Prehabilitation in older patients prior to elective cardiac procedures (PRECOVERY): study protocol of a multicenter randomized controlled trial

BACKGROUND

Previous studies have demonstrated the efficacy of rehabilitation after a cardiovascular procedure. Especially older and multimorbid patients benefit from rehabilitation after a cardiac procedure. Prehabilitation prior to cardiac procedures may also have positive effects on patients' pre- and postoperative outcomes. Results of a current meta-analysis show that prehabilitation prior to cardiac procedures can improve perioperative outcomes and alleviate adverse effects. Germany currently lacks a structured cardiac prehabilitation program for older patients, which is coordinated across healthcare sectors.

METHODS

In a randomized, controlled, two-arm parallel group, assessor-blinded multicenter intervention trial (PRECOVERY), we will randomize 422 patients aged 75 years or older scheduled for an elective cardiac procedure (e.g., coronary artery bypass graft surgery or transcatheter aortic valve replacement). In PRECOVERY, patients randomized to the intervention group participate in a 2-week multimodal prehabilitation intervention conducted in selected cardiac-specific rehabilitation facilities. The multimodal prehabilitation includes seven modules: exercise therapy, occupational therapy, cognitive training, psychosocial intervention, disease-specific education, education with relatives, and nutritional intervention. Participants in the control group receive standard medical care. The co-primary outcomes are quality of life (QoL) and mortality after 12 months. QoL will be measured by the EuroQol 5-dimensional questionnaire (EQ-5D-5L). A health economic evaluation using health insurance data will measure cost-effectiveness. A mixed-methods process evaluation will accompany the randomized, controlled trial to evaluate dose, reach, fidelity and adaptions of the intervention.

DISCUSSION

In this study, we investigate whether a tailored prehabilitation program can improve long-term survival, QoL and functional capacity. Additionally, we will analyze whether the intervention is cost-effective. This is the largest cardiac prehabilitation trial targeting the wide implementation of a new form of care for geriatric cardiac patients.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00030526). Registered on 30 January 2023.

Sexual dysfunction in patients with adult attention deficit hyperactivity disorder: A pilot study

Attention deficit hyperactivity disorder (ADHD) symptomatology, comorbid diseases, and pharmacological treatment with antidepressants can have a negative impact on sexual function, which in turn increases the likelihood of sexual dysfunction in people with ADHD. The objective of this pilot study was to differentiate and delineate possible sexual dysfunction in adults with ADHD. Adult ADHD patients (n = 32, cisgender / heterosexual) and healthy controls (n = 32, cisgender / heterosexual) filled out the DÄS-Zuf questionnaire with 59 items (Krieger, 2013). This questionnaire is divided into the scales “general contentment with life,” “anxiety/depression,” “sexual dysfunction” and “sexual satisfaction.” Patients with ADHD had significantly higher scores on single items measuring various aspects of sexual dysfunction as well as higher scores on the “anxiety/depression” scale and lower scores on the “general contentment with life” scale. Following repeated measures analyses of covariance in which the scale “anxiety/depression” was controlled as covariate, none of the previously differences for single items between ADHD patients and controls remained significant. ADHD patients with methylphenidate showed stronger physical sexual arousal compared to those without methylphenidate. The results of this pilot study suggest several explanations for sexual dysfunction among adults with ADHD and offer tentative routes for practical treatment approaches.

Pulsoximetric monitoring of fetal arterial oxygen saturation and fetal pulse at stage II of labor to predict acidosis in newborn Holstein Friesian calves

During stage II of parturition, the bovine fetus is at risk of oxygen deficiency caused by insufficient gas exchange between the dam and the fetus. The early detection of this critical condition, followed by assistance at calving, can help to improve the vitality of the newborn calf, or even prevent it from being born dead. By using pulse oximetry, the arterial oxygen saturation, as well as the pulse rate, can be continuously and non-invasively measured. The aim of our study was to identify critical thresholds for the parameters 'arterial oxygen saturation (FSpO₂)' and 'pulse rate (PR)' that indicate a severe postnatal risk for calves to suffer from acidosis. FSpO₂ and PR from 40 bovine fetuses were recorded during the last 25 min of calving with a commercially available pulse oximeter (Radius-7, Masimo Corporation, Irvine, USA). The calves were tested immediately after birth for acidosis by analyzing their blood with a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, USA). Retrospectively, the pulsoximetric data were scanned for predefined patterns. The validity of these patterns to predict acidosis in newborn calves was analyzed by using receiver operating characteristics (ROC) curve analyses. In general, PR was a stronger predictive parameter for acidosis than FSpO₂, with the greatest area under the curve (AUC) for the PR criteria 'Pulse rate > 120 beats per minute (bpm) for at least 2 min', with an AUC of 0.764, in contrast to an AUC of 0.613 for the best FSpO₂ criteria 'FSpO2 < 40% for at least 50% of the measurement'. Further studies should investigate whether vitality after calving can be improved and fetal death rate can be reduced when obstetric assistance is performed as soon as one of these criteria apply to the bovine fetus. For more practical implementation in the field, improvement of the device's hardware would be necessary.

Evaluation of an ear-attached accelerometer for detecting estrus events in indoor housed dairy cows

Precision dairy farming technologies have tremendous potential to improve and support farmers in herd management decisions, particularly in reproductive management. Nowadays, estrus detection in cows is challenging and several supporting tools are available. In this study, a 3D-accelerometer integrated into an ear-tag (SMARTBOW, Smartbow GmbH, Weibern, Austria) was used for the detection of cows in estrus. Movement pattern based on accelerometer data were analyzed and processed by algorithms and machine learning, resulting in estrus alerts. For the evaluation of the system, reproductive performance data of 579 estrus events of multiparous cows were used to retrospectively evaluate the accuracy of estrus alerts generated by the accelerometer-based system and the overall performance of the system. Estrus events were classified as 'gold standard' events, if an estrus followed by AI resulted in pregnancy, and as 'recorded estrus' events, if two estrus events with an interval of 18-25 d were in the herd records, independent of whether estrus was followed by AI or pregnancy. In total, 316 'gold standard' events were matched with estrus alerts generated by the accelerometer-based system, resulting in a sensitivity of 97%. Furthermore, 263 'recorded estrus' events were compared with correct or incorrect estrus alerts by the system. Sensitivity, specificity, positive and negative predictive values, accuracy, and error rate for 'recorded estrus' events were 97%, 98%, 96%, 94%, 96%, and 2%, respectively. In summary, the SMARTBOW system is suitable for an automated detection of estrus events of multiparous cows in indoor housed dairy cows.

Adaptation of two groups of Oenococcus oeni strains to red and white wines: the role of acidity and phenolic compounds

AIMS

Oenococcus oeni is the lactic acid bacteria species which is the most adapted to wine. Recently, two groups of strains that form two genetic lineages were described in red and white Burgundy wines. The aim of this study was to analyse the phenotypes of these strains in order to determine how they have adapted specifically to either red or white wine.

METHODS AND RESULTS

Four strains from each group were tested in grape must and in wines to evaluate their tolerance to pH and to phenolic compound content. White wine strains proved to be the most tolerant to low pH, both in grape must and in wine, whereas they were inhibited by the presence of grape tannins in wine. Red wine strains were more sensitive to acidity, but very resistant to phenolic compounds.

CONCLUSIONS

The results suggest that pH and phenolic compounds drive strain selection at several stages of wine production.

SIGNIFICANCE AND IMPACT OF THE STUDY

Although it is well known that O. oeni is well adapted to wine, this study shows that strains of some genetic lineages within this species have evolved to adapt better than others to specific types of wines.

Technical note: Evaluation of a wireless pulse oximeter for measuring arterial oxygen saturation and pulse rate in newborn Holstein Friesian calves

Pulse oximetry is a well-established technique in human and veterinary medicine. In farm animals, it could also be a useful tool for the detection of critical conditions relating to oxygen supply and the cardiovascular system. Among other uses, an innovative application could be the monitoring of fetuses during birth. This could help in the early identification of critical situations and support farmers and veterinarians in their decision to start obstetric or life-support interventions. Until now, however, its use in ruminant medicine was still limited to experimental applications. The objective of this study was to evaluate the accuracy of the Radius-7 Wearable Pulse CO-Oximeter (Masimo Corporation, Irvine, CA) for monitoring vital parameters in newborn calves. All measurements were conducted on animals in the lying down position. The sensor of the pulse oximeter was placed in the interdigital space of the calves' front legs and fixed with a homemade latex hoof cover. The pulsoximetric measurements of arterial oxygen saturation (SpO₂) in 40 newborn calves were compared with the corresponding results (SaO₂) from a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, CA), which served as the reference. For this, an arterial blood sample was taken from the medial intermediate branch of the caudal auricular artery. In addition, the pulse rate was measured in 10 calves aged between 0 and 7 d with the pulse oximeter and simultaneously with a heart rate belt (Polar Equine Belt, Polar Electro Oy, Kempele, Finland) to determine their level of agreement. Spearman correlation coefficient for oxygen saturation was 93.8% for the pulse oximeter and the blood gas analyzer, and 97.7% for the pulse rate measured with the pulse oximeter and the heart rate belt. Bland-Altman plots revealed an overestimation of SaO₂ by 2.95 ± 6.39% and an underestimation of the pulse rate by -0.41 ± 3.18 beats per minute compared with the corresponding reference methods. In summary, the pulse oximeter is suitable for continuous monitoring of arterial oxygen saturation and pulse in newborn Holstein Friesian calves. For practical use, purpose-built technical equipment is required to attach the sensor to the calves' legs.

Assessment of the functional impact of germline BRCA1/2 variants located in non-coding regions in families with breast and/or ovarian cancer predisposition

PURPOSE

The molecular mechanism of breast and/or ovarian cancer susceptibility remains unclear in the majority of patients. While germline mutations in the regulatory non-coding regions of BRCA1 and BRCA2 genes have been described, screening has generally been limited to coding regions. The aim of this study was to evaluate the contribution of BRCA1/2 non-coding variants.

METHODS

Four BRCA1/2 non-coding regions were screened using high-resolution melting analysis/Sanger sequencing or next-generation sequencing on DNA extracted from index cases with breast and ovarian cancer predisposition (3926 for BRCA1 and 3910 for BRCA2). The impact of a set of variants on BRCA1/2 gene regulation was evaluated by site-directed mutagenesis, transfection, followed by Luciferase gene reporter assay.

RESULTS

We identified a total of 117 variants and tested twelve BRCA1 and 8 BRCA2 variants mapping to promoter and intronic regions. We highlighted two neighboring BRCA1 promoter variants (c.-130del; c.-125C > T) and one BRCA2 promoter variants (c.-296C > T) inhibiting significantly the promoter activity. In the functional assays, a regulating region within the intron 12 was found with the same enhancing impact as within the intron 2. Furthermore, the variants c.81-3980A > G and c.4186-2022C > T suppress the positive effect of the introns 2 and 12, respectively, on the BRCA1 promoter activity. We also found some variants inducing the promoter activities.

CONCLUSION

In this study, we highlighted some variants among many, modulating negatively the promoter activity of BRCA1 or 2 and thus having a potential impact on the risk of developing cancer. This selection makes it possible to conduct future validation studies on a limited number of variants.

DNMT3A mutant transcript levels persist in remission and do not predict outcome in patients with acute myeloid leukemia

We investigated the prognostic impact of minimal residual disease (MRD) monitoring in acute myeloid leukemia patients harboring DNA methyltransferase 3A-R882H/-R882C mutations (DNMT3A^mut). MRD was determined by real-time quantitative PCR (RQ-PCR) in 1494 samples of 181 DNMT3A^mut patients. At the time of diagnosis, DNMT3A^mut transcript levels did not correlate with presenting clinical characteristics and concurrent gene mutations as well as the survival end points. In Cox regression analyses, bone marrow (BM) DNMT3A^mut transcript levels (log10-transformed continuous variable) were not associated with the rate of relapse or death. DNMT3A^mut transcript levels were significantly higher in BM than in blood after induction I (P=0.01), induction II (P=0.05), consolidation I (P=0.004) and consolidation II (P=0.008). With regard to the clinically relevant MRD time points, after two cycles of induction and at the end of therapy, DNMT3A^mut transcript levels had no impact on the end point remission duration and overall survival. Of note, only a minority of the patients achieved RQ-PCR negativity, whereas most had constantly high DNMT3A^mut transcript levels, a finding which is consistent with the persistence of clonal hematopoiesis in hematological remission.

Bay11-7082 inhibits the disintegration of the lymphendothelial barrier triggered by MCF-7 breast cancer spheroids; the role of ICAM-1 and adhesion

Background:

Many cancers spread through lymphatic routes, and mechanistic insights of tumour intravasation into the lymphatic vasculature and targets for intervention are limited. The major emphasis of research focuses currently on the molecular biology of tumour cells, while still little is known regarding the contribution of lymphatics.

Methods:

Breast cancer cell spheroids attached to lymphendothelial cell (LEC) monolayers were used to investigate the process of intravasation by measuring the areas of ‘circular chemorepellent-induced defects' (CCID), which can be considered as entry gates for bulky tumour intravasation. Aspects of tumour cell intravasation were furthermore studied by adhesion assay, and siRNA-mediated knockdown of intracellular adhesion molecule-1 (ICAM-1). Replacing cancer spheroids with the CCID-triggering compound 12(S)-hydroxyeicosatetraenoic acid (HETE) facilitated western blot analyses of Bay11-7082- and baicalein-treated LECs.

Results:

Binding of LECs to MCF-7 spheroids, which is a prerequisite for CCID formation, was mediated by ICAM-1 expression, and this depended on NF-κB and correlated with the expression of the prometastatic factor S100A4. Simultaneous inhibition of NF-κB with Bay11-7082 and of arachidonate lipoxygenase (ALOX)-15 with baicalein prevented CCID formation additively.

Conclusion:

Two mechanisms contribute to CCID formation: ALOX15 via the generation of 12(S)-HETE by MCF-7 cells, which induces directional migration of LECs, and ICAM-1 in LECs under control of NF-κB, which facilitates adhesion of MCF-7 cells to LECs.

[Trauma care - a global challenge. Experience gathered in a (trauma) center managing urban violence in Nigeria]

Internal fixation of fractures is an integral part of health care. However this is a privilege of the developed world. For humanitarian aid internal fixation has always been considered as too prone to infection given the poor hygienic conditions, too specialized, too costly and the infrastructure of so-called developing countries too weak to perform internal fixation successfully. Due to the globally increasing density of road traffic an alarming increase in victims of road traffic accidents can be observed. The World Health Organization (WHO) estimates that in 2030 road traffic accidents will be responsible for twice as many deaths as caused by HIV/AIDS.Road traffic accidents are considered to be the new global epidemic. Since the victims are generally young, their rehabilitation has not only a humanitarian, but also an economic impact for low-income countries. The organization Doctors Without Borders (Médecins Sans Frontières; MSF) is not only providing surgical care for victims of violence in war and conflict regions, but has expanded its portfolio to include victims of road traffic accidents and started to perform internal fixation under good hygienic circumstances in closed fractures. The following is a report about the work in a hospital for surgical trauma care in Port Harcourt, Nigeria where victims of road traffic accidents are treated besides victims of urban violence.

[Trauma surgery catastrophe aid following the earthquake in Haiti 2010--a report on experiences: injury patterns, special challenges, prospects]

The earthquake in Haiti in January 2010 resulted in more than 220,000 deaths and over 300,000 injured and was one of the greatest mass casualties in recent history. "Doctors Without Borders" started a medical relief response immediately after the earthquake, building up to the biggest disaster relief activity in the organization's history. Roughly 173,000 medical consultations and more than 11,700 surgical interventions were performed in 26 medical facilities during the first 4 months. A particular challenge was the sheer number of patients in a situation with a completely destroyed medical infrastructure. While the initial phase mainly focused on life saving surgery, the second phase concentrated on reconstructive surgery of the extremities. Crucial for effective patient care is an ability to act early and employ surgical techniques which are adapted to the overall situation. The following article is a personal report of the early emergency response from the viewpoint of two orthopedic trauma surgeons, who have surgical careers in Germany and also frequently volunteer for "Doctors Without Borders".

Combined topotecan and lapatinib in patients with early recurrent ovarian or peritoneal cancer after first line of platinum-based chemotherapy: A French FEDEGYN-FNCLCC phase II trial

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Background: High HER1 expression is associated with poor prognosis. Preliminary data have shown links between HER1 expression and topotecan efficacy. The objective of the trial was to evaluate the efficacy of the association of topotecan and lapatinib in non-HER screened patients who failed first line platinum-based chemotherapy within 12 months. Methods: Chemotherapy consisted of 4-week course of topotecan (d1, d8, d15, 3.2 mg/m2 IV) and lapatinib (1250 mg/d PO). Response was assessed using RECIST or RUSTIN criteria. The primary objective was global response (GR, i.e. CR, PR, and SD). Biomarker profiles were evaluated according treatment response. A two-step phase II trial was designed to include 54 patients assuming a GR rate of 75% for the combination compared to 55% for topotecan alone. Results: From March to September 2008, 39 patients (37 ovarian and 2 peritoneal carcinomas), median age 60 (18 to 80), were included in 16 institutions. Patients presented with FIGO stage I (n = 1), II (n = 2), III (n = 29), and IV (n = 7) disease. Twenty and 19 patients had disease relapse occurring < 6 and 6–12 months after initial chemotherapy respectively. 2 patients were non evaluable. After 1 to 8 cycles (median 2) of topotecan-lapatinib there were 0/2 PR, 7/9 SD, 12/7 progressions in patients who failed <6 or 6–12 months respectively. The GR rate was 46% (35 and 58%; 95% confidence limits, 30–63%) and the trial was prematurely stopped. Three patients developed toxicity leading to treatment discontinuation after 3 cycles. Biological data will be presented at meeting. Conclusions: Combined topotecan and lapatinib is associated with modest GR rate. Biological profiles of responders are pending.

No significant financial relationships to disclose.

Screening BRCA1 and BRCA2 unclassified variants for splicing mutations using reverse transcription PCR on patient RNA and an ex vivo assay based on a splicing reporter minigene

BACKGROUND

Many unclassified variants (UV) of BRCA1 or BRCA2 may have an effect on pre-mRNA splicing. Patient blood samples suitable for RNA extraction are not always available for testing UVs at the RNA level.

METHODS

Analyses of RNA from patient peripheral blood were performed, using a one-step reverse transcriptase-PCR (RT-PCR) protocol, and were compared with an ex vivo splicing assay based on PCR-amplified patient DNA inserted into a splicing reporter minigene. Using both methods 20 variants found in 17 patients were examined.

RESULTS

Data from patient RNA and from the minigene assay were fully concordant, but the ex vivo splicing assay, which is monoallelic, clarified several ambiguities in the patient RNA data. Two intronic variants induced strong splicing defects: BRCA1 c.4987-5T-->A (IVS16-5T-->A) induced exon 17 skipping and BRCA2 c.316+5G-->C (IVS3+5G-->C) induced complete skipping of exon 3. Of the exonic variants, BRCA2 c.7805G-->C (p.Arg2602Thr), at the last base of exon 16, induced both exon skipping and activation of a cryptic exonic donor site, and BRCA2 c.8023A-->G (p.Ile2675Val) generated a strong donor site within exon 18. These four variants were thus classified as pathogenic, because of the total absence of a normal transcript from the corresponding allele. Variant BRCA2 c.9501+3A-->T (IVS25+3A-->T) induced incomplete skipping of exon 25, suggesting a mutation with incomplete penetrance, and BRCA2 c.8257_8259del (p.Leu2753del) modified the alternative splicing of exons 17 and 18.

CONCLUSIONS

We show that functional analysis using a splicing reporter minigene is sensitive and specific, and should be used for initial screening of potential splicing defects, especially when patient RNA is not readily available.

Intra-tumoral gene delivery of feIL-2, feIFN-gamma and feGM-CSF using magnetofection as a neoadjuvant treatment option for feline fibrosarcomas: a phase-I study

Despite aggressive pre- or postoperative treatment, feline fibrosarcomas have a high relapse rate. In this study, a new treatment option based on immune stimulation by intra-tumoral delivery of three feline cytokine genes was performed. The objective of this phase-I dose-escalation study was to determine a safe dose for further evaluation in a subsequent phase-II trial. Twenty-five client-owned cats with clinical diagnosis of fibrosarcoma - primary tumours as well as recurrences - entered the study. Four increasing doses of plasmids coding for feIL-2, feIFN-gamma or feGM-CSF, respectively, were previously defined. In groups I, II, III and IV these doses were 15, 50, 150 and 450 microg per plasmid and a corresponding amount of magnetic nanoparticles. Two preoperative intra-tumoral injections of the magnetic DNA solution were followed by magnetofection. A group of four control cats received only surgical treatment. Side effects were registered and graded according to the VCOG-CTCAE scale and correlated to treatment. Statistical analyses included one-way anova, post hoc and Kruskal-Wallis tests. ELISA tests detecting plasma feIFN-gamma and plasma feGM-CSF were performed. One cat out of group IV (450 microg per plasmid) showed adverse events probably related to gene delivery. As these side effects were self-limiting and occurred only in one of eight cats in group IV, this dose was determined to be well tolerable. Altogether six cats developed local recurrences during a 1-year observation period. Four of these cats had been treated with dose IV. Regarding these observations, a subsequent phase-II trial including a representative amount of cats should be tested for the efficacy of dose IV as well as dose III.

Hypothalamic-pituitary-adrenal axis function and the cellular immune response in former preterm children

CONTEXT

Animal data suggest that adverse early experiences may affect endocrine and immune functioning in later life.

OBJECTIVE

Our objective was to assess the impact of preterm delivery on hypothalamus-pituitary-adrenal axis functioning, heart rate responses, and immune function.

PARTICIPANTS

Former preterm children [aged 8-14 yr (n = 18)], sex and age-matched full-term born control children (n = 18), data on birth weight, gestational age, birth weight for gestational age (in sd units), actual body weight, height, and body mass index were assessed.

DESIGN AND OUTCOME MEASURES

Subjects were exposed to a standardized laboratory stressor ("Trier Social Stress Test for Children"). Cortisol in saliva was determined in 10-min intervals before and after the stress test; heart rates were obtained continuously during the stress test. Additional assessment of saliva cortisol was performed: 1) on 3 consecutive days after awakening and at +10, +20, and +30 min (morning cortisol); and 2) at 0800, 1400, 1600, and 1900 h (short diurnal profile). Measurement of the delayed type hypersensitivity reaction to seven recall antigens [Multitest cellular mediated immunity (Multitest-Immignost, Biosyn, Fellbach, Germany)].

RESULTS

Exposure to the Trier Social Stress Test for Children yielded significantly increased cortisol levels [F (8, 232) = 19.86; P < 0.001] and heart rates [F (38, 988) = 10.46; P < 0.001], however, no difference between former preterms and full-terms could be observed. No between-group differences were found in the short diurnal cortisol profile. Former preterms showed significantly higher cortisol levels after awakening [F (3, 102) = 3.14; P < 0.05]. In addition, a significantly suppressed delayed type hypersensitivity response [reduced number of positive antigens (t = -2.64, P < 0.05); induration (t = -2.4, P < 0.05)] was found in former preterms.

CONCLUSION

The data suggest that preterm delivery may be associated with altered endocrine and immune functions well into late childhood.

Subcellular localisation of Cdc25A determines cell fate

Cell division cycle 25A (Cdc25A) was shown to colocalise both with nuclear and cytoplasmic proteins. Recently, we have demonstrated that overexpressed Cdc25A promoted the survival of rat 423 cells through indirect activation of PKB-protein kinase B. Using a Cdc25A:ER fusion protein, which can be shuttled from the cytoplasm into the nucleus, the present investigation evidences that the antiapoptotic effect of Cdc25A was restricted to its cytoplasmic localisation in rat 423 cells. In contrast, nuclear Cdc25A overexpression caused dephosphorylation and nuclear retention of the proapoptotic transcription factor Forkhead in rhabdomyosarcoma-like 1 (FKHRL1) in human N.1 ovarian carcinoma cells. This resulted in the increased constitutive expression of the FKHRL1 targets Fas ligand and Bim, and promoted apoptosis. Thus, the Cdc25A oncogene, which was found to be frequently overexpressed in certain human cancers, can increase or decrease the susceptibility to apoptosis depending on the cell-type-specific subcellular distribution.

Cognitive subprocesses and schizophrenia. A. Reaction-time decomposition

OBJECTIVE

The aim of the study is to demonstrate that deficits of information processing in schizophrenic patients can be isolated with reaction-time (RT) decomposition paradigms.

METHOD

Three types of visually presented tasks were applied: simple, disjunctive and choice RT-tasks. RT were split into movement latency and time necessary to execute movements. Comparisons of three samples of schizophrenic patients (295.3) with individually matched (age, sex. education and handedness) healthy controls are presented: Sample 1: 10 drug-naive first-onset patients, Sample 2: 10 neuroleptically treated first-onset patients, Sample 3: 10 neuroleptically treated chronically ill patients.

RESULTS

Findings indicate that schizophrenia affects primarily subprocesses in which percepts are translated into appropriate actions (response-selection). Neuroleptic treatment improves processing at this stage but is accompanied by slowing of movement execution.

CONCLUSION

Response-selection is selectively impaired in first-onset patients. This disturbance, which might be specific for schizophrenia, can be regarded as indication of a disconnection between frontal and posterior areas.

Reaction-times and bioelectrical brain signals of drug-naive schizophrenic first-onset patients in identification and classification tasks

OBJECTIVE

The question of the present study is whether disturbances of response-selection in schizophrenic patients are discernible only if overt motor-actions are required, or also if covert cognitive actions are necessary.

METHOD

Visual identification (digits) and classification (dot-enumeration) tasks were presented to 18 drug-naive, first-onset schizophrenic patients and healthy controls. It is assumed that enumeration of more than three dots requires additional cognitive processes as buffering and re-focusing of attention. Reaction-times and 21-channel-EEG were measured. For eye-movement artefact-elimination a new non-parametric regression approach was applied.

RESULTS

Reaction-times revealed that in the patient group response selection is lengthened in both tasks. Perception of dot numbers is not affected. Bioelectrical data depicted a left-lateralization of posterior P100 and N 100 in the patient group as well as an enhanced fronto-central P200.

CONCLUSION

Whereas in reaction-times of patients only a disturbance of response selection is discernible, bioelectrical measurements also point to an altered organization of perceptive processes.

Cognitive subprocesses and schizophrenia. B. Maze tasks

OBJECTIVE

In a companion paper we demonstrated that in reaction-time tasks the response selection stage is selectively disturbed in schizophrenia. The aim of the present study is the investigation of subprocesses, which are incorporated into repeatedly activated loops of cognitive processes and need additional information from working memory.

METHOD

Maze tasks of varying complexity (with and without bifurcations) were presented to drug-naive and treated first-onset schizophrenic patients. The tasks had to be solved under easy and difficult motor-conditions. Both patient samples were compared with healthy control groups matched by age, sex, education and experience with the experimental setting.

RESULTS

In mazes with alternative routes patients exhibited the expected decrease of performance. However, untreated patients improved under difficult motor conditions. This improvement is smaller after neuroleptic treatment.

CONCLUSION

Under difficult motor conditions attention is focused on the execution of movements and thus withdrawn from perceiving irrelevant response alternatives, i.e. the effects of disturbed response selection are reduced.

[Success and failure with the Demers catheter in dialysis]

Between January 1995 and January 1999 54 Demers atrial catheters were implanted in 48 uraemic patients. Indications for implantation were: urgent need for haemodialysis with missing vascular access (39), fistula occlusion (7), low shunt flow (3) and problems with a previously implanted catheter (5). We observed 7 catheter infections, 5 catheter occlusions, 1 intraoperative air embolism, 3 haematomas and 1 dacron socket dislocation. The average period of use of an atrial catheter was 170 days, the longest period almost 2 years. The majority of catheters were explanted without any dysfunction. The long time of availability makes Demers atrial catheters an alternative to fistula for multimorbid patients on dialysis with poor long-term survival.

Trypanosomes lacking trypanothione reductase are avirulent and show increased sensitivity to oxidative stress

In Kinetoplastida, trypanothione and trypanothione reductase (TRYR) provide an intracellular reducing environment, substituting for the glutathione-glutathione reductase system found in most other organisms. To investigate the physiological role of TRYR in Trypanosoma brucei, we generated cells containing just one trypanothione reductase gene, TRYR, which was under the control of a tetracycline-inducible promoter. This enabled us to regulate TRYR activity in the cells from less than 1% to 400% of wild-type levels by adjusting the concentration of added tetracycline. In normal growth medium (which contains reducing agents), trypanosomes containing less than 10% of wild-type enzyme activity were unable to grow, although the levels of reduced trypanothione and total thiols remained constant. In media lacking reducing agents, hypersensitivity towards hydrogen peroxide (EC50 = 3.5 microM) was observed compared with the wild type (EC50 = 223 microM). The depletion of TRYR had no effect on susceptibility to melarsen oxide. The infectivity and virulence of the parasites in mice was dependent upon tetracycline-regulated TRYR activity: if the trypanosomes were injected into mice in the absence of tetracycline, no infection was detectable; and when tetracycline was withdrawn from previously infected animals, the parasitaemia was suppressed.

The genexpress IMAGE knowledge base of the human muscle transcriptome: a resource of structural, functional, and positional candidate genes for muscle physiology and pathologies

Sequence, gene mapping, and expression data corresponding to 910 genes transcribed in human skeletal muscle have been integrated to form the muscle module of the Genexpress IMAGE Knowledge Base. Based on cDNA array hybridization, a set of 14 transcripts preferentially or specifically expressed in muscle have been selected and characterized in more detail: Their pattern of expression was confirmed by Northern blot analysis; their structure was further characterized by full-insert cDNA sequencing and cDNA extension; the map location of the corresponding genes was refined by radiation hybrid mapping. Five of the 14 selected genes appear as interesting positional and functional candidate genes to study in relation with muscle physiology and/or specific orphan muscular pathologies. One example is discussed in more detail. The expression profiling data and the associated Genexpress Index2 entries for the 910 genes and the detailed characterization of the 14 selected transcripts are available from a dedicated Web server at. The database has been organized to provide the users with a working space where they can find curated, annotated, integrated data for their genes of interest. Different navigation routes to exploit the resource are discussed.

Citromicrobium bathyomarinum, a novel aerobic bacterium isolated from deep-sea hydrothermal vent plume waters that contains photosynthetic pigment-protein complexes

We have taxonomically and phylogenetically characterized a new aerobic bacterial strain (JF-1) that contains photosynthetic pigment-protein complexes and which was recently isolated from black smoker plume waters of the Juan de Fuca Ridge. Strain JF-1 is a gram-negative, yellow-pigmented, motile bacterium that is salt-, pH-, and thermotolerant. These properties are consistent with an oligotrophic adaptation to varied environmental conditions thought to exist around deep-sea hydrothermal vents. The analysis of 16S rDNA sequences revealed that strain JF-1 forms a separate phylogenetic branch between the genus Erythromonas and the Erythromicrobium-Porphyrobacter-Erythrobacter cluster within the alpha subclass of the Proteobacteria. The taxonomic name Citromicrobium bathyomarinum (gen. nov., sp. nov.) is proposed for strain JF-1.

Cognitive dysfunction in schizophrenia: a new set of tools for the assessment of cognition and drug effects

Cognitive impairment in schizophrenia must be seen as a disturbance of cortico-sub-cortical connectivity with a neurotransmitter imbalance in a circuitry system, which connects thalamic input with prefrontal processing and supplementary motor cortex and basal ganglia output. The concept of maze-solving behaviour as a continuous cognitive task evoking a conflict between prefrontal cortex and basal ganglia activity is explained and introduced to distinguish between the effects of D2 blocking agents and substances with a predominant 5HT2A receptor affinity, such as clozapine and risperidone. Complex mazes show a cognitive deficit in untreated schizophrenic patients that are impaired by conventional and improved by atypical antipsychotic substances. Processing speed improves most on clozapine, while parallel processing is best supported by the non-sedative atypical substance risperidone. Maze paradigms are presented.

Mass mailing and staff experience in a total recruitment program for a clinical trial: the SHEP experience. Systolic Hypertension in the Elderly Program. Cooperative Research Group

The Systolic Hypertension in the Elderly Program (SHEP) staff contacted 447,921 screenees, of whom 11,919 (2.7%) were originally eligible and 4,736 (1.1%) maintained eligibility and were randomized. The total number of participants enrolled at the 16 clinical centers ranged from 133 to 559. The low yield of screenees to randomizations resulted from the study design, not from low levels of agreement to participate, and required the employment of a variety of recruitment strategies in a prudent overall plan. SHEP was one of the first clinical trials to use mass mailing as a primary strategy of recruitment. The study used mailing lists from seven generic sources. More than 3.4 million letters of invitation were mailed; they yielded an overall response rate of 4.3%. Motor vehicle and voter registration lists provided the greatest numbers of names. Mailings to members of health maintenance organizations (HMOs) and registrants of the Health Care Finance Administration (HCFA) provided the greatest response rates. Considerable variability in response rates existed among clinical centers using generically similar mailing lists. Generally, the number of hours spent on recruitment showed a positive, but not statistically significant, association with randomization yields. The recruitment yield was statistically significantly higher in clinics with experienced recruitment coordinators than in clinics with inexperienced ones (p = 0.0008). From these findings we conclude that mass mailing is an important strategy in an overall recruitment program, that the involvement of experienced recruitment staff is important, and that although the total time spent by staff on recruitment may also improve results, it matters less than the staff's level of recruiting experience.

[Vena cava filter--prevention of pulmonary embolism. Report of clinical experiences]

Between 1982 and 1997 inferior vena cava filters were implanted in 182 patients. Indications were recurrent pulmonary embolism, massive embolism and prophylactic use prior to planned high-risk-operations upon patients with thromboembolic complications in shorter history. Kimray-Greenfield, Cardial and Vascor-systems were implanted. Mortality was 0, neither relevant bleedings, nor infections occurred. Vena-cava-filters prevented from re-embolism in 98%. During hospitalisation 3 cases of re-embolism (1.6%) were noticed due to incorrect filter-placement. One patient died (< 1%). Follow-up-examinations were performed in 74 cases 6 to 24 months after implantation. We discovered 8 cases (11%) of filter-migration, 3 cases (4%) of filter-kinking, one case of filter-perforation and one case of filter-shrut-fracture. All these patients remained without clinical sequelae. Cava-thrombosis was found in 2 patients 6 to 24 months after filter-insertion (2.7%). There was no sign of re-embolism in our longterm follow-up. In our opinion the vena cava filter is an effective and safe method to prevent pulmonary re-embolism. Handling is quite easy and filter complications are low. In some elected cases prophylactic use of vena cava filters in high-risk-patients may be indicated.

The topography of non-linear cortical dynamics at rest, in mental calculation and moving shape perception

Differential cortical activation by cognitive processing was studied using dimensional complexity, a measure derived from nonlinear dynamics that indicates the degrees of freedom (complexity) of a dynamic system. We examined the EEG of 32 healthy subjects at rest, during a visually presented calculation task, and during a moving shape perception task. As a nonlinear measure of connectivity, the mutual dimension of selected electrode pairs was used. The first Lyapunov coefficient was also calculated. Data were tested for non-linearity using a surrogate data method and compared to spectral EEG measures (power, coherence). Surrogate data testing confirmed the presence of nonlinear structure in the data. Cognitive activation led to a highly significant rise in dimensional complexity. While both tasks activated central, parietal and temporal areas, mental arithmetic showed frontal activation and an activity maximum at T3, while the moving shape task led to occipital activation and a right parietal activity maximum. Analysis of mutual dimension showed activation of a bilateral temporal-right frontal network in calculation. The Lyapunov coefficient showed clear topographic variation, but was not significantly changed by mental tasks (p<.09). While dimensional complexity was almost unrelated to power values, nonlinear (mutual dimension) and linear (coherence) measures of connectivity shared up to 37% of variance. Data are interpreted in terms of increased cortical complexity as a result of recruitment of asynchronously active, distributed neuronal assemblies in cognition. The topography of nonlinear dynamics are related to neuropsychological and neuroimaging findings on mental calculation and moving shape perception.

Presence of cartilage-derived morphogenetic proteins in articular cartilage and enhancement of matrix replacement in vitro

OBJECTIVE

To investigate the effects of the cartilage-derived morphogenetic proteins (CDMPs) in an in vitro cartilage explant model that mimics the chondrocytic response to matrix depletion, and to demonstrate their presence in articular cartilage.

METHODS

Adult bovine articular cartilage and postmortem specimens from adult human donors with and without osteoarthritic (OA) lesions were stained by immunohistochemistry using polyclonal antibodies specific for CDMP-1 and CDMP-2. Extracts of bovine articular cartilage were analyzed by Western blotting for the presence of the CDMPs. Bovine articular cartilage explants were depleted of their matrix by trypsin digestion, followed by a 7-day culture period in a chemically defined serum-free basal medium (BM), with or without recombinant CDMPs 1 and 2. The metabolic activity of chondrocytes was measured by 35S-sulfate incorporation into macromolecules. Newly synthesized proteoglycans (PGs) were analyzed using Sephacryl S-500 HR gel chromatography. The expression levels of the messenger RNA (mRNA) for chondrogenic markers were investigated by Northern analysis.

RESULTS

CDMP-1 and CDMP-2 were detected in both bovine and human healthy and OA articular cartilage. Treatment of matrix-depleted cartilage explants with CDMPs 1 and 2 increased equally the incorporation of 35S-sulfate into PGs compared with tissue maintained in BM. Gel chromatography analysis indicated that aggrecan was the predominant PG species. Northern blot analysis showed that the expression of link protein, type II collagen, and aggrecan mRNA transcripts was not modulated by CDMP treatment.

CONCLUSION

This study shows the presence of CDMP-1 and CDMP-2 in adult bovine and human articular cartilage. In addition, our in vitro data indicate that CDMPs 1 and 2 stimulate the metabolic activity of articular chondrocytes. Therefore, these signaling molecules may be contributing to the maintenance of the integrity of the joint surface.

MRI findings in chronic hepatic encephalopathy depend on portosystemic shunt: results of a controlled prospective clinical investigation

BACKGROUND/AIMS

Deterioration of hepatic encephalopathy is a major concern with the transjugular intrahepatic portosystemic shunt procedure. Symmetric hyperintense globus pallidus on T1-weighted cranial magnetic resonance imaging in patients with liver cirrhosis anticipates hepatocerebral disease. It is hypothesized that hepatic encephalopathy and basal ganglia signal intensity progress in patients with cirrhosis of the liver undergoing transjugular intrahepatic portosystemic shunt.

METHODS

Twenty-four patients were randomized to undergo either transjugular intrahepatic portosystemic shunt or elective sclerotherapy. At study entry and 6 months after randomization, neurologic assessment, psychometric tests, standard EEG, and magnetic resonance imaging were performed. The severity of liver failure was graded using Child-Pugh's classification. The signal intensity of the globus pallidus was determined on sagittal T1-weighted magnetic resonance imaging.

RESULTS

The T1-weighted signal intensity of the globus pallidus on magnetic resonance imaging significantly increased after transjugular intrahepatic portosystemic shunt placement (p<0.01), but not with elective sclerotherapy. At follow-up, neurological symptoms indicating decline of mental status and motor performance were somewhat more prevalent in transjugular intrahepatic portosystemic shunt patients. Significant deterioration of EEG abnormalities occurred in patients treated with transjugular intrahepatic portosystemic shunt as opposed to elective sclerotherapy (p<0.01).

CONCLUSIONS

Transjugular intrahepatic portosystemic shunt procedure increases hyperresonant globus pallidus on magnetic resonance imaging. Neuropsychiatric evaluation shows advancing hepatic encephalopathy, in particular with transjugular intrahepatic portosystemic shunt; however, it does not parallel the augmentation of pallidal signal intensity on magnetic resonance imaging.

Improvement of cognitive function in schizophrenic patients receiving clozapine or zotepine: results from a double-blind study

Clinical interest in the so-called atypical antipsychotics currently focuses on the possibility of improving the negative symptoms of schizophrenia and the cognitive dysfunction associated with the disease. While clozapine has been shown to be effective in this respect, no data are available on zotepine. We report on a double-blind randomized study designed to evaluate the impact of zotepine and clozapine on cognitive dysfunction in schizophrenia. Cognitive function was operationalized by a maze test in which patients traversed computer-displayed mazes of increasing complexity. Passage time, route, and motor errors were evaluated. 25 schizophrenic (DSM-IIIR) patients were included in each group. After washout, they were randomized on zotepine or clozapine and given up to 450 mg of substance each. Patients were followed for six weeks and evaluated weekly. We report on a subsample of 26 patients matched for baseline BPRS, SANS, and age. 13 matched healthy persons were recruited as controls. ANOVA with group and course over time as factors was used for analysis. Both clozapine and zotepine achieved a highly significant decrease in overall symptoms (BPRS) and negative symptoms (SANS). Zotepine and clozapine were equally effective. In the maze tests, motor errors in simple mazes were stable over time and differentiated schizophrenics from controls as a "trait" marker. In passage time and maze route, schizophrenics performed worse than controls. An improvement by medication was evident in both medication groups, but was more pronounced in the zotepine-treated group. The study confirms previous results on the efficacy of clozapine and zotepine in treating negative symptoms of schizophrenia. The data presented show for the first time that zotepine is efficacious in improving cognitive dysfunction, confirming this substance's value as an atypical antipsychotic.

Recruitment in the Trial of Nonpharmacologic Intervention in the Elderly (TONE)

OBJECTIVE

To compare the effectiveness of different approaches to participant enrollment in a behavior modification trial.

DESIGN

Concurrent, prospective evaluation performed in context of recruitment for a randomized, controlled trial.

SETTING

Four study centers located in Baltimore, Maryland, Memphis, Tennessee New Brunswick, New Jersey, and Winston-Salem, North Carolina.

PARTICIPANTS

Men and women aged 60 to 80 years who were being treated with a prescription medication for control of hypertension.

MAIN OUTCOME MEASURES

Visit counts and percent yields were assessed at each stage of the screening and randomization process. Logistic regression was used to contrast the randomization yields for different recruitment strategies and to explore the impact of sociodemographic characteristics and geographic location on recruitment yields.

RESULTS

The overall randomization yields from a prescreen contact and a first screening visit to enrollment in the trial were 11% and 31%, respectively. Randomization yields varied significantly by participant age, education, and marital status.

CONCLUSIONS

Our results demonstrate the feasibility of recruitment for trials of nonpharmacologic interventions in older people and suggest that mass mailing and mass media advertising campaigns provide an effective means of enrolling in such studies participants with a broad range of personal characteristics.

Can negative self-schemes in depressives be altered through sleep deprivation?

This paper addresses the question whether negative cognitive style represents a state or trait variable of depressive patients. For this reason, it studies the influence of sleep deprivation on negative self-schemes of those patients. 10 patients suffering from DSM-III-R major depression were compared with 10 age- and sex-matched controls on a task for rating the self-descriptiveness of positive and negative adjectives as well as a subsequent word recognition task. Three sessions were involved: an initial session (baseline), the second following a night of sleep deprivation, and the third after a successive full night's sleep. During the baseline examination, depressives showed a relatively negative cognitive bias; that is, the same number of positive and negative self-scheme elements. In comparison to controls, they showed significantly more negative and significantly less positive self-scheme elements. The same pattern emerged in a word recognition task for the number of recognized self-scheme elements. These variables indicated no change in the depressive group following sleep deprivation. Depressive subjects' reaction times on self-descriptiveness rating were significantly longer for positive than for negative self-scheme elements at the baseline session. The opposite was true for controls. Here, a sleep deprivation effect was evident. There was no longer a difference in the speed of information processing for positive as compared to negative self-scheme elements. This applied to both depressive and control groups.