Association of symptom severity and cerebrospinal fluid alterations in recent onset psychosis in schizophrenia-spectrum disorders - An individual patient data meta-analysis

Neuroinflammation and blood-cerebrospinal fluid barrier (BCB) disruption could be key elements in schizophrenia-spectrum disorderś(SSDs) etiology and symptom modulation. We present the largest two-stage individual patient data (IPD) meta-analysis, investigating the association of BCB disruption and cerebrospinal fluid (CSF) alterations with symptom severity in first-episode psychosis (FEP) and recent onset psychotic disorder (ROP) individuals, with a focus on sex-related differences. Data was collected from PubMed and EMBASE databases. FEP, ROP and high-risk syndromes for psychosis IPD were included if routine basic CSF-diagnostics were reported. Risk of bias of the included studies was evaluated. Random-effects meta-analyses and mixed-effects linear regression models were employed to assess the impact of BCB alterations on symptom severity. Published (6 studies) and unpublished IPD from n = 531 individuals was included in the analyses. CSF was altered in 38.8 % of individuals. No significant differences in symptom severity were found between individuals with and without CSF alterations (SMD = -0.17, 95 %CI -0.55-0.22, p = 0.341). However, males with elevated CSF/serum albumin ratios or any CSF alteration had significantly higher positive symptom scores than those without alterations (SMD = 0.34, 95 %CI 0.05-0.64, p = 0.037 and SMD = 0.29, 95 %CI 0.17-0.41p = 0.005, respectively). Mixed-effects and simple regression models showed no association (p > 0.1) between CSF parameters and symptomatic outcomes. No interaction between sex and CSF parameters was found (p > 0.1). BCB disruption appears highly prevalent in early psychosis and could be involved in positive symptomś severity in males, indicating potential difficult-to-treat states. This work highlights the need for considering BCB breakdownand sex-related differences in SSDs clinical trials and treatment strategies.

Impact of adult-onset multiple sclerosis on MRI-based intracranial volume: A study in clinically discordant monozygotic twins

OBJECTIVE

Intracranial volume (ICV) represents the maximal brain volume for an individual, attained prior to late adolescence and remaining constant throughout life after. Thus, ICV serves as a surrogate marker for brain growth integrity. To assess the potential impact of adult-onset multiple sclerosis (MS) and its preceding prodromal subclinical changes on ICV in a large cohort of monozygotic twins clinically discordant for MS.

METHODS

FSL software was used to derive ICV estimates from 3D-T1-weighted-3 T-MRI images by using an atlas scaling factor method. ICV were compared between clinically affected and healthy co-twins. All twins were compared to a large healthy reference cohort using standardized ICV z-scores. Mixed models assessed the impact of age at MS diagnosis on ICV.

RESULTS

54 twin-pairs (108 individuals/80female/42.45 ± 11.98 years), 731 individuals (375 non-twins, 109/69 monozygotic/dizygotic twin-pairs; 398female/29.18 ± 0.13 years) and 35 healthy local individuals (20male/31.34 ± 1.53 years). In 45/54 (83 %) twin-pairs, both clinically affected and healthy co-twins showed negative ICV z-scores, i.e., ICVs lower than the average of the healthy reference cohort (M = -1.53 ± 0.11, P<10-5). Younger age at MS diagnosis was strongly associated with lower ICVs (t = 3.76, P = 0.0003). Stratification of twin-pairs by age at MS diagnosis of the affected co-twin (≤30 versus > 30 years) yielded lower ICVs in those twin pairs with younger age at diagnosis (P = 0.01). Comparison within individual twin-pairs identified lower ICVs in the MS-affected co-twins with younger age at diagnosis compared to their corresponding healthy co-twins (P = 0.003).

CONCLUSION

We offer for the first-time evidence for strong associations between adult-onset MS and lower ICV, which is more pronounced with younger age at diagnosis. This suggests pre-clinical alterations in early neurodevelopment associated with susceptibility to MS both in individuals with and without clinical manifestation of the disease.

Assessing the impact of sex on high-frequency repetitive transcranial magnetic stimulation´s clinical response in schizophrenia - results from a secondary analysis

Background: The evidence for repetitive transcranial magnetic stimulation (rTMS) to treat negative symptoms in schizophrenia (SCZ) is increasing, although variable response rates remain a challenge. Subject´s sex critically influences rTMS´ treatment outcomes. Females with major depressive disorder are more likely to respond to rTMS, while SCZ data is scarce.Methods: Using data from the 'rTMS for the Treatment of Negative Symptoms in Schizophrenia' (RESIS) trial we assessed the impact of sex on rTMS´ clinical response rate from screening up to 105 days after intervention among SCZ patients. The impact of resting motor threshold (RMT) on response rates was also assessed.Results: 157 patients received either active or sham rTMS treatment. No significant group differences were observed. Linear mixed model showed no effects on response rates (all p > 0.519). Apart from a significant sex*time interaction for the positive subscale of the positive and negative syndrome scale (PANSS) scores (p = 0.032), no other significant effects of sex on continuous PANSS scores were observed. RMT had no effect on response rate.Conclusion: In the largest rTMS trial on the treatment of SCZ negative symptoms we did not observe any significant effect of sex on treatment outcomes. Better assessments of sex-related differences could improve treatment individualization.

Association of Four Medication Classes and Non-suicidal Self-injury in Adolescents with Affective Disorders - A Retrospective Chart Review

BACKGROUND

Non-suicidal self-injury (NSSI) behaviour is frequently observed in children and adolescents with psychiatric conditions. Affected individuals are regularly treated with psychotropic drugs, although the impact of these agents on NSSI behaviour remains elusive.

METHODS

We performed a retrospective chart review from clinical routine data in a large cohort (N=1140) of adolescent inpatients with primary affective and non-affective psychiatric disorders according to ICD-10 (mean age=15.3±1.3 years; 72.6% female). Four separate mixed regression models compared the frequency of NSSI between treatment periods without any medication and four medication categories (benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), high- and low-potency antipsychotics).

RESULTS

In those individuals with affective disorders as the primary diagnosis, periods without medication were associated with significantly lower NSSI/day compared to all four other medication conditions (benzodiazepines p<10-8, antidepressants/SSRIs p=0.0004, high-potency antipsychotics p=0.0009, low-potency antipsychotics p<10 -4). In individuals with a primary diagnosis other than an affective disorder, NSSI was significantly lower during the period without medication compared to the treatment periods with benzodiazepines (p=0.005) and antidepressants/SSRIs (p=0.01). However, NSSI rates in the no-medication condition were comparable to NSSI rates under high-potency (p=0.89) and low-potency antipsychotics (p=0.53).

CONCLUSIONS

The occurrence of NSSI correlates with the treatment with a psychotropic drug in children and adolescents with psychiatric disorders. Due to the retrospective design, it remains elusive to what extent psychotropic drugs might alter the frequency of NSSI in adolescents or if NSSI might indicate a transdiagnostic feature of more pronounced disease severity.

The multimodal Munich Clinical Deep Phenotyping study to bridge the translational gap in severe mental illness treatment research

Introduction

Treatment of severe mental illness (SMI) symptoms, especially negative symptoms and cognitive dysfunction in schizophrenia, remains a major unmet need. There is good evidence that SMIs have a strong genetic background and are characterized by multiple biological alterations, including disturbed brain circuits and connectivity, dysregulated neuronal excitation-inhibition, disturbed dopaminergic and glutamatergic pathways, and partially dysregulated inflammatory processes. The ways in which the dysregulated signaling pathways are interconnected remains largely unknown, in part because well-characterized clinical studies on comprehensive biomaterial are lacking. Furthermore, the development of drugs to treat SMIs such as schizophrenia is limited by the use of operationalized symptom-based clusters for diagnosis.

Methods

In line with the Research Domain Criteria initiative, the Clinical Deep Phenotyping (CDP) study is using a multimodal approach to reveal the neurobiological underpinnings of clinically relevant schizophrenia subgroups by performing broad transdiagnostic clinical characterization with standardized neurocognitive assessments, multimodal neuroimaging, electrophysiological assessments, retinal investigations, and omics-based analyzes of blood and cerebrospinal fluid. Moreover, to bridge the translational gap in biological psychiatry the study includes in vitro investigations on human-induced pluripotent stem cells, which are available from a subset of participants.

Results

Here, we report on the feasibility of this multimodal approach, which has been successfully initiated in the first participants in the CDP cohort; to date, the cohort comprises over 194 individuals with SMI and 187 age and gender matched healthy controls. In addition, we describe the applied research modalities and study objectives.

Discussion

The identification of cross-diagnostic and diagnosis-specific biotype-informed subgroups of patients and the translational dissection of those subgroups may help to pave the way toward precision medicine with artificial intelligence-supported tailored interventions and treatment. This aim is particularly important in psychiatry, a field where innovation is urgently needed because specific symptom domains, such as negative symptoms and cognitive dysfunction, and treatment-resistant symptoms in general are still difficult to treat.

Multiple sclerosis and subclinical neuropathology in healthy individuals with familial risk: A scoping review of MRI studies

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MRI evidence of MS pathology in healthy individuals reflects a subclinical period.

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First-degree relatives of MS patients are ideal to study MS subclinical neuropathology.

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MRI found WM focal inflammation in a substantial proportion of these healthy relatives.

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Diffuse tissue damage is also found by MRI in healthy relatives of MS patients.

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MS prodromal phase can be characterized by studying healthy subjects at high risk.

Multiple genetic and non-heritable factors have been linked to the risk of multiple sclerosis (MS). These factors seem to contribute to disease pathogenesis before the onset of clinical symptoms, as suggested by incidental MRI evidence of subclinical MS neuropathology in individuals without clinical symptoms. Individuals with high familial risk for MS, such as first-degree relatives of patients with MS, can be studied by MRI to characterize the neuropathology during a subclinical period of MS. 16 studies published in English, which performed brain MRI on healthy individuals with high familial risk of MS were included in this scoping review. Studies suggest either no conclusive (5), or inconclusive yet considerable (4), or conclusive evidence (7) for the incidence of subclinical neuropathology, including focal and diffuse tissue damage. Across all studies, white matter lesions fulfilling MS criteria were observed in 86 of 613 individuals (14%). Future research is needed to evaluate the longitudinal dynamics and clinical relevance of preclinical imaging abnormalities in MS.

The roles played by IL-10, IL-23 and IL-17A in term delivery

BACKGROUND

The immune system significantly participates in the development of the successful delivery process. The roles played by cytokine molecules in the induction of term delivery are yet to be clarified. The aim of this project was to explore the serum levels of interleukin-10 (IL-10), IL-17A, and IL-23 in the mothers with term and prolonged pregnancy and their infants.

MATERIALS AND METHODS

In this study, 60 samples were collected from either mothers with term and prolonged pregnancy or their infants, collectively 240 samples. Serum levels of IL-10, IL-17A and IL-23 were explored using enzyme linked immunosorbent assay (ELISA) technique.

RESULTS

IL-10 serum levels significantly decreased in the neonates with prolonged pregnancy when compared to their mothers. Serum levels of IL-23 were increased either in term or prolonged pregnancy neonates when compared to their corresponded mothers. Serum levels of IL-10 and IL-23 significantly decreased and increased, respectively, in the female in comparison to male in the prolonged pregnancy neonates. IL-10 also significantly decreased in the term mothers who had higher gravidity.

CONCLUSION

Although, IL-17A does not play a key role in the delivery mechanism, IL-10 and IL-23 may be considered as potential factors in the modulation of term delivery.

Neural correlates of visual spatial selective attention are altered at early and late processing stages in human amblyopia

Amblyopia is a neurodevelopmental visual disorder which results in reduced visual acuity in one eye and impaired binocular interactions. Previous studies suggest attentional deficits in amblyopic individuals. However, spatial cues which orient attention to a visual field improved performance. Here, we investigate the neural correlates of auditory-visual spatial selective attention in amblyopia during EEG recording. An auditory cue, that was followed by the presentation of two Gabor patches presented in the lower left and right visual fields, indicated the most likely location of an upcoming target Gabor. The target Gabor differed in orientation from the more frequently presented non-target Gabor patches. Adults with amblyopia and neurotypical observers were asked to detect the target Gabor monocularly at the cued location, while withholding their response to targets presented at the uncued location and to all non-target Gabor patches. Higher response rates were observed for cued compared to uncued targets in both groups. However, amblyopic individuals detected targets less efficiently with their amblyopic eye as compared to their fellow eye. Correspondingly, event-related potentials (ERPs) recorded to the onset of the non-target Gabor patches were delayed at early processing stages (150-300 ms: posterior N100) and reduced in amplitude at later time windows (150-350 ms: P200, 300-500 ms: sustained activity) in the amblyopic eye compared to the fellow eye. Such interocular differences were not observed in neurotypical observers. These findings suggest that neural resources allocated to the early formation of visual discrimination as well as later stimulus recognition processes are altered in the amblyopic eye.

Neural Correlates of Enhanced Visual Attentional Control in Action Video Game Players: An Event-Related Potential Study

Action video game players (AVGPs) outperform non–action video game players (NAVGPs) on a range of perceptual and attentional tasks. Although several studies have reported neuroplastic changes within the frontoparietal networks of attention in AVGPs, little is known about possible changes in attentional modulation in low-level visual areas. To assess the contribution of these different levels of neural processing to the perceptual and attentional enhancements noted in AVGPs, visual event-related potentials (ERPs) were recorded from 14 AVGPs and 14 NAVGPs during a target discrimination task that required participants to attend to rapid sequences of Gabor patches under either focused or divided attention conditions. AVGPs responded faster to target Gabors in the focused attention condition compared with the NAVGPs. Correspondingly, ERPs to standard Gabors revealed a more pronounced negativity in the time range of the parietally generated anterior N1 component in AVGPs compared with NAVGPs during focused attention. In addition, the P2 component of the visual ERP was more pronounced in AVGPs than in NAVGPs over the hemisphere contralateral to the stimulus position in response to standard Gabors. Contrary to predictions, however, attention-modulated occipital components generated in the low-level extrastriate visual pathways, including the P1 and posterior N1, showed no significant group differences. Thus, the main neural signature of enhanced perceptual and attentional control functions in AVGPs appears linked to an attention-dependent parietal process, indexed by the anterior N1 component, and possibly to more efficient higher-order perceptual processing, indexed by the P2 component.

Comparison of experimental and bioelectrical impedance analysis methods in calculation of dry weight in peritoneal dialysis patients

BACKGROUND

To optimize dialysis prescription and fluid balance of the peritoneal dialysis (PD) patients, it is important to assess their dry weight accurately. The experimental evaluation is the method which is widely used in PD centers which needs continuous and controlled reduction of the postdialysis weight down to the point where patient does not show any signs of hypotension and volume overload. This study intends to indicate that the bioelectrical impedance analysis (BIA) method can be used as an alternative method to evaluate the dry weight.

MATERIALS AND METHODS

The demographic data of 101 continuous ambulatory peritoneal dialysis (CAPD) patients of Alzahra and Noor hospitals of Isfahan University (50 males and 51 females) who had been referred for periodical examinations from April 2009 to April 2010 were extracted from their files. The normal body volume was selected as the inclusion criteria and identified by an examiner group (a nephrologist, a general practitioner and a PD nurse). The patients' dry weights were calculated based on both methods. The bioelectrical impedance analysis method was done by the Maltron Bioscan ver916 and data were analyzed by SPSS program ver18.

RESULTS

There were 49.5% males and 50.5% females with the mean age of 54.6±17 years. The mean dry weight in the experimental method was 63.4±13.3 kg in comparison to the other (61.5± 13.7 kg). There was a significant difference between the results (P value <0.001) depended on the gender t-test, but there was a 98% correlation between the results by two methods. No correlation observed between the patient's age, body mass index, blood pressure, previous hemodialysis history, PD duration time, and underlying disease.

CONCLUSION

The study showed that there is significant difference between the two methods. However, there was 98% direct correlation between them. It is concluded that bioelectrical impedance analysis could be a better alternative for accurate evaluation of dry weight in PD patients because it is a fast and cheap method and does not depend on examiner's capability. Further studies based on the results of this method are recommended to consider this method as the gold standard.

Immunosuppressive proteins isolated from spiral and coccoid cytoplasmic solutions of Helicobacter pylori

The aim of this study was to investigate the antiproliferative proteins that probably have a role in Helicobacter pylori evade of immune response and cause chronic infection disease and also to see if coccoid form had a role in its chronicity. H. pylori strain VacA s2/m2 positive and CagA negative, from a gastric biopsy of a patient with peptic ulcer disease, was isolated and cultured in brucella agar. Both spiral and coccoid forms were harvested and ruptured by sonication. The cytoplasmic solutions of both forms were collected and their fractions obtained by gel chromatography and preparative polyacrylamide gel electrophoresis. The fractions were analyzed by MTT assay for their antiproliferative activity. We isolated two proteins with a significant dose dependent antiproliferative activity that analyzed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis, one of them that was urease positive showed two bands with 61 and 27 kDa, which is resumed to urease of H. pylori, another consist of 57 and 63 kDa. Helicobacterpylori secret some proteins like urease that inhibit immune cells proliferation response against its antigens.

High performance multilayered nano-crystalline silicon/silicon-oxide light-emitting diodes on glass substrates

A low-temperature hydrogenation-assisted sequential deposition and crystallization technique is reported for the preparation of nano-scale silicon quantum dots suitable for light-emitting applications. Radio-frequency plasma-enhanced deposition was used to realize multiple layers of nano-crystalline silicon while reactive ion etching was employed to create nano-scale features. The physical characteristics of the films prepared using different plasma conditions were investigated using scanning electron microscopy, transmission electron microscopy, room temperature photoluminescence and infrared spectroscopy. The formation of multilayered structures improved the photon-emission properties as observed by photoluminescence and a thin layer of silicon oxy-nitride was then used for electrical isolation between adjacent silicon layers. The preparation of light-emitting diodes directly on glass substrates has been demonstrated and the electroluminescence spectrum has been measured.

Flora, life forms and chorotypes of plants of Salok protected area (North Khorassan Province Iran)

Salok protected Area is located in the 37 degrees 15' to 37 degrees 08' of the North latitude and 57 degrees 16' to 57 degrees 06' of East longitude, in West North Esfarayen in North khorassan province. In this research 52 families, 174 genera and 213 species were identified. The largest plant family is Asteraceae (34 species), Poaceae (18 species), Brassicaceae (17 species) and Fabaceae (17 species), respectively. Chief life forms are Hemicryptopytes (49.29%), Therophytes 23.47% and cryptophytes (12.67%). The most of plants chorotype with 62.91% is influenced by Irano-Touranina elements. Among 213 identified species of this region and 15 species endemic of Iran contain 0.87% of total endemic species of Iran's flora.

Mutation of Streptomyces griseoflavus in order to obtain high yield desferrioxamine producing fused cells

Streptomyces griseoflavus PTCC 1130 was mutated by UV irradiation. Two mutants were obtained (C7031 and S7011). These two mutants were able to produce desferioxamine. Desferrioxamine was extracted from the culture broth of the two mutated strains and the thin layer chromatogram of the products showed the R(F) values of 0.461, 0.463 and 0.456 for S7011, C7031 and the standard, respectively. The protoplasts of mutated Streptomyces griseoflavus were isolated and fused together. Total numbers of 58 fusions were obtained and only 17 fusions showed significant resistance to sodium azide and crystal violet. In terms of production of desferrioxamine only fusion PF9 and PF10 increased 68.3 and 81.8% desferrioxamine production as compared to parent strain (PTCC 1130), respectively.

Kidney transplantation candidates and cardiovascular risk factors

OBJECTIVE

We sought to determine the prevalence of cardiovascular disease and risk factors among chronic renal failure (CRF) patients on the transplantation waiting list.

METHODS

Fifty CRF patients on chronic hemodialysis who underwent evaluation for transplantation were compared with 60 hypertensive patients matched for age. We used Framingham scoring to calculate the absolute risk; relative risk was calculated based on the low-risk Framingham cohort.

RESULTS

According to traditional risk factors, a significant difference was observed in systolic blood pressure and total cholesterol (greater in the hypertensive group), and in the prevalence of the male gender, smoking, and diabetes, which were greater in the CRF group. The latter had a greater degree of left ventricular hypertrophy, lower diastolic blood pressure, and a lower prevalence of familial history of cardiovascular disease and obesity. Patients with CRF had a greater relative risk compared with the Framingham control population, but it did not differ from that observed in the group of hypertensive individuals.

CONCLUSION

The prevalence of cardiovascular disease and traditional risk factors is high among renal transplantation candidates. The Framingham equations do not adequately quantify the real cardiovascular risk; other risk factors specific for that population probably contribute to their greater cardiovascular risk.

Comparison of zinc oxide and eugenol, and Vitapex for root canal treatment of necrotic primary teeth

OBJECTIVES

The aims of this study were to evaluate iodoform base materials for root canal treatment of necrotic primary teeth, and to compare them with traditionally used zinc oxide and eugenol (ZOE).

SAMPLE AND METHODS

Zinc oxide and eugenol and Vitapex (a premixed calcium hydroxide and iodoform paste) were compared for root canal treatment in 52 necrotic primary teeth in two groups of children with a mean age of 5 years and 8.4 months. All the patients were followed-up clinically and radiographically 3 months and 10-16 months postoperatively.

RESULTS

The overall success rates of Vitapex and ZOE were 100% and 78.5%, respectively. Using Fisher's Exact Test, the difference was statistically significant (P < 0.05).

CONCLUSION

Both ZOE and Vitapex gave encouraging results. Vitapex, however, can be used more safely whenever there is a doubt about the patient's return for follow-up.

Spatially Resolved Spin-Injection Probability for Gallium Arsenide

We report a large spin-polarized current injection from a ferromagnetic metal into a nonferromagnetic semiconductor, at a temperature of 100 Kelvin. The modification of the spin-injection process by a nanoscale step edge was observed. On flat gallium arsenide [GaAs(110)] terraces, the injection efficiency was 92%, whereas in a 10-nanometer-wide region around a [111]-oriented step the injection efficiency is reduced by a factor of 6. Alternatively, the spin-relaxation lifetime was reduced by a factor of 12. This reduction is associated with the metallic nature of the step edge. This study advances the realization of using both the charge and spin of the electron in future semiconductor devices.

A semiautomated turbidimetric method for determination of plasma fibrinogen

A semiautomated turbidimetric technic for determination of the concentration of fibrinogen in plasma was compared with chemical analysis of the fibrin formed by addition of thrombin to plasma. The overall coefficient of correlation between the two methods was 0.98, although the turbidimetric technic was somewhat more accurate in hypofibrinogenemic plasma, and the chemical method, in normal plasma.