Psychiatry training goes virtual: the experience of the first online edition of the EPA Research Summer School

Introduction

The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely.

Objectives

To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19.

Methods

The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a “breaking the ice session” one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty.

Results

Participants were divided on a voluntary basis into three working groups: 1) “Drug repurposing: overcoming challenges in pharmacoepidemiology” 2) “Psychopathological research in psychiatry”; 3) “How to conduct a cross-sectional survey?”. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants.

Conclusions

Although the remote format limits social interactions during the Summer School, overall participants’ high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.

Disclosure

No significant relationships.

The effect of myo-inositol, vitamin D3 and melatonin on the oocyte quality and pregnancy in in vitro fertilization: a randomized prospective controlled trial

OBJECTIVE

To evaluate the efficacy of a treatment with Myo-inositol (MI) plus melatonin and vitamin D3 in women underwent intra cytoplasmatic sperm injection (ICSI).

PATIENTS AND METHODS

100 women undergoing ICSI procedure were enrolled and randomly divided 1:1 in two groups. The study group was treated with 2 g MI, 50 mg Alpha-Lactalbumin (alpha-LA) and 200 µg folic acid in powder every morning for 6 months (3 months before oocyte pick up and 3 months after ICSI); the same patients underwent treatment with 600 mg MI, 1 mg melatonin plus 200 µg folic acid during the evening for 3 months before oocyte pick up; subsequently the pick up these patients were treated with 600 mg MI, 200 µg folic acid, 1 mg melatonin, 50 µg vitamin D3 as cholecalciferol until the 12th week of gestation. The control group was treated with 200 µg folic acid twice a day. Clinical pregnancy rate was evaluated as primary outcome, followed by blastocyst and oocyte quality, as well as gestational period as secondary outcomes.

RESULTS

Treatment significantly improved blastocyst and oocyte quality in the study group, achieving the 42% of clinical pregnancies vs. 24% in the control group, even though the course of pregnancy did not significantly differ between the groups. However, the mean gestational period was shorter in the control group.

CONCLUSIONS

The supplementation of MI in combination with melatonin in the first 3 months before oocyte pick up and with vitamin D3 in the further 3 months could represent an innovative support for all those women undergoing ICSI.

The impact of 3,4-methylendioxymetamphetamine (MDMA) abstinence on seeking behavior and the expression of the D2-like and mGlu5 receptors in the rat brain using saturation binding analyses

The abundance of research indicates that enriched environment acts as a beneficial factor reducing the risks of relapse in substance use disorder. There is also strong evidence showing the engagement of brain dopaminergic and glutamatergic signaling through the dopamine D₂-like and metabotropic glutamate type 5 (mGlu₅) receptors, respectively, that has a direct impact on drug reward and drug abstinence. The present study involved 3,4-methylendioxymethamphetamine (MDMA) self-administration with the yoked-triad procedure in rats kept under different housing conditions during abstinence - enriched environment (EE) or isolation cage (IC) conditions - aimed at evaluating changes in brain receptors affecting drug-seeking behavior as well as density and affinity of the D₂-like and mGlu₅ receptors in several regions of the animal brain. Our results show that exposure to EE conditions strongly reduced active lever presses during cue-induced drug-seeking. At the neurochemical level, we demonstrated marked decreases of D₂-like receptor affinity in the dorsal striatum in rats previously self-administering MDMA under EE and increases in density under IC conditions. Moreover, we found the increases in the density and decreases in the affinity of the D₂-like receptor in the prefrontal cortex and nucleus accumbens provoked by IC conditions. The mGlu₅ receptor density decreased only in the prefrontal cortex after IC and EE abstinence. Moreover, our study has revealed a clear decrease in mGlu₅ receptor density in the nucleus accumbens in the group actively administering MDMA only under EE conditions. This study demonstrates that housing conditions have impact on drug-seeking behavior in rats during abstinence from MDMA self-administration. The observed changes in the dopamine D₂-like and mGlu₅ receptor B_max and/or K_d values were brain-region specific and related to either pharmacological and/or motivational features of MDMA.

Puncture site bleeding complications in patients with Clopidogrel hyper-response

Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.

[Minimally Invasive Posterior Lumbar Interbody Fusion and Instrumentation - Outcomes at 24-Month Follow-up]

PURPOSE OF THE STUDY Minimally invasive posterior lumbar interbody fusion and percutaneous instrumentation were introduced in the clinical practice with the aim to reduce the damage to musculoligamentous structures associated with open surgeries. The purpose of the study is to evaluate the clinical outcomes, radiological results and complications of the group of patients operated with the use of the minimally invasive posterior lumbar interbody fusion technique. MATERIAL AND METHODS The group of 31 patients operated for lumbar degenerative disc disease was followed-up prospectively. The surgical technique included a unilateral microsurgical decompression of the spinal canal with the insertion of interbody cages supplemented by percutaneous transpedicular fixation. The clinical outcomes were evaluated by means of the Oswestry Disability Index (ODI), Macnab classification, VAS score for low back pain (VAS LBP) and lower extremity pain (VAS LE) at 2, 6, 12 and 24 months postoperatively. The success rate of interbody fusion and complications was also assessed. RESULTS The inclusion criteria were met by 29 patients. The mean preoperative ODI score of 68.4 decreased to 25.1 at two-year follow-up (p 0.001). Based on the modified Macnab scale excellent and good outcomes were achieved at two-year-followup by 82.4% patients. The mean value of VAS LBP score decreased from 6.2 to 2.1 and in case of VAS LE from 5.38 to 1.34 (p ˂ 0.001). The mean time of operation was 157 minutes. Solid interbody fusion was achieved in 80% of patients. In one case, revision surgery for dislocation of the interbody cage was performed one year after the operation. A total of five misplaced transpedicular screws (5.2%) were recorded. DISCUSSION Dorsal minimally invasive spinal operational techniques, when compared with the open surgery, result in less iatrogenic injury to paravertebral muscles. From a short-term perspective, there is also less blood loss and lower frequency of infectious complications. Together with the reduction of postoperative pain and shorter hospital stay, they enable faster recovery and rehabilitation with comparable clinical effectiveness of the procedure. Apart from the above-mentioned benefits, also some shortcomings are discussed such as higher frequency of complications, longer time of operation, higher occurrence of implant malposition and higher exposure of the patient and the surgeon to radiation. CONCLUSIONS The minimally invasive posterior lumbar interbody fusion technique resulted in a statistically significant clinical improvement in the ODI, Macnab scale, VAS LBP and VAS LE scores. The percutaneous instrumentation technique shows an acceptable rate of incorrectly inserted screws. Key words: degenerative disc disease, minimally invasive spinal surgery, posterior lumbar interbody fusion, spine stabilization, lumbar interbody fusion complications.

Brain region-dependent changes in the expression of endocannabinoid-metabolizing enzymes in rats following antidepressant drugs

The endocannabinoid (eCB) system plays a role in the pathophysiology of depression. The aim of this study was to investigate the expression of the eCB synthesizing enzymes (N-acyl phosphatidylethanolamine phospholipase D (NAPE-PLD) and diacylglycerol lipase α (DAGLα)) and eCB degrading enzymes (fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL)) after acute or chronic administration of antidepressant drugs (imipramine (IMI, 15 mg/kg), escitalopram (ESC, 10 mg/kg) and tianeptine (TIA, 10 mg/kg)). eCB metabolizing enzymes were altered in drug-dependent and brain region-specific fashion. After IMI treatment a reduction was noted in the expression of FAAH protein in the dorsal striatum, MAGL in the frontal cortex and DAGLα in the cerebellum. On the other hand, ESC treatment provoked an increase in the MAGL expression in the prefrontal cortex or NAPE-PLD and in DAGLα in the hippocampus and dorsal striatum, while reducing the FAAH expression in the dorsal striatum. TIA administration increased the levels of all enzymes in the prefrontal cortex as well as elevated DAGLα expression in the frontal cortex and dorsal striatum. In conclusion, our results indicate that changes in the eCBs levels after antidepressant drug treatment were related to the expression of their metabolizing enzymes.

IL28B Genetic Variations in Patients with Recurrent Herpes Simplex Keratitis

Background and objectives: Recurrent herpes simplex keratitis (HSK) is the most common cause of corneal blindness in the developed world. A relationship between host gene polymorphisms and the recurrence of herpes simplex virus (HSV) infection has previously been proposed. Thus, the aim of this study was to investigate a potential association between the IL28B host genotype and recurrent HSK. Materials and Methods: Eighty patients older than 18 years of age of both genders with a history of recurrent herpes simplex labialis (HSL) were considered for inclusion. Seventy-five of these patients were found to be seropositive for HSV-1 and were subsequently enrolled in the study. Twenty-four of the enrolled patients also had a history of recurrent HSK associated with severe corneal scarring and visual acuity deterioration. Total DNA was isolated from whole blood samples. A single-nucleotide polymorphism (SNP) rs12979860 near the IL28B gene on chromosome 19 was genotyped. Results: A significant association was observed between recurrent HSK and two SNPs of the IL28B genotype (CCrs12979860 and CTrs12979860, p < 0.01). The variation CCrs12979860 showed a significantly greater association with HSK (16 out of 26 patients) compared with CTrs12979860 (8 out of 34 patients). Conclusion: Seropositive individuals with a history of recurrent HSK are likely to have the CC IL28B genotype. This genotype may be related to incomplete control of the infection and more frequent periodical viral shedding along the first nerve branch of the trigeminal ganglion, which clinically manifests as recurrent herpes keratitis. The clinical manifestation of recurrent HSV-1 infection seems to be influenced by polymorphism of the IL28B genotype.

Maternal high-fat diet during pregnancy and lactation provokes depressive-like behavior and influences the irisin/brain-derived neurotrophic factor axis and inflammatory factors in male and female offspring in rats

A balanced maternal diet is necessary for the proper health and development of offspring. Recent clinical and preclinical studies have strongly indicated that maternal exposure to a high-fat diet (HFD) can have an irreversible impact on the structure and function of the offspring's brain and affect the immune system, which may predispose the offspring to brain disorders, including depression. The irisin/brain-derived neurotrophic factor (BDNF) axis is a pathway that influences several neurobehavioral mechanisms involved in the pathogenesis of mental disorders. The aim of the present study was to evaluate the influence of a maternal HFD during pregnancy and lactation on depressive-like behavior, serum irisin concentration and hippocampal levels of irisin, BDNF and inflammatory factors (interleukin-1α, interleukin-6 and tumor necrosis factor-α) in adolescent and adult male and female offspring. The main findings indicate that offspring exposed to a maternal HFD are characterized by an increased immobility time in the forced swimming test at both stages of life. Our results showed that a maternal HFD decreased serum and hippocampal irisin levels in females on postnatal day (PND) 28 and decreased the level of interleukin-1α at postnatal days 28 and 63 in the hippocampus. Interestingly, significant age-dependent changes were observed in irisin, BDNF and interleukin levels. To summarize, our study indicates that a maternal HFD during pregnancy and lactation provokes depressive-like behaviour in the offspring. However, despite the observed changes in the levels of irisin and IL-1α in females, further investigations are required to identify the underlying molecular mechanism associated with depressive-like behavior in the offspring of HFD-fed dams.

Regorafenib therapy in metastatic colorectal cancer patients: markers and outcome in an actual clinical setting

The oral multikinase inhibitor regorafenib had beneficial effects in randomized clinical phase III trials compared to the placebo in patients with metastatic colorectal cancer (mCRC) who progressed on standard therapies. The factors which influence regorafenib response and therapy sequence during treatment history are still highly discussed, and herein we analyzed the therapy algorithm, outcome and clinical markers following regorafenib application in a single center register study. Clinical data for 48 metastatic colorectal cancer patients were collected from 01.01.2013 to 31.12.2016. Treatment effects according to various patient and tumor characteristics were evaluated using univariate and multivariate Cox proportional hazard regression models. The 48 patients comprised 14 (29%) females and 34 (71%) males, with mean age 64.2±9 and ECOG 0-1. Progression free survival under regorafenib therapy was 2.9 months (quartiles 2.2; 4.4) and the overall response rate was 2 (4%) and disease control rate was 19 (40%). Overall survival (OS) and progression free survival (PFS) were investigated under regorafenib in the chemotherapy regimen given immediately before and afterthis treatment. Variables including tumor localization, Ras status, CEA and CA 19-9 plasma levels were analyzed for their impact on PFS, and the regorafenib-related adverse events were also observed. Our study confirms the efficacy of regorafenib in a real-life setting. We established that response rate and PFS in regorafenib treatment are independent of tumor localization, Ras status or biomarkers such as CEA and CA 19-9. Trifluridin/tripacil application or re-induction of chemotherapy +/- target therapy was effective following regorafenib therapy.

[First Experience with Cranioplasty Using the Polyetheretherketone (PEEK) Implant - Retrospective Five-Year Follow-up Study]

PURPOSE OF THE STUDY Cranioplasty is currently the most common neurosurgical procedure. The purpose of this study is to describe the first experience with successful use of the Cranio-Oss (PEEK) custom implant for cranioplasty. MATERIAL AND METHODS In the period 2012 to 2013, a total of 26 cranioplasties were performed. In fourteen patients, their own bone flap was used for reconstruction. In four cases, a synthetic Cranio-Oss bone implant made of PEEK was used. In six patients, the defect was covered by an intraoperatively-made Palacos implant and in two cases, minor defects were covered with a titanium mesh. The patients were followed up for at least five years. Cranio-Oss is a cranial implant made from polyetheretherketone (PEEK), a synthetic biocompatible material. The implant is created using the CAD/CAM method in the shape of the bone defect based on the CT scan. Creating optimal roughness of the implant surface and of the surface of the contact area attached to the bone bed is controlled and included already in the strategy for machining individual areas of the implant during its manufacturing at a 5-axis machining centre. RESULTS The Cranio-Oss implant was used in four younger patients to cover larger and complex-shaped defects. The mean age of patients in this group was 47 years. The implant was fixed to the skull by micro-plates. In all the cases the wound healed well with good cosmetic results without the necessity of revision with respect to the used implant. The follow-up CT scans always showed the implant in situ with no signs of malposition. DISCUSSION Autologous bone flap is the most suitable material for defect reconstruction after craniectomy. This option is affordable and represents one of the best methods of reconstruction of defects after craniectomy in terms of cosmetic results. In some cases, the original skull cannot be used for cranioplasty (e.g. if destructed by tumourous process, infected or in comminuted fractures). In such cases, the defect needs to be managed using a synthetic implant. In case of extensive defects, the most suitable option is a custom made implant from advanced biomaterials. CONCLUSIONS Authors prefer using autologous bone flaps during cranioplasty. In cases where this method is unavailable, a synthetic bone substitute has to be used. The first medium-term experience with the use of a Cranio-Oss implant made of PEEK showed that it is a suitable alternative to the patient's own bone. No complications associated with this synthetic implant were reported and its use to manage skull defects can be strongly recommended. With respect to legal and accreditationrelated difficulties connected with bone fragments storage and thanks to the continuous cost reduction of synthetic implants will their importance grow in the future. Key words: decompressive craniectomy, bone substitute, craniotrauma.

Antimicrobial activity and thiosulfinates profile of a formulation based on Allium cepa L. extract

Background

Allium species extracts including Allium cepa L. contain sulfur compounds, known for their antiplatelet, antimicrobial, antineoplasic activities.

Methodology

Antibacterial activity of a formulation based on A. cepa extracts-liquid and lyophilized samples, has been demonstrated using two classes of bacteria: Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) and three methods: discs soaked with liquid extract, the wells method in the culture medium, filled with the liquid extract and lyophilized formulation extracts transformed by the incorporation of ultrapure water. The second part of this study includes identification of thiosulfinates compounds from the studied samples by high performance liquid chromatography - mass spectrometry (HPLC-MS).

Results

The most important inhibition and the highest antibacterial effficiency were observed against Gram-positive bacteria, such as Staphylococcus aureus. The HPLC-MS thiosulfinates profile of the tested formulation extracts shows the presence of seven thiosulfinate compounds, MeS(O)S 1-propenyl (E,Z); n-PrS(O)S 1-propenyl-(E); n-PrS(O)S 1-propenyl-(Z); trans-zwiebelane; n-PrS(O)CHEtSS-1propenyl; 1-propenylS(O)CHEtSS1-propenyl, which may be responsible for antibacterial activity.

Conclusion

Testing antimicrobial effects using the three mentioned methods confirmed the antimicrobial activity of the tested samples based on A. cepa extracts, with a demonstrated content of seven thiosulfinate compounds.

Why we use AT.Lisa multifocals?

In this paper, the authors try to motivate their preference for implanting AT.Lisa Multifocals from all other premium IOL's from the market. It is emphasized, through clinical examples, that their choice comes after a long experience with this type of mul- tifocals IOL's. We make a short presentation of this particular type of MIOL's with their good but also weak points and try to motivate our decision to change from other types. We present the steps that each patient has to follow in our clinic prior to surgery itself, stressing out the idea that the discussion with the patient is very important in taking a decision regarding the implantation of a Premium IOL.

[Pseudoexfoliative glaucoma]

Secondary open-angle glaucoma, characterized by the deposition of whitish, fibrillar material within the structures of the anterior segment of the eye.

[Protein S100b in differential diagnosis of brain concussion and superficial scalp injury in inebriated patients]

INTRODUCTION

Concussion cannot be differentiated from superficial scalp injury, especially in inebriated or uncooperative patients. This can have serious medical or forensic consequences. The aim of the study was to determine whether serum concentrations of S-100b in mild traumatic brain injury (MTBI) patients are significantly higher than those in patients with superficial scalp injury with scalp wound and alcohol intoxication.

MATERIAL AND METHODS

A total of 50 patients with head injury, 25 with mild concussion without scalp wound and alcohol intoxication, 25 superficial scalp injury patients with scalp wound and clinical signs of inebriety. Neurological status and cranial CT scan were evaluated 60-120 minutes after injury in all the 50 patients to exclude focal cerebral injury or skull fracture.

RESULTS

The serum levels of S-100b were significantly increased in patients with concussion (median 0.36 ± 0.15 μg/l ) in comparison with the group of patients with scalp injury and alcohol intoxication (median 0.09 ± 0.002 μg/l). All 50 patients had a normal cranial CT finding and neurological status. In all superficial scalp injury patients alcohol intoxication was confirmed (0.96 - 3.11š).

CONCLUSION

We proved significantly higher values of S-100b in patients with brain concussion. Diagnostically decisive value of S-100b concentration in the serum was set at 146 μg/l and higher (94% sensitivity and 100% specificity). Alcohol intoxication (up to 3.11 š) and scalp wound seem to have had no crucial impact on serum S-100b level.

Stimulation of postsynaptic 5-HT1A receptors is responsible for the anticonflict effect of ipsapirone in rats

Ipsapirone (1·25–10 mg kg−1), a non-benzodiazepine anxiolytic drug with high affinity for 5-hydroxytryptamine1A (5-HT1A) receptors, increased dose-dependently the number of punished licks in the drinking conflict test (Vogel test) in rats. The anticonflict effect of the drug administered at a dose of 5 mg kg−1 was not modified in animals with lesions of 5-HT neurones, produced by p-chloroamphetamine (PCA, 2× 10 mg kg−1). The anticonflict effect of ipsapirone in PCA-pretreated rats was antagonized by the 5-HT1A receptor and α1-adrenoceptor antagonist NAN-190 (1-(2-methoxyphenyl)-4-[4-(2-phthalimmido)]butylpiperazine hydrobromide; 0·5–1 mg kg−1), but not by the selective α1-adrenoceptor blocker prazosin (0·5 mg kg−1). Neither NAN-190 nor prazosin affected the punished response in PCA-pretreated rats. The present results indicate that the anticonflict effect of ipsapirone depends on stimulation of postsynaptic 5-HT1A receptors.

The effects of fatty acid amide hydrolase inhibitors on maintenance of cocaine and food self-administration and on reinstatement of cocaine-seeking and food-taking behavior in rats

Some empirical evidence suggests that the endocannabinoids (eCB) (e.g. anandamide) may play an important role in cocaine addiction. The eCB act as a retrograde messengers activating CB receptors at the presynaptic membrane and are degraded by enzymatic actions of fatty acid amide hydrolase (FAAH). The present study aimed to examine the effect of the FAAH inhibitors, phenylmethylsulphonyl fluoride (PMSF; i.p.) or cyclohexylcarbamic acid 3-carbamoyl biphenyl-3-yl ester (URB597; i.p.) on the cocaine- or food-maintained self-administration as well as on the cocaine-seeking or food-taking behaviors in rats. Male Wistar rats were implanted with a catheter (iv.) and trained to self-administer cocaine (0.5 mg/kg/infusion) on a fixed ratio 5 schedule of reinforcement with a conditioned stimulus (tone+light). After self-administration stabilized, extinction/reinstatement procedures were carried out during which the rats were tested for the response reinstatement induced by cocaine (10 mg/kg, ip) or a cue (light+tone). The food (sweetened milk) self-administration and extinction/reinstatement procedures were conducted in a manner resembling cocaine self-administration. Neither PMSF (30-120 mg/kg) nor URB597 (0.1-3 mg/kg) affected cocaine self-administration. PMSF, 60 mg/kg, significantly reduced cocaine-induced reinstatement and at 120 mg/kg (combined with the challenge dose of cocaine) it evoked behavioral disruption. PMSF (60-120 mg/kg) dose-dependently inhibited cue-induced reinstatement. URB597 (1-3 mg/kg) attenuated both cocaine- and cue-induced drug-seeking behaviors. PMSF (60 mg/kg) decreased food self-administration. Toward reinstatement of food-taking behavior PMSF (60-120 mg/kg) and URB597 (3 mg/kg) showed inhibitory effects. Our results indicate that FAAH inhibitors could be potent modulators of motivational and conditioned aspects of goal-directed behaviors with less prominent effects on consumatory behaviors.

Activation of endocannabinoid transmission induces antidepressant-like effects in rats

Recent reports indicate that endocannabinoid (eCB) system may be involved in depression and in the antidepressant-like activity demonstrated in experimental models. The present study examined the effects of the eCB uptake inhibitor 4-hydroxyphenyl-5Z,8Z,11Z,14Z-eicosatetraenamide (AM404; 0.1-3 mg/kg), the fatty acid amide hydrolase (FAAH) inhibitor cyclohexylcarbamic acid 3-carbamoylbiphenyl-3-yl ester (URB597; 0.03-0.3 mg/kg), the cannabinoid CB(1) receptor agonist (-)-cis-3-[2-hydroxy-4-(1,1-dimethylheptyl) phenyl]-trans-4-(3-hydroxypropyl)-cyclohexanol (CP55,940; 0.03-0.3 mg/kg) and the CB(1) receptor antagonist rimonabant (0.3-3 mg/kg) on immobility time in the forced swim test (FST) in rats. Moreover, the effects of AM404, CP55,940 and URB597 on the antidepressant-like activity of imipramine and citalopram in the FST were also examined. We found that AM404 (0.3-3 mg/kg), CP55,940 (0.1 mg/kg) and URB597 (0.1-0.3 mg/kg) reduced the immobility time of rats, while rimonabant (0.3-3 mg/kg) was inactive in this respect. We also observed that the anti-immobility effects of AM404 (1 mg/kg), CP55,940 (0.1 mg/kg) and URB597 (0.3 mg/kg), but not of imipramine (30 mg/kg), were blocked by rimonabant (3 mg/kg). In another set of experiments we showed that the inactive dose of AM404 (0.1 mg/kg) potentiated the effects of the inactive doses of imipramine (15 mg/kg) or citalopram (30 mg/kg), while CP55,940 (0.03 mg/kg) and URB597 (0.03 mg/kg) enhanced the effect of imipramine only. None of the drugs studied, given alone or in combination, increased the basal locomotor activity of rats. Our results indicate that activation of the eCB system induces antidepressant-like effects in the FST in rats, and that these effects are mediated by CB(1) receptors. Moreover, they also indicate that agents activating eCB transmission enhance the anti-immobility responses to antidepressant drugs.

Effects of 1-methyl-1,2,3,4-tetrahydroisoquinoline on the behavioral effects of cocaine in rats

The efficacy of 1-methyl-1,2,3,4-tetrahydroisoquinoline (1MeTIQ), a member of endogenous tetrahydroisoquinolines, in cocaine- and food-maintained responding in self-administration procedures under a fixed ratio 5 schedule of reinforcement as well as in cocaine and food seeking behaviors in male Wistar rats was examined. The effects of 1MeTIQ on cocaine discrimination and on basal locomotor activity were also assessed. In rats trained to self-administered either cocaine (0.5 mg/kg/injection) paired with the cue (light+tone) or food under a fixed ratio 5 schedule of reinforcement, 1MeTIQ (25 - 50 mg/kg) dose-dependently decreased the cocaine-maintained responding, but did not alter the food-maintained responding. 1MeTIQ (25 - 50 mg/kg) decreased the cocaine seeking behavior reinstated by a noncontingent presentation of cocaine (10 mg/kg, i.p.), but altered neither behavior reinstated by a discrete cue (tone+light) nor food-induced reinstatement. In rats trained to discriminate cocaine (10 mg/kg) from saline in water-reinforced fixed ratio 20 task, pretreatment with 1MeTIQ resulted in neither substitution nor significant alterations in the cocaine (1.25 - 10 mg/kg)-induced discriminative stimulus effects. 1MeTIQ (25 - 50 mg/kg) did not produce also a significant changes in basal horizontal activity. In conclusion, our present results outline a significance of exogenously applied 1MeTIQ in attenuating drug-evoked relapses to cocaine as well as the direct rewarding properties of cocaine (that model the cocaine-induced "high"), but not cocaine subjective effects. Moreover, a dissociation between effects of 1MeTIQ on cocaine vs. food-maintained responding was demonstrated.

N-oleoyl-dopamine increases locomotor activity in the rat

N-oleoyl-dopamine (OLDA), a condensation product of oleic acid and dopamine (DA), is a bioactive lipid whose biological functions are not yet fully explored. The compound crosses the blood-brain barrier and might be considered as a carrier of DA into the brain. In this study we sought to determine whether OLDA would influence locomotor behavior and whether the central DA system would be involved in such influence. We addressed this issue by investigating horizontal locomotor activity in male Wistar rats after intraperitoneal administration of OLDA, 5-20 mg/kg, before and after pre-treatment with haloperidol, a D2 receptor antagonist. We found that OLDA caused a prompt stimulation of locomotor activity, with a bell-shaped dose-response. The maximum stimulatory effect was observed after 10 mg/kg of OLDA where the mean distance traveled by rats during a 2-hour test increased to 1213+/-196(SE) cm from the 403+/-89 cm in the vehicle-treated rats (P<0.05). This effect was dose-dependently antagonized by haloperidol (0.1-0.2 mg/kg). The results support the hypothesis that the OLDA-induced hyperlocomotion was mediated by the stimulation of DA systems. Using in vitro assays, we further demonstrated that OLDA is a stable compound that resists hydrolysis over a 2-hour period and thus the integral OLDA compound exerted DA-like effects. We conclude that OLDA is a potential brain modifier of motor behavior, the biological consequences of which remain to be explored.

An endogenous neuroprotectant substance, 1-methyl-1,2,3,4-tetrahydroisoquinoline (1MeTIQ), prevents the behavioral and neurochemical effects of cocaine reinstatement in drug-dependent rats

Drug abuse disorder is induced by a variety of substances and results from their interaction with the brain reward system. It is characterized by a high frequency of relapse, usually associated with to craving. In this study we investigated the effects of 1-methyl-1,2,3,4-tetrahydroisoquinoline, an endogenous compound with antidopaminergic and neuroprotective activity, on cocaine-induced reinstatement in cocaine-dependent, self-administering rats. 1-methyl-1,2,3,4-tetrahydroisoquinoline (50 mg/kg i.p.) completely inhibited the expression of reinstatement of cocaine self-administration and accompanying neurochemical changes induced by a single priming cocaine dose (10 mg/kg i.p.). The priming cocaine dose inhibited dopamine metabolism in the structures containing nerve endings (frontal cortex, nucleus accumbens, and striatum) but not in the substantia nigra and ventral tegmental area. A behaviorally active dose of 1-methyl-1,2,3,4-tetrahydroisoquinoline administered 30 min before a priming dose of cocaine significantly increased the dopamine concentration in the limbic structures, and strongly inhibited dopamine metabolism in the substantia nigra and ventral tegmental area. Cocaine also inhibited noradrenaline and serotonin metabolism, and 1-methyl-1,2,3,4-tetrahydroisoquinoline abolished the inhibition in noradrenaline metabolism, while it intensified the inhibition of serotonin metabolism. Our results strongly support the view that 1-methyl-1,2,3,4-tetrahydroisoquinoline, an endogenous compound, has considerable potential as a drug for combating substance abuse disease through the attenuation of craving.

[Toxic anterior segment syndrome]

The authors present two cases of TASS which occurred consequent upon anterior chamber administration of cefuroxime(Axetin). The ESCRS guidelines on prevention, investigation and management of postoperative endophthalmitis recommends intracameral injection of an antibiotic agent (cephalosporin) at the conclusion of surgery. In our group of patients TASS occurred. Elements of diagnosis and treatment in TASS are discussed. As a conclusion to our study we decided to discontinue cefuroxime administration.

A lymphoid conjunctival tumor--clinical aspects; therapeutical options

A female woman, 34 years old, having a history of 10 years of conjunctival allergy, came to our Clinic for a pale pink mass lesion, occupying both the upper and the lower fornices. The therapeutical and also investigational approach was to excise all suspected tissue and to biopsy to determine if benign or malignant (clinically indistinguishable). The conjunctival biopsy revealed a non-Hodgkin malignant conjunctival MALT lymphoma. A complete medical check-up performed by a hematologist-oncologist confirmed that the disease was localized. In this case, of ocular adnexal MALT lymphoma with localised disease, we took into account local treatment: external beam radiation therapy, topical use of chemotherapy agents and biologic therapy (subconjunctival injections with interferon-alpha). Systemic chemotherapy was avoided. Interesting results were obtained with

[Anterior uveal malignant melanoma with subconjunctival extension--a clinical case]

The authors present the case of a patient with intraocular tumour and secondary glaucoma, which has been surgically treated for acute angle-closure glaucoma in a local hospital. Patient sits for examination at the clinic 11 months after surgery. Multiple conjunctiva pigmented metastasis are present at physical examination. Chosen therapeutic approach: exenteration.

[Post-operatory biometry and refraction results estimated and refraction surprises--clinical study]

Preoperative biometry has a major influence on the success or failure of IOL implantation procedures. The paper wishes to demonstrate the significance of this manoeuvre for the refraction and visual outcome and for the postoperative satisfaction rate of the patients. The clinical study has rulled out for one year period and a number of 239 patients suffered a IOL implantation procedure (cataract or lens extraction for refractive purposes). The preoperative biometry was always necessary. We used one of the existing IOL power calculation formula (SRK II, SRK T, Holladay). The surgeon decided about the IOL power, always after discussing with the patient their postoperative refractive expectations. The postoperative refraction was, in the majority of cases, the estimated refraction and the errors were similar with those from the literature. Refractive surprises of several diopters were registered in high myopic and hyperopic eyes or in cases of coexisting ocular diseases which have modified the anatomical parameters of the eye. In conclusion, small errors in calculation can have large effects on visual outcome. This problem will be solved in the future, because the field is evolving rapidly driven by a new understanding of the anatomy of the eye and new hardware for measuring that anatomy.

[Cataract surgery in Romania--2003]

AIM

to evaluate cataract surgery performed in Romania analyzing: --the number of cataract surgery performed in 2003; --the surgical technique used: intracapsular extraction, extracapsular extraction, phacoemulsification; --the number and type of intraocular lenses used; --the number of ophthalmologists that performed cataract surgery;

MATERIAL AND METHOD

--a questionnaire was sent to all ophthalmologists which do cataract surgery.

RESULTS

--38,000 surgeries for cataract were performed in 2003; --the surgical techniques used were : Phacoemulsification (18,000 cases), classic extracapsular extraction ( 19,000 cases) and intracapsular extraction (1000 cases); --28,500 rigid and 8,000 foldable intraocular lenses were implanted; - 223 ophthalmologists perform cataract surgery in Romania.

New concepts in etiology, clinic and management of postoperative endophthalmitis

THE AIM OF THE PAPER

In the last few years, as a result of the continuing changing of the ethiological, clinical and therapeutical aspects of the postoperative endophthalmitis, there are a lot of efforts to find the adequate means to prevent and to treat this severe complication of cataract surgery. So, the paper presents the most actual therapeutical approaches in the field.

MATERIAL AND METHODS

The goals of treatment of postoperative endophthalmitis are: to regain vision and to save the bulb. From the prophylactic techniques, preoperative povidone-iodine antisepsis is the most recommended procedure for decreasing the risk of endophthalmitis related to surgery. The main elements of the modern treatment of endophthalmitis are medical treatment by intravitreal injections or by systemic drugs and surgical treatment with vitrectomy.

CONCLUSIONS

Although endophthalmitis remains a potential cause of visual loss, both medical therapies and surgical techniques have evolved so that prognosis is not always as negative as it used to be.

[Particular aspects of treatment in diabetic eye cataract]

The knowing of the ocular consequences of diabetes is essential for the evaluation of the risk factors for the cataract surgery. The clinical study was made on a total number of 19 diabetic patients (3 with insulin dependent diabetes and the rest with noninsulin dependent diabetes), which were operated for cataract from september 2001 till march 2002. Preoperatory preparation presumed a good metabolic control of diabetes and a very carefully examination of the retina. The surgical technique was the extracapsular cataract extraction, followed by the implantation of a posterior chamber IOL, respectively phacoemulsification with the implantation of a foldable lens. The presence of a proliferative diabetic retinopathy, of a rubeosis iridis, of the neovascularization of the angle, or the preexistence of the vitreoretinal surgery (vitrectomy) were the main factors which dictated the anatomical and functional postoperatory prognosis. In conclusion, evenly the diabetic patient is a highly risk patient, the adequate preoperator preparation, the right treatment and a carefully follow-up could assure the success of the surgery in those cases.

[Laser in glaucoma treatment ; 1-year personal experience]

THE AIM OF THE PAPER

The paper establishes the role of the laser treatment in the complex treatment of glaucoma and realizes a comparison between our clinical results and the results from the literature.

MATERIAL AND METHODS

Along a period of one year, we have treated a number of 117 glaucoma patients: Open angle glaucoma (POAG), angle closure glaucoma (ACG), normal tension glaucoma (NTG) and symptomathic narrow anterior chamber. The complex treatment consists of medication, laser and/or surgery. To treat the patients, we have used the VISULAS 532 Combi laser, manufactured by Zeiss.

RESULTS

The results are presented in a synthetic way for different pathological entities and different methods of laser treatment.

CONCLUSIONS

In glaucoma, laser treatment represents a step between the medical treatment and surgery and is a very good alternative when the medication in inefficient or is not well tolerated. Our results are, in majority, similar with those from the literature.

Dry eye syndrome. Etiological and therapeutic aspects

"Dry eye syndrome" is a common disorder of the tear film that results from inadequate tear production, excessive tear evaporation or abnormality in mucin or lipid components of the tear film. A number of 53 patients suffering from dry eye syndrome were followed up for a period of 18 months. The study group was heterogeneous, including a lot of conditions accompanied by dry eye syndrome: Syogren's syndrome, lupus erythematous, ocular rosacea, patients with systemic treatments with antidepressants, betablockers, diuretics, oral contraceptives, glaucomatous patients with topical beta-blockers, postmenopausal women, aging people, computer users and long-term contact lens wearers. The therapeutical options were dictated by the severity of the syndrome: substitution therapy, treatment of the underlying eyelid diseases, modifying of the environmental conditions and treatment of the complications in the most severe cases. The new pathological approach is innovative and it may provide a real therapeutical measure for this condition: topical A Cyclosporine and androgen drops.

[High-altitude retinopathy]

High-altitude retinopathy is a very rare ocular disease in our country, which can occur isolately or as a part of high-altitude illness. This paper presents the case of a patient with high-altitude illness and the diagnosis and treatment problems of this case.

[Choroidal neovascularization]

Choroidal neovascularization (CNV) may occur in any ocular condition affecting the integrity of the choriocapillaris-Bruch's membrane-retinal pigment epithelium-outer retinal layer complex. CNV in the macula is a major cause of severe central visual loss. A variety of clinical symptoms suggest the diagnosis of CNV. Fluorescein and indocyanine green angiography play a very important role in the detection and precise localization of CNV in relation to the centre of the foveal avascular zone. In the present, CNV benefits by many treatment possibilities. The goal of treatment is specifically to decrease the risk of visual acuity loss.

Effects of 5-HT1B receptor ligands microinjected into the accumbal shell or core on the cocaine-induced locomotor hyperactivity in rats

The present study was designed to examine the effect of 5-HT1B receptor ligands microinjected into the subregions of the nucleus accumbens (the shell and the core) on the locomotor hyperactivity induced by cocaine in rats. Male Wistar rats were implanted bilaterally with cannulae into the accumbens shell or core, and then were locally injected with GR 55562 (an antagonist of 5-HT1B receptors) or CP 93129 (an agonist of 5-HT1B receptors). Given alone to any accumbal subregion, GR 55562 (0.1-10 microg/side) or CP 93129 (0.1-10 microg/side) did not change basal locomotor activity. Systemic cocaine (10 mg/kg) significantly increased the locomotor activity of rats. GR 55562 (0.1-10 microg/side), administered intra-accumbens shell prior to cocaine, dose-dependently attenuated the psychostimulant-induced locomotor hyperactivity. Such attenuation was not found in animals which had been injected with GR 55562 into the accumbens core. When injected into the accumbens shell (but not the core) before cocaine, CP 93129 (0.1-10 microg/side) enhanced the locomotor response to cocaine; the maximum effect being observed after 10 microg/side of the agonist. The later enhancement was attenuated after intra-accumbens shell treatment with GR 55562 (1 microg/side). Our findings indicate that cocaine induced hyperlocomotion is modified by 5-HT1B receptor ligands microinjected into the accumbens shell, but not core, this modification consisting in inhibitory and facilitatory effects of the 5-HT1B receptor antagonist (GR 55562) and agonist (CP 93129), respectively. In other words, the present results suggest that the accumbal shell 5-HT1B receptors play a permissive role in the behavioural response to the psychostimulant.

The effect of amphetamine sensitization on mouse immunoreactivity

Recent studies indicate a role of the immune system in the behavioral effects of amphetamine in rodents. In the present study we attempted to find a connection between the behavioral changes induced by repeated, intermittent administration of amphetamine and some immunological consequences of sensitization to amphetamine in mice. Male Albino Swiss mice were treated repeatedly (for 5 days) with amphetamine (1 mg/kg, i.p.). On day 9, they received a challenge dose of amphetamine (1 mg/kg). Acute administration of amphetamine increased their locomotor activity by ca. 40%. In animals treated repeatedly with amphetamine, the challenge dose of the psychostimulant induced behavioral sensitization, i.e. the higher locomotor activation as compared with that after its first administration to mice. Immune functions were evaluated by the ability of splenocytes to proliferate and to produce cytokines such as interferon gamma (IFN-gamma), interleukin (IL)-4 and IL-10. Acute amphetamine administration significantly decreased, by ca. 30% and 25%, the proliferation of splenocytes in response to an optimal and a suboptimal dose of concanavalin A (Con A), respectively, and increased their ability to produce IL-4. Chronic intermittent treatment with amphetamine significantly decreased, by ca. 65% and 50%, the proliferative response of T cells to an optimal and a suboptimal dose of Con A, respectively, and diminished by 20% the metabolic activity of splenocytes. The above data showed that both acute and chronic amphetamine administration diminished some aspects of the cell-mediated immunity; nevertheless, immunosuppression was particularly evident in amphetamine-sensitized mice. Our findings seem to indicate possible importance of monitoring and correcting immune changes in the therapy of amphetamine addiction.

[Verification of a surgical technique using a new biotitanium cage in degenerative diseases of the lumbar spine--experimental study]

PURPOSE OF THE STUDY

Authors performed experimental PLIF operations on cadavers to verify appropriate shape and size of cage made from bioactive titan material. The approach for application into intervertebral space of the lumbar spine and appearance on X-ray and CT scans was also investigated.

MATERIAL

In experiment on cadavers five implantations of interbody cages were performed, two of them in interbody space L3/L4 and three of them in L4/L5. Subtotal discectomy and end platec preparation was done before cage insertion. Our type of cage is made from bioactive titan material and fastened in the application instrument that we developed for this purpose.

METHOD

To verify operational approach we used midline incision and opened spinal canal through laminectomy, partial hemilaminectomy or partial medial facetectomy. This phase was followed by discectomy and end plates preparation. Stability of inserted cages in intervertebral space is ensured by rotation and anchorage of cage wings in end plates. Operated motion segment was taken out and evaluated by X-rays and CT scans.

RESULTS

The operational approach through partial hemilaminectomy and partial medial facetectomy was fully sufficient for cage application with respect to operated segment. All implantations were successful and position of cages satisfactory. Thanks to less robust gripping instrument the approach was more thrifty compared to glass-ceramic cage and comparable with commercially produced cages that we have experience with (Spine Tech, Stryker, Comesa). Due to cage radio opaque, proper position of cages is easy to control on X-ray and CT scans and allows good peroperative monitoring by X-ray magnifier.

DISCUSSION

Usage of bioactive materials in spinal surgery started by introduction of glass ceramics. Based on our experience we determined suitable indications. To eliminate some of te disadvantages of glass ceramics (mainly mechanical properties), a cage made from bioactive material was developed. This type of cage does not require bone harvesting to fill the cage. This fact results in better comfort for patient in postoperative period and eliminates complications from bone graft harvesting. Bioactive surface of the cage with osseo conductive and osseo integrative features creates prerequisites for solid fusion without bone grafts. Titanium material guarantees mechanical strength and makes possible to produce a wide range of shapes and sizes. Strength of the material enables more advantageous gripping of cage in application instrument. The cage is well visible on X-ray and in MRI scans artifacts are considerably reduced. Operational approach and technique are similar to other commercially produced cages and the extent of destabilization is limited to minimum.

CONCLUSION

Experimentally we repeatedly verified operational approach, suitable shape and applicability of bioactive titanium cage into intervertebral space. For clinical use bioactive titanium could be a possible way how to replace bone grafts. For spinal surgeons it represents a chemically and mechanically stable material capable of interaction in an environment where it is implanted. Even in difficult conditions the level of osseo integration is high.

[Laser phacoemulsification--a method of cataract surgery]

Today, ultrasound phacoemulsification is the most used method of cataract surgery. Because the side effects (injury of corneal endothelium and other nearly tissues), was tried to find alternative energy forms. Erbium laser was proven to be the most effective method among all of these.

Does combined treatment with novel antidepressants and a dopamine D3 receptor agonist reproduce cocaine discrimination in rats?

It is established that dopamine (DA) neurotransmission plays a critical role in the behavioral (e.g. discriminative stimulus) effects of cocaine in rodents. Nonetheless, research has also demonstrated that reciprocal signaling between DA and monoamine neurotransmitters, i.e. serotonin (5-HT) and norepinephrine (NE) has important implication for understanding the actions of cocaine. The present study was focussed on the ability of novel antidepressant drugs (milnacipram, reboxetine and venlafaxine), which affect either NE or both 5-HT and NE reuptake mechanism, to alter (enhance or antagonize) the discriminative stimulus effects of cocaine. Moreover, we investigated if the combined treatment with those drugs and a DA D3 receptor agonist (pramipexole) could reproduce cocaine discrimination. Male Wistar rats were trained to discriminate cocaine (10 mg/kg, ip) from saline (ip) in a two-choice, water-reinforced fixed-ratio 20 drug discrimination paradigm. Given alone, none of antidepressant drugs induced substitution for the cocaine-lever responses. Pramipexole (0.25 mg/kg) produced a partial substitution for cocaine (i.e. 43-52% cocaine-lever responding). In combination experiments, milnacipram (10 mg/kg) or reboxetine (10 mg/kg) given with submaximal doses of cocaine (1.25-5 mg/kg) did not affect the cocaine dose-response curve or its ED50 values. Venlafaxine (10 mg/kg) given in combination with submaximal doses of cocaine (0.6-5 mg/kg) produced significant enhancement of cocaine discrimination with a leftward shift in the cocaine dose-response curve and a decrease in its ED50 value. Pretreatment with either milnacipram (10 mg/kg) or reboxetine (10 mg/kg) failed to modulate the partial substitution evoked by pramipexole (0.25 mg/kg). On the other hand, venlafaxine (10 mg/kg) given in combination with a submaximal dose of pramipexole (0.25 mg/kg), which separately elicited 16 and 42% the cocaine-lever responses, produced significant enhancement of cocaine discrimination (up to 99% of the drug-lever responding). These results indicate that the discriminative stimulus effects of cocaine in rats can be enhanced by venlafaxine or mimicked by the combination with this antidepressant drug and the DA D3 receptor agonist. This finding, together with the recent data reporting the lack of rewarding properties of venlafaxine and the attenuation of morphine dependence and withdrwal signs in rats by the drug, may indicate a possible therapeutic use of this antidepressant in cocaine abuse.

Differential regulation of the mesoaccumbens circuit by serotonin 5-hydroxytryptamine (5-HT)2A and 5-HT2C receptors

Serotonin [5-hydroxytryptamine (5-HT)] 5-HT(2A) and 5-HT(2C) receptors (5-HT(2A)Rs and 5-HT(2C)Rs), which innervate the dopamine mesoaccumbens pathway, may play an important role in the behavioral effects of cocaine. To test this hypothesis, the present study measured cocaine-evoked locomotor activity after bilateral microinjection of selective 5-HT(2A)R and 5-HT(2C)R antagonists into the ventral tegmental area (VTA) or the nucleus accumbens (NAc) shell. Locomotor activity was measured after intracranial microinjection of saline (0.2 microl/side), the selective 5-HT(2A)R antagonist R-(+)-alpha-(2,3-dimethoxyphenyl)-1-[2-(4-fluorophenylethyl)]-4-piperidine methanol (M100907) (0.1 or 0.3 microg. 0.2 microl(-1). side(-1)), or the selective 5-HT(2C)R antagonist 8-[5-(2,4-dimethoxy-5-(4-trifluoromethylphenylsulfon-amido)phenyl-5-oxopentyl)]-1,3,8-triazaspiro[4.5]decane-2,4-dione hydrochloride (RS 102221) (0.05-0.5 microg. 0.2 microl(-1). side(-1)) followed by an injection of saline (1 ml/kg, i.p.) or cocaine (10 mg/kg, i.p.). Microinjection of M100907 (0.1-0.3 microg/side) into the VTA or RS 102221 (0.15-0.5 microg/side) into the NAc shell attenuated cocaine-induced hyperactivity in a dose-related manner. However, hyperactivity evoked by cocaine was not altered by microinjection of RS 102221 into the VTA or M100907 into the NAc shell. No changes in basal activity were observed after microinjection of M100907 or RS 102221 into either brain region. These findings are the first to demonstrate that the behavioral effects of cocaine are generated in part by activation of 5-HT(2A)Rs in the VTA and by activation of 5-HT(2C)Rs in the NAc shell. The selective regulation of the mesoaccumbens circuit by 5-HT(2A)Rs and 5-HT(2C)Rs implicates these 5-HT receptors as important in the behavioral outcomes of systemic cocaine administration.