No clear relationship between systemic availability and solubility, partition coefficient, or stability was observed for the remaining esters of 1. Although significant enhancements in systemic availability were observed with some of the 5′-esters of this series, their limited water solubility precluded their use in intravenous formulations.

2-Ester Prodrugs of the Varicella-Zoster Antiviral Agent, 6-Methoxypurine Arabinoside

6-Methoxypurine arabinoside [9-(β-D-arabinofuranosyl)-6-methoxy-9H-purine; 1] is a potent and selective agent against varicella-zoster virus in vitro. Studies in the rat indicated that extensive first pass metabolism of this nucleoside occurred after oral dosing, presumably from high levels of adenosine deaminase in the intestine. Only 3.8% of an oral dose of 6-methoxypurine arabinoside was recovered in the urine. In an attempt to improve these unfavourable pharmacokinetics, a series of twenty-five 2′-esters of 6-methoxypurine arabinoside were prepared either by direct acylation or by a protection, acylation, and deprotection sequence. These esters were evaluated in the rat for their suitability as prodrugs on the basis of urinary recovery of 1 after oral dosing. The straight-chain aliphatic esters, but not the branched chain or aromatic esters, improved this urinary recovery. The 2′-valerate, hexanoate, heptanoate, and octanoate esters (2d–g, respectively) were the most effective, with urinary recoveries of 1 above 15%. The water solubility of the valerate ester was high (107 mM at 37°C and pH 7.2), but solubilities progressively decreased with the longer chain esters. The combination of high water solubility and improved metabolic stability upon oral dosing made 2d the prodrug of choice for both oral and intravenous dosing.

Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial

PURPOSE

Latino Medicare enrollees report suboptimal rates of colorectal cancer screening (CRCS) despite Medicare policies designed to improve CRCS access for older persons. Patient navigation (PN) may address many underlying barriers to CRCS, yet little is known about the effectiveness of PN to increase CRCS adherence among Latino Medicare enrollees.

METHODS

Using a randomized controlled trial study design, we evaluated tailored PN delivered outside of primary care settings as an intervention to increase CRCS adherence in this population. Intervention participants (n = 135) received tailored PN services which included education, counseling, and logistical support administered in their language of choice. Comparison participants (n = 168) received mailed cancer education materials. We compared CRCS rates between interventions and used multivariable logistic regression to assess the odds of CRCS adherence for PN versus comparison groups after adjusting for covariates of interest.

RESULTS

More navigated than non-navigated participants became CRCS adherent during the study period (43.7 vs. 32.1%, p = 0.04). The odds of CRCS adherence were significantly higher for PN relative to comparison participants before and after adjusting for covariates (unadjusted OR 1.64, p = 0.04; adjusted OR 1.82, p = 0.02). Higher CRCS adherence rates were observed primarily in the uptake of endoscopic screening methods.

CONCLUSION

This study demonstrates that PN delivered outside of the primary care environment is modestly effective in increasing CRCS adherence among Latino Medicare enrollees. This intervention strategy should be further evaluated as a complement to primary care-based PN and other care coordination strategies to increase adherence with CRCS and other evidence-based screenings among older Latinos.

Abstract P1-01-01: Fluorescence mapping with indocyanine green for sentinel lymph node detection in early breast cancer – results of the ICG-10 study

Background: Dual localization methods with blue dye and radioisotope are commonly employed for SLN identification but potential drawbacks include allergic reactions, radiation exposure and mandatory licencing. Identification rates exceeding 95% have been reported using the fluorescent tracer indocyanine green (ICG) as a navigation system. A feasibility study was undertaken to confirm the sensitivity and safety of ICG as a tracer agent for sentinel lymph node (SLN) identification in early breast cancer.

Methods: In an open, non-randomised study, 100 clinically node negative patients (95 unilateral; 5 bilateral) scheduled to undergo routine SLN biopsy for core-biopsy proven invasive breast cancer were identified at the multidisciplinary team meeting [53 screen-detected; 51 symptomatic]. All patients received triple localization with blue dye (2.5% Patent Blue), radiocolloid and ICG (0.5%). The number of sentinel nodes for each patient were recorded numerically and whether blue, radioactive or fluorescent. Subcutaneous lymphatics were visualized with a Photodynamic Eye camera and sensitivity of individual tracers alone and in combination calculated. Approval was granted by the Local Research Ethics Committee and the Medicines and Healthcare Products Regulatory Agency for use of ICG as a third tracer agent.

Results: Final analysis was performed on 104 procedures in 99 patients (1 exclusion - benign adenomyoepithelioma on definitive pathology). A total of 242 nodes were removed of which 201 were defined as sentinel (blue and/or radioactive) with an average nodal retrieval of 2.33 per procedure. Amongst these, 25 contained either macrometastases (n = 16) or micrometastases (n = 9), yielding procedural and node specific positivity rates of 17.3% (18/104) and 12.4% (25/201) respectively. 100% of these ‘true’ SLNs were fluorescent (201/201), 95.0% (191/201) were both fluorescent and blue, 77.6% (156/201) were fluorescent and radioactive whilst 73.1% (147/201) were blue, radioactive and fluorescent. The procedural detection rates were 99% (103/104) for blue dye, 91.3% (95/104) for radioisotope and 100% for fluorescence. All 25 positive nodes were identified with all three tracers and all 18 node positive patients had tumour deposits in the first SLN excised. The majority of ‘non-sentinel’ nodes were fluorescent (36/41) and no serious adverse reactions occurred.

Conclusion: ICG fluorescence imaging permits real-time visualization of lymphatics and provides an additional dimension to SLN biopsy which is safe and effective. These results confirm high sensitivity for fluorescence in SLN identification and the combined nodal sensitivity for ICG and blue dye (95.0%) was higher than for blue dye and radioisotope (73.1%). With further refinements in the technique may it may be possible to eventually rely on ICG as a sole tracer agent. Moreover, a marginally higher nodal yield with fluorescent mapping may allow more confident omission of completion axillary dissection in selected SLN positive patients.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-01.

Tactile and Haptic Illusions

This paper surveys the research literature on robust tactile and haptic illusions. The illusions are organized into two categories. The first category relates to objects and their properties, and is further differentiated in terms of haptic processing of material versus geometric object properties. The second category relates to haptic space, and is further differentiated in terms of the observer's own body versus external space. The illusions are initially described and where possible addressed in terms of their functional properties and/or underlying neural processes. The significance of these illusions for the design of tactile and haptic displays is also discussed. We conclude by briefly considering a number of important general themes that have emerged in the materials surveyed.

A new, passive dosemeter for gamma, beta and neutron radiations

The Defence Science and Technology Laboratory (Dstl) provides personal radiation dosimetry to the UK Ministry of Defence. Dstl has recently developed a dosemeter that is based on a combination of thermoluminescent and etched-track detectors. The Dstl Combined Dosemeter is capable of assessing doses due to photons, beta particles and neutrons. This paper presents the laboratory type testing results for the Combined Dosemeter, and also describes the procedure for calibrating the dosemeter for use in workplace neutron fields. The Combined Dosemeter meets the type test requirements that are relevant to its intended applications, and gives neutron doses that are within 50% of the true dose in the workplaces in which it is used, even when the wearer has the potential to be exposed to a variety of neutron spectra (e.g. on board nuclear-powered submarines).

Magnesium sulphate in the treatment of acute asthma: evaluation of current practice in adult emergency departments

BACKGROUND

A recent meta-analysis showed that intravenous and nebulised magnesium sulphate have similar levels of evidence to support their use in the treatment of acute asthma in adults. This consisted of weak evidence of effect on respiratory function and hospital admissions, with wide confidence intervals ranging from no effect to significant positive effects. Current BTS/SIGN guidelines suggest an equivocal role for intravenous magnesium sulphate and no role for nebulised magnesium sulphate. A study was performed to assess what emergency physicians currently do in their management of acute asthma.

METHOD

A postal survey was undertaken of all adult emergency departments within the UK. A structured questionnaire was sent to all clinical leads in emergency medicine about their current usage of both intravenous and nebulised magnesium sulphate in the treatment of acute asthma.

RESULTS

180 of the 251 emergency departments in the UK responded (72%). Magnesium sulphate was used in 93%, mostly because it was expected to relieve breathlessness (70%) or reduce HDU/ITU admissions (51%). It was predominantly given to those patients with acute severe asthma (84%) and life-threatening exacerbations (87%), with most stating they would give the drug if there was no response to repeated nebulisers (68%). In comparison, nebulised magnesium sulphate was only used in two emergency departments (1%). The main reason for not administering the drug via a nebuliser was insufficient evidence (51%).

CONCLUSIONS

Intravenous magnesium sulphate is widely used for acute asthma, usually for patients with severe or life-threatening asthma who have not responded to initial treatment. Nebulised magnesium sulphate, by contrast, is hardly used at all. The use of intravenous magnesium sulphate is more extensive than current guidelines or available evidence would appear to support.

Immunomodulatory effects of dietary protein during Nippostrongylus brasiliensis re-infection in lactating rats

Periparturient relaxation of immunity (PPRI) to secondary infection with nematodes is believed to have a nutritional basis due to differential partitioning of scarce nutrient resources, particularly protein, to reproductive rather than immune functions. At times of protein scarcity, an increase in protein supply has been reported to assuage this phenomenon. The Nippostrongylus brasiliensis reinfected lactating rat model is now being utilized to investigate the immune reactions underlying the modifying role of dietary protein on PPRI. Herein, we demonstrate that lactating rats reinfected with N. brasiliensis under high protein (HP) dietary conditions exhibit decreased worm burdens and reduced colon egg counts compared to their low protein (LP) counterparts. These reductions correlated with increased mastocytosis and greater goblet cell hyperplasia. Additionally, the local antibody profile revealed that HP reinfected lactating rats developed a stronger antigen specific IgG2b response earlier in infection in comparison with their LP counterparts. Our study provides evidence that increased dietary protein content reduces the PPRI to N. brasiliensis re-infection in the lactating rat through improved mucosal immune responses.

Corneal reshaping and myopia progression

BACKGROUND/AIMS

Anecdotal evidence indicates that corneal reshaping contact lenses may slow myopia progression in children. The purpose of this investigation is to determine whether corneal reshaping contact lenses slow eye growth.

METHODS

Forty subjects were fitted with corneal reshaping contact lenses. All subjects were 8 to 11 years and had between -0.75 D and -4.00 D myopia with less than 1.00 D astigmatism. Subjects were age-matched to a soft contact lens wearer from another myopia control study. A-scan ultrasound was performed at baseline and annually for 2 years.

RESULTS

Twenty-eight of 40 (70%) subjects wore corneal reshaping contact lenses for 2 years. The refractive error and axial length were similar between the two groups at baseline. The corneal reshaping group had an annual rate of change in axial lengths that was significantly less than the soft contact lens wearers (mean difference in annual change = 0.16 mm, p = 0.0004). Vitreous chamber depth experienced similar changes (mean difference in annual change = 0.10 mm, p = 0.006).

CONCLUSION

Results confirm previous reports of slowed eye growth following corneal reshaping contact lens wear.

CD54 is a surrogate marker of antigen presenting cell activation

There is no single universally accepted hallmark of antigen presenting cell (APC) activation. Instead a variety of methods are used to identify APCs and assess their activation state. These activation measures include phenotypic methods [e.g., assessing the increased expression of surface markers such as major histocompatability (MHC) class II] and functional assays (e.g., evaluating the enhanced ability to take up and process antigen, or stimulate naïve T cells). Sipuleucel-T is an investigational autologous active cellular immunotherapy product designed to stimulate a T cell immune response against human prostatic acid phosphatase (PAP), an antigen highly expressed in prostate tissue. Sipuleucel-T consists of peripheral blood mononuclear cells (PBMCs), including activated APCs displaying epitopes of PAP. In order to develop a robust reproducible potency assay that is not hampered by MHC restriction we have developed a method to simply assess the biological activation of antigen presenting cells (APCs). In the course of sipuleucel-T characterization, we analyzed various phenotypic and functional parameters to define the activation state of APCs obtained from peripheral blood. Flow cytometric assays revealed that CD54+ cells are responsible for antigen uptake, and that expression of CD54 predominantly localizes to APCs. Costimulation, as measured by an allogeneic mixed lymphocytic reaction (alloMLR) assay, showed that activity was restricted to the CD54+ cell population. Similarly, CD54+ cells harbor all of the PAP-specific antigen presentation activity, as assayed using a PAP-specific HLA-DRbeta1-restricted T cell hybridoma. Finally we show that CD54 expression is substantially and consistently upregulated on APCs during culture with a GM-CSF fusion protein, and that this upregulation activity can be quantified. Thus these data support the use of CD54 upregulation as a surrogate for assessing human APC activation and validates its utility as a potency measure of sipuleucel-T.

Precision of anthropometric measurements: the value of mid-arm circumference

A study was carried out to examine how reproducible anthropometric measurements were within and between two observers on a group of 24 normal subjects and 20 obese individuals. A further study was performed on 28 malnourished patients with Crohn's disease undergoing a controlled trial of nutritional therapy to assess how weight change correlated with other anthropometric parameters. The measurement that was most reproducible and correlated most with weight change was mid-arm circumference. As it is the simplest measurement to perform, we recommend that it is used more often in nutritional studies.

Response of the Panasonic UD803AS TLD in workplace neutron fields

Between 1983 and 2004, the United Kingdom Ministry of Defence (UK MOD) assessed photon and beta doses using the Panasonic UD803AS thermoluminescent dosemeter (TLD). The Panasonic UD803AS dosemeter is also sensitive to neutrons, and the aim of the present study was to ascertain whether dose assessments made using the Panasonic UD803AS TLD in UK MOD radiation fields include a conservative estimate of any neutron exposures. This would allow Panasonic UD803AS results to be taken as a measure of the total photon, beta and neutron dose when reconstructing dose records for the purpose of the 'Compensation Scheme for Radiation Linked Diseases'. The neutron response of the Panasonic UD803AS TLD was calculated as a function of neutron energy and angle of incidence by using the MCNP5 Monte Carlo computer code, and the results used to predict the response of the dosemeter in UK MOD neutron fields. It was found that the UD803AS dosemeter over-responded in the majority of these fields. It was therefore concluded that historical Panasonic UD803AS dose assessments will, for the most part, include a conservative estimate of any neutron exposure.

Warm or Cool, Large or Small? The Challenge of Thermal Displays

Thermal displays have been developed to present thermal cues to the hand to facilitate object recognition in virtual environments or in teleoperated robotic systems. This review focuses on this application domain of thermal displays and considers the models developed to simulate the thermal interaction between an object and the hand as they make contact. An overview of thermal perception and the mechanisms underlying the processing of thermal information is provided to give a framework for analyzing the design of thermal displays. The models developed to simulate thermal feedback are examined together with a description of the implementation of these models in thermal displays. The domains in which thermal displays have been used are described; this includes the simulation of material properties, the recreation of large-scale thermal effects in virtual environments, the encoding of abstract concepts and the use of thermal feedback in interactive art. The review concludes by considering the advantages and challenges associated with using thermal displays in these diverse areas.

Material identification using real and simulated thermal cues

The objective of this study was to develop a thermal display for simulating the thermal cues associated with making contact with materials with different thermal properties. The thermal display was designed based on a semiinfinite body model. The performance of subjects using this display was compared to that with real materials in a material identification experiment. The results indicated that there was no significant difference in material identification when subjects were presented with real or simulated materials. The decreases in skin temperature were also comparable in the two experiments and were related to the contact coefficient of the material palpated, which is consistent with the semiinfinite body model. These findings suggest that thermal feedback in a haptic display can facilitate object recognition when visual cues are limited.

A stochastic method for generating signals with jointly specified probability mass, spectral, and correlation properties for the identification of physiological systems

An efficient stochastic interchange method was developed that allows two discrete time sequences to be created with a specified cross-correlation function and individually defined amplitude and spectral characteristics. The technique is particularly useful for creating sequences for the stimulation of multi-input physiological systems. It is very general in that sequences of any signal type can be manipulated and are not limited to being white and/or uncorrelated. By temporally separating occurrences of common frequencies, the method can even be used to create sequences that share common power, but can be treated as uncorrelated. The method is made practical by an algorithm that updates efficiently the auto- and cross-correlation functions of the sequences as they are being created.

Ocular toxoplasmosis: in the storm of the eye

Ocular toxoplasmosis (OT) can occur in the children of mothers infected with Toxoplasma gondii during pregnancy. It is not limited to the congenitally infected, but can also occur following adult-acquired infection or as a result of disease reactivation in immune-compromised and pregnant individuals. Many aspects of immune privilege in the eye, including constitutive TGF-beta expression and reduced MHC class 1 expression, would appear at first to favour parasite survival. Conversely, many of the mechanisms that control parasite multiplication in other anatomical sites, such as nitric oxide expression, IFN-gamma and TNF-alpha, are known to disrupt immune privilege and are associated with ocular damage. Taking into account the opposing needs of limiting parasite multiplication and minimizing tissue destruction we review the pathogenesis of OT in the murine model.

Pre-irradiation and post-irradiation fading of the Harshaw 8841 TLD in different environmental conditions

The pre-irradiation and post-irradiation fading of a commercially available LiF:Mg,Cu,P thermoluminescent detector (TLD)-the Harshaw 8841 TLD-have been assessed. The Harshaw 8841 TLD comprises three TLD-700H chips (99.7% 7LiF and 0.03% 6LiF by weight) and one TLD-600H chip (4.4% 7LiF and 95.6% 6LiF by weight). Pre-irradiation and post-irradiation fading were measured for storage times up to 164 d and three different storage temperatures (-8, 25 and 50 degrees C). Dosemeters were irradiated in a mixed photon-neutron field so that the fading behaviour of the photon and neutron signals could be studied. The TLD-700H and TLD-600H chips exhibited complex changes in sensitivity and signal that depended on storage time, storage temperature and the type of radiation to which the chips had been exposed. However, the magnitudes of these changes in sensitivity and signal were relatively small. TLD-600H and TLD-700H, therefore, exhibit good stability of sensitivity and signal.

When do auditory/visual differences in duration judgements occur?

Four experiments examined judgements of the duration of auditory and visual stimuli. Two used a bisection method, and two used verbal estimation. Auditory/visual differences were found when durations of auditory and visual stimuli were explicitly compared and when durations from both modalities were mixed in partition bisection. Differences in verbal estimation were also found both when people received a single modality and when they received both. In all cases, the auditory stimuli appeared longer than the visual stimuli, and the effect was greater at longer stimulus durations, consistent with a "pacemaker speed" interpretation of the effect. Results suggested that Penney, Gibbon, and Meck's (2000) "memory mixing" account of auditory/visual differences in duration judgements, while correct in some circumstances, was incomplete, and that in some cases people were basing their judgements on some preexisting temporal standard.

Detection of chromosomal aberrations by fluorescence in situ hybridization in cervicovaginal biopsies from women exposed to diethylstilbestrol in utero

Epidemiologic studies have associated estrogens with human neoplasms such as those in the endometrium, cervix, vagina, breast, and liver. Perinatal exposure to natural (17beta-estradiol [17beta-E(2)]) and synthetic (diethylstilbestrol [DES]) estrogens induces neoplastic changes in humans and rodents. Previous studies demonstrated that neonatal 17beta-E(2) treatment of mice results in increased nuclear DNA content of cervicovaginal epithelium that precedes histologically evident neoplasia. In order to determine whether this effect was associated with chromosomal changes in humans, the frequencies of trisomy of chromosomes 1, 7, 11, and 17 were evaluated by the fluorescence in situ hybridization (FISH) technique in cervicovaginal tissue from 19 DES-exposed and 19 control women. The trisomic frequencies were significantly elevated in 4 of the 19 (21%) DES-exposed patients. One patient presented with trisomy of chromosomes 1, 7, and 11, while trisomy of chromosome 7 was observed in one patient. There were two patients with trisomy of chromosome 1. Trisomy of chromosomes 1, 7, 11, and 17 was not observed in the cervicovaginal tissue taken from control patients. These data suggest that DES-induced chromosomal trisomy may be an early event in the development of cervicovaginal neoplasia in humans.

Cervical cancer among Vietnamese women: Efforts to define the problem among Houston's population

INTRODUCTION

Asian American/Pacific Islanders (AAPIs) in the United States (US) continue to bear a disproportionate burden of cancer. This report focuses on the interviews with local health-care delivery providers, directors, administrators, and community outreach liaisons in the Vietnamese community in Houston, Texas.

METHODS

The Center for Minority Health (CMRH) at the University of Texas M.D. Cancer Center interviewed 17 leaders, as defined above, to identify factors that have a negative impact on screening practices among Vietnamese women.

RESULTS

The results show that some of the barriers to cervical cancer screening include: lack of knowledge, lack of female physicians, language barriers, lack of insurance, and embarrassment. Interviews established that "prevention" is a Western concept that the Vietnamese community has not yet adopted. Vietnamese women used their churches, community physicians (licensed or not), circle of friends, and families for their health information. Many patients used herbs as alternative or complementary therapies.

CONCLUSION

Cultural factors play a vital role in limiting Vietnamese women in the use of cervical screening. Further research needs to focus on identifying specific barriers and how they can be overcome.

Genome wide significant linkage in schizophrenia conditioning on occurrence of depressive episodes

BACKGROUND

Schizophrenia shows substantial clinical heterogeneity. One common important clinical variable in presentation is the occurrence of episodes of major depression.

METHODS

We undertook analyses in an attempt to detect loci that influence susceptibility to, or modify the clinical expression of, schizophrenia according to the occurrence of episodes of major depression. We used a logistic regression framework in which lifetime presence/absence of major depression was entered as a covariate in the linkage analysis of our UK schizophrenia affected sibling pair series (168 affected sibling pairs typed for a 10 cM map of microsatellite markers).

RESULTS

Inclusion of presence/absence of depression as a covariate detected a genome wide significant linkage signal on chromosome 4q28.3 at 130.7 cM (LOD = 4.59; p = 0.038; increase in maximum LOD over univariate analysis (ILOD) = 3.62). Inclusion of the depression covariate also showed suggestive evidence of linkage on 20q11.21 (LOD = 4.10; expected to occur by chance 0.093 times per genome scan, ILOD = 2.83).

CONCLUSIONS

Our findings identify loci that may harbour genes that play a role in susceptibility to, or modify the risk of, episodes of major depression in people with schizophrenia.

Association of p53 mutations and a codon 72 single nucleotide polymorphism with lower overall survival and responsiveness to adjuvant radiotherapy in endometrioid endometrial carcinomas

p53 Genetic alterations are associated with advanced stage and aggressive tumors in a variety of human malignancies. The aim of this study was to examine p53 for genetic alterations and to evaluate the association of these alterations with clinical outcome and response to adjuvant radiotherapy in endometrioid endometrial carcinomas. p53 mutations in exons 2-11 were assessed in 59 endometrioid carcinomas by polymerase chain reaction-single-strand conformational polymorphism and sequence analysis. Twelve mutations (20.3%) and nine polymorphisms were identified. Seven of the nine polymorphisms were codon 72 single nucleotide polymorphisms (SNP) with an Arg/Pro allelotype. Women harboring either a mutation or an Arg/Pro allelotype at codon 72 had a lower overall survival rate than women whose tumors lacked alterations in the p53 gene (P= 0.0029). Women were stratified based on p53 genetic alterations (p53 mutation or p53 codon 72 SNP) and whether or not they received adjuvant radiation therapy. Women with p53 genetic alterations who did not receive adjuvant radiotherapy had the lowest survival rate (P= 0.0005). Treated women with p53 genetic alterations and untreated women with no p53 alteration had similar rates of survival. Among women with p53 alterations, adjuvant radiotherapy substantially increased survival (P= 0.035). In multivariate analyses, the group of women with p53 genetic alterations who did not receive adjuvant radiation therapy had a 5.9-fold increased risk of death (95% confidence interval: 1.5-22.7) compared to women whose tumors lacked p53 alterations and did not receive adjuvant radiation therapy.

Therapeutic potential of dendritic-based vaccines

Involving a delicate balance of cell types, the interaction between the immune system and disease or abnormality in the human body is complex. Moreover, the mere presence of antigen and immune cells is necessary, yet insufficient to elicit immune reactivity. In order to elicit an immune response, an antigen in some form must be processed and presented to the immune system. Arguably, the most efficient antigen-presenting cell, the dendritic cell (DC), is the centre of intense investigation. The elicitation or cessation of an immune response is not a simple matter. The body must be able either to up-regulate (e.g., in the case of infectious disease) or down-regulate (e.g., in the case of transplantation) immunity to antigens located anywhere in the body. This sentinel role is capably filled via the distribution of Langerhans cells in the epidermis of the skin, and the migration of DCs throughout the lymphatic and circulatory systems. DCs are potent, as well as efficient: small numbers of cells and low levels of antigen still induce clinically relevant immunity. Lastly, they are capable of tolerance induction to self components by helping to delete self-reactive thymocytes and generating anergy in committed T-cells. Since DCs both initiate and modulate immunity, they are a component of a vast array of vaccines. This review highlights some of the intriguing basic research involving the development of DC-based therapeutics. Furthermore, whenever an area of study has progressed to human treatment, recent and on-going clinical trials are discussed.

Changes in pinch force with bidirectional load forces

The forces used to grasp an object were measured while positive (push) and negative (pull) load forces were applied to the hand under varying frictional conditions. Subjects held between the tips of their thumb and index finger a manipulandum composed of two symmetrically mounted disks. The manipulandum was connected to the stage of an electromagnetic linear motor that generated load forces under computer control. In the first experiment, subjects held the position of the manipulandum constant while the motor generated forces in first the positive and then the negative direction. The motor force at which the manipulandum slipped from the fingers was measured in the second experiment. In both experiments, friction was varied by changing the surface (sandpaper, suede, or plastic) of the manipulandum disks. The pinch forces produced by subjects were linearly related to changes in motor force in both the positive and negative directions, with the slope of this relation varying as a function of the surface properties of the manipulandum. The modulation of pinch force with motor force was influenced, however, by the direction of the load force; higher forces were produced in response to negative load forces. Slip forces varied as a function of pinch force and surface texture; higher forces were associated with materials with lower coefficients of friction. These findings suggest that the friction between the skin and an object being grasped changes as a function of the direction of force that the object applies to the skin, possibly due to the anisotropic nature of glabrous skin, and that this mechanical property contributes to variations in pinch force.

Self-reported schizotypy and bipolar disorder: demonstration of a lack of specificity of the Kings Schizotypy Questionnaire

Previous studies have demonstrated that schizophrenia patients score highly on self-reported measures of schizotypy such as the Kings Schizotypy Questionnaire (KSQ), but relatively little is known about the specificity of these self-reported features to schizophrenia. We aimed to explore the specificity of schizotypal features to schizophrenia by measuring their prevalence in subjects with bipolar disorder. The Kings Schizotypy Questionnaire (KSQ) was administered to participants (n=92) in a sibling-pair genetic linkage study of bipolar disorder. Scores were compared with those of participants in a similarly designed, concurrent family study of schizophrenia (n=135) and psychiatrically well controls (n=263). The bipolar group had significantly more schizotypal features than controls but significantly less than schizophrenia patients. Whether a bipolar subject had experienced positive psychosis had no effect on his/her schizotypy score. We conclude that elevated self-reported schizotypy as measured by the KSQ is not specific to schizophrenia, and may be associated with functional psychosis in general.

A systematic genomewide linkage study in 353 sib pairs with schizophrenia

We undertook a genomewide linkage study in a total of 353 affected sib pairs (ASPs) with schizophrenia. Our sample consisted of 179 ASPs from the United Kingdom, 134 from Sweden, and 40 from the United States. We typed 372 microsatellite markers at approximately 10-cM intervals. Our strongest finding was a LOD score of 3.87 on chromosome 10q25.3-q26.3, with positive results being contributed by all three samples and a LOD-1 interval of 15 cM. This finding achieved genomewide significance (P<.05), on the basis of simulation studies. We also found two regions, 17p11.2-q25.1 (maximum LOD score [MLS] = 3.35) and 22q11 (MLS = 2.29), in which the evidence for linkage was highly suggestive. Linkage to all of these regions has been supported by other studies. Moreover, we found strong evidence for linkage (genomewide P<.02) to 17p11.2-q25.1 in a single pedigree with schizophrenia. In our view, the evidence is now sufficiently compelling to undertake detailed mapping studies of these three regions.

Correlation of p53 mutations with resistance to platinum-based chemotherapy and shortened survival in ovarian cancer

PURPOSE

The p53 tumor suppressor gene plays a central role in cell cycle regulation and induction of apoptosis. We analyzed p53 alterations and their impact on response to chemotherapy and clinical outcome in ovarian cancer patients.

EXPERIMENTAL DESIGN

One hundred seventy-eight ovarian carcinomas, snap frozen and stored at -80 degrees C, were analyzed for mutations of the p53 gene (exons 2-11) by single-strand conformation polymorphism and DNA sequencing and for p53 overexpression by immunohistochemistry (monoclonal antibody DO7).

RESULTS

p53 mutations were found in 56% (99 of 178) of the tumors, and 62% of these were located in evolutionary highly conserved domains of the gene. Time to progression and overall survival were significantly shortened in patients with p53 mutations compared with wild-type p53 (P = 0.029 and P = 0.014) and patients with mutations in highly conserved domains as opposed to nonconserved domains or wild-type p53 (P = 0.010 and P = 0.007). p53 protein overexpression (>10% positively stained nuclei) was found in 62% (110 of 178). Time to progression and overall survival were shorter in cases with p53 overexpression (cutpoint, 10%: P = 0.071 and P = 0.056) but only marginally significant. Resistance to adjuvant cisplatin or carboplatin chemotherapy was significantly more frequent in patients with p53 overexpression (P = 0.001) or p53 missense mutations (P = 0.008) than patients with normal p53.

CONCLUSIONS

p53 alterations correlate significantly with resistance to platinum-based chemotherapy, early relapse, and shortened overall survival in ovarian cancer patients in univariate analysis. In multivariable analysis though, p53 was not an independent prognostic factor.

Aggressive behaviour in patients with schizophrenia is associated with catechol-O-methyltransferase genotype

BACKGROUND

Evidence exists for an association between aggression and schizophrenia. Although the aetiology of aggression is multifactorial, three studies have reported associations between polymorphisms of the catechol-O-methyltransferase (COMT) gene and aggression in schizophrenia.

AIMS

To replicate these findings in a larger sample using the Overt Aggression Scale (OAS).

METHOD

A sample of 180 people with DSM-IV schizophrenia were rated for aggression using the OAS. Kruskal-Wallis and contingency table analyses were applied to the OAS results.

RESULTS

The high-activity homozygotes showed significantly higher scores of aggression, whereas the heterozygotes showed significantly lower scores. The odds ratio for aggression for the high-activity homozygotes was 2.07 (95% Cl=1.03-4.15), whereas that for the heterozygotes was 0.54 (95% Cl=0.30-1.00). CONCLUSIONS; The high-activity COMT homozygote confers a higher risk of recorded aggression in schizophrenia. Heterozygotes had a significantly lower risk, which may represent an example of heterosis/heterozygote advantage.

The contact lens and myopia progression (CLAMP) study: design and baseline data

BACKGROUND

Although previous contact lens myopia control studies indicate that rigid contact lenses slow the progression of myopia in children, they have all suffered from limitations that challenge the significance of their results. The Contact Lens and Myopia Progression (CLAMP) Study addresses the limitations of previous studies and attempts to correct them by implementing alternative Study designs. The CLAMP study also measures all the ocular components to examine the potential mechanism of treatment effect.

METHODS

Eligible children were fitted with rigid gas-permeable contact lenses and enrolled in a run-in period to determine whether they were able to adapt to rigid contact lens wear. Subjects who successfully completed the run-in period were randomly assigned to wear rigid contact lenses or soft contact lenses for the remainder of the 3-year study. The primary outcome measure will be the 3-year change in cycloplegic autorefraction; the secondary outcome measures will include the 3-year change in axial length, peripheral autorefraction, crystalline lens curvatures, corneal curvature and thickness, accommodation, and intraocular pressure, which are being measured annually.

RESULTS

We examined 148 eligible subjects who participated in the run-in period. Of the 148 eligible subjects, 116 (78.4%) were able to adapt to rigid contact lens wear and were enrolled in the CLAMP Study. The mean age of the participants at the baseline visit was 10.5 years, and 59.5% were girls. At the randomization visit, the mean (+/-SD) spherical equivalent refractive error in the right eye was -2.09 +/- 0.89 D, the mean central curvature of the right cornea by videokeratography was 44.5 +/- 1.3 D, and the mean axial length of the right eye was 24.13 +/- 0.71 mm.

CONCLUSIONS

Four of five children aged 8- to 11-years-old were able to adapt to rigid gas-permeable contact lens wear. The CLAMP Study aims to further clarify the effect of rigid gas-permeable contact lenses on myopia progression in children.

Comparison of animal models for the evaluation of radiolabeled androgens

Biodistribution of two 18F-labeled androgens and an 124I/125I-labeled androgen were studied in five androgen receptor (prostate) animal models with or lacking sex hormone binding globulin (SHBG). As models for androgen-receptor positive ovarian cancer, xenografts of three human ovarian cancer cell lines were tested in SCID mice. SHBG in the prostate model systems significantly affects the metabolism, clearance, and distribution of the radiolabeled androgens in several tissues, but ovarian cancer animal models were disappointing.

A genomewide linkage study of age at onset in schizophrenia

There is strong evidence for a genetic contribution to age at onset of schizophrenia, which probably involves both susceptibility loci for schizophrenia and modifying loci acting independent of disease risk. We sought evidence of linkage to loci that influence age at onset of schizophrenia in a sample of 94 affected sibling pairs with DSM-IV schizophrenia or schizoaffective disorder, and age at first psychiatric contact of 45 years or less. Individuals were genotyped for 229 microsatellite markers spaced at approximately 20 cM intervals throughout the genome. Loci contributing to age at onset were sought by a quantitative maximum-likelihood multipoint linkage analysis using MAPMAKER/SIBS. A nonparametric multipoint analysis was also performed. The genomewide significance of linkage results was assessed by simulation studies. There were six maximum-likelihood LOD score peaks of 1.5 or greater, the highest being on chromosome 17q (LOD = 2.54; genomewide P = 0.27). This fulfils Lander and Kruglyak's [1995: Nat Genet 11:241-247] criteria for suggestive linkage in that it would be expected to occur once or less (0.3 times) per genome scan. However, this finding should be treated with caution because the LOD score appeared to be almost solely accounted for by the pattern of ibd sharing at one marker (D17S787), with virtually no evidence of linkage over flanking markers. None of the linkage results achieved genomewide statistical significance, but the LOD score peak on chromosome 13q (LOD = 1.68) coincided with the region showing maximum evidence for linkage in the study by Blouin et al. [1998: Nat Genet 20:70-73] of categorical schizophrenia.