Targeted Lung Health Check: breast related incidental findings-imaging appearances and lessons learned

OBJECTIVE

The introduction of Targeted Lung Health Checks (TLHC) to screen for lung cancer has highlighted that incidental findings are common and require management strategies. This study analyses retrospectively, incidentally detected breast lesions reported as part of the TLHC referred to the Breast Cancer clinicians.

METHODS

All participants with incidental breast nodules referred to the Breast Cancer team in the first year of screening were reviewed.

RESULTS

Fifty-two participants (48 female; 92.3%) were referred to the Breast Multidisciplinary Team Meeting for assessment of 43 breast nodules, 8 breast asymmetry/dense breasts, and 2 likely breast related metastatic disease. One participant declined breast team referral. For the 42 breast nodules investigated, the final diagnoses were 5 breast carcinomas, 10 normal breast tissue, and 27 benign nodules. One male patient was diagnosed with breast carcinoma. The 29 breast nodules classified as smooth and well defined were all benign. No malignancy was demonstrated in the group with asymmetric or dense breast tissue. Metastatic breast carcinoma was confirmed in two participants. Twenty-six out of thirty-seven (54%) females had prior breast screening mammograms precluding further investigation.

CONCLUSION

Incidental breast nodules are common on THLC scans. Smooth, sharply defined breast nodules are likely to be benign but low-dose CT is poor at accurately assessing breast nodules. Agreed breast referral pathways prior to starting the Lung Cancer Screening programme are recommended. Access to screening mammograms can reduce referrals to the Breast clinic.

ADVANCES IN KNOWLEDGE

Lessons learned from TLHC pilot studies can be useful to sites commencing national TLHC programme.

Immunotherapy for thymoma

Thymic epithelial tumors (TETs) are rare thymic neoplasms. There are approximately 1.5 cases per million TETs per year. They are the most common anterior mediastinal tumors in adults. Due to limited activity of available treatment options novel strategies and treatment options are needed and treatment with immune checkpoint inhibitors is an attractive option. Thymic epithelial tumors have one of the lowest tumor mutational burden among all cancer in adults, but high expression of PD-L1 on tumor cells and abundant CD8+ lymphocytes provide a strong rational for implementing immune checkpoint inhibitors (ICIs) which target PD-1/PD-L1 pathway in the treatment of TETs. Few small early stage clinical trials were published so far evaluating efficacy of pembrolizumab and avelumab in thymoma and thymic carcinoma patients. Al trials showed reasonable response rates and progression-free survival. Higher PD-L1 expression was predictor of response in all trials. However, increased incidence of immune-related adverse events was seen in TET patients treated with immune checkpoint inhibitors compared to patients with other cancers. At the moment, ICIs are not standard of care for patients with TET and larger trials are needed to establish the right role of ICIs regarding efficacy and safety of these agents.

Atezolizumab and platinum-based chemotherapy in extensive-stage small cell lung cancer: A single center experience

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Background: In extensive stage small-cell lung cancer (ES-SCLC) immune check-point inhibitors, atezolizumab and durvalumab, when combined with chemotherapy in the first-line setting show better efficacy than chemotherapy alone with safety profile similar as the adverse events of individual agents. Methods: We administered atezolizumab, etoposide and platinum, either carboplatin or cisplatin, in the first-line treatment in 24 newly diagnosed patients with ES-SCLC. Patients were treated until disease progression or unacceptable toxicity. Results: Out of 24 treated patients 13 were males and 11 were females, median age 61 (ranging from 44 to 80). Majority of patients were ECOG 1. Median number of atezolizumab doses was 8 (ranging from 2 to 11). We observed median progression free survival of 6 months (95%CI 4,28-7,72), while median overall survival was not reached. 10 patients (41%) are still undergoing treatment and 9 patients (37%) have died. Immune-related adverse events occurred in 6 patients (25%). Four patients developed pneumonitis (all of them CTCAE grade 2), two patients colitis (CTCAE grade 2 and 3) and one patient rash, CTCAE grade 3. Median treatment pause was 5 weeks (ranging from 3 to 12 weeks). There were no treatment discontinuations due to adverse events nor treatment related deaths. Conclusions: Atezolizumab combined with chemotherapy in ES-SCLC showed good tolerability and effectiveness in real world setting. Our data are consistent with published clinical trial data. There was no new safety signal in our patient cohort. Limitations of our report are small sample size and short follow-up time.

Experimental Demonstration of Hadron Beam Cooling Using Radio-Frequency Accelerated Electron Bunches

Cooling of beams of gold ions using electron bunches accelerated with radio-frequency systems was recently experimentally demonstrated in the Relativistic Heavy Ion Collider at Brookhaven National Laboratory. Such an approach is new and opens the possibility of using this technique at higher energies than possible with electrostatic acceleration of electron beams. The challenges of this approach include generation of electron beams suitable for cooling, delivery of electron bunches of the required quality to the cooling sections without degradation of beam angular divergence and energy spread, achieving the required small angles between electron and ion trajectories in the cooling sections, precise velocity matching between the two beams, high-current operation of the electron accelerator, as well as several physics effects related to bunched-beam cooling. Here we report on the first demonstration of cooling hadron beams using this new approach.

Measurement of the Spin Tune Using the Coherent Spin Motion of Polarized Protons in a Storage Ring

This Letter reports the first spin tune measurement at high energies (24 and 255 GeV) with a driven coherent spin motion. To maintain polarization in a polarized proton collider, it is important to know the spin tune of the polarized proton beam, which is defined as the number of full spin precessions per revolution. A nine-magnet spin flipper has demonstrated high spin-flip efficiency in the presence of two Siberian snakes [H. Huang et al., Phys. Rev. Lett. 120, 264804 (2018).10.1103/PhysRevLett.120.264804]. The spin flipper drives a spin resonance with a given frequency (or tune) and strength. When the drive tune is close to the spin tune, the proton spin direction is not vertical anymore, but precesses around the vertical direction. By measuring the precession frequency of the horizontal component, the spin tune can be precisely measured. A driven coherent spin motion and fast turn-by-turn polarization measurement are keys to the measurement. The vertical spin direction is restored after turning the spin flipper off and the polarization value is not affected by the measurement. The fact that this manipulation preserves the polarization makes it possible to measure the spin tune during the operation of a high energy accelerator.

High Spin-Flip Efficiency at 255 GeV for Polarized Protons in a Ring With Two Full Siberian Snakes

In polarized proton collision experiments, it is highly advantageous to flip the spin of each bunch of protons during the stores to reduce the systematic errors. Experiments done at energies less than 2 GeV have demonstrated a spin-flip efficiency over 99%. At high energy colliders with Siberian snakes, a single magnet spin flipper does not work because of the large spin tune spread and the generation of multiple, overlapping resonances. A more sophisticated spin flipper, constructed of nine-dipole magnets, was used to flip the spin in the BNL Relativistic Heavy Ion Collider. A special optics choice was also used to make the spin tune spread very small. A 97% spin-flip efficiency was measured at both 24 and 255 GeV. These results show that efficient spin flipping can be achieved at high energies using a nine-magnet spin flipper.

Operational Head-on Beam-Beam Compensation with Electron Lenses in the Relativistic Heavy Ion Collider

Head-on beam-beam compensation has been implemented in the Relativistic Heavy Ion Collider in order to increase the luminosity delivered to the experiments. We discuss the principle of combining a lattice for resonance driving term compensation and an electron lens for tune spread compensation. We describe the electron lens technology and its operational use. To date, the implemented compensation scheme approximately doubled the peak and average luminosities.

Geographical distribution and clinical relevance of non-tuberculous mycobacteria in Croatia

SETTING

The clinical relevance of non-tuberculous mycobacteria (NTM) in Croatia is unknown.

OBJECTIVE

To estimate the isolation rate of NTM, record geographical differences and assess the burden of pulmonary NTM disease in Croatia.

DESIGN

Nationwide retrospective cohort study of all Croatian residents with NTM isolated by culture in the period from 2006 to 2010. Microbiological criteria of the American Thoracic Society were used to establish a laboratory-based case definition of possible and probable NTM disease.

RESULTS

Of 1187 individuals with pulmonary NTM isolates, 8.6% met the possible and 5.5% met the probable disease criteria. We estimated an annual incidence of probable pulmonary NTM disease of 0.23 per 100,000 population. This estimated annual incidence was 0.35/100,000 in the coastal region and 0.17/100,000 in the continental region. Species distribution differed between coastal and continental Croatia. NTM isolation frequency increased over the study period.

CONCLUSION

Geography plays an important role in NTM species distribution and possible disease. The overall burden of NTM pulmonary disease in Croatia is still low compared to that of tuberculosis, but it is higher in the coastal region compared to the continental region.

Suicide methods in Europe: a gender-specific analysis of countries participating in the "European Alliance Against Depression"

OBJECTIVE

To identify the most frequent gender-specific suicide methods in Europe.

DESIGN

Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied.

SETTING AND PARTICIPANTS

Data on suicide methods for 119,122 male and 41,338 female cases in 2000-4/5 from 16 EAAD countries, covering 52% of European population were obtained.

RESULTS

Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results.

CONCLUSIONS

Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.

Measuring depression: comparison and integration of three scales in the GENDEP study

BACKGROUND

A number of scales are used to estimate the severity of depression. However, differences between self-report and clinician rating, multi-dimensionality and different weighting of individual symptoms in summed scores may affect the validity of measurement. In this study we examined and integrated the psychometric properties of three commonly used rating scales.

METHOD

The 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI) were administered to 660 adult patients with unipolar depression in a multi-centre pharmacogenetic study. Item response theory (IRT) and factor analysis were used to evaluate their psychometric properties and estimate true depression severity, as well as to group items and derive factor scores.

RESULTS

The MADRS and the BDI provide internally consistent but mutually distinct estimates of depression severity. The HAMD-17 is not internally consistent and contains several items less suitable for out-patients. Factor analyses indicated a dominant depression factor. A model comprising three dimensions, namely 'observed mood and anxiety', 'cognitive' and 'neurovegetative', provided a more detailed description of depression severity.

CONCLUSIONS

The MADRS and the BDI can be recommended as complementary measures of depression severity. The three factor scores are proposed for external validation.

Genome-wide scan for genes involved in bipolar affective disorder in 70 European families ascertained through a bipolar type I early-onset proband: supportive evidence for linkage at 3p14

Preliminary studies suggested that age at onset (AAO) may help to define homogeneous bipolar affective disorder (BPAD) subtypes. This candidate symptom approach might be useful to identify vulnerability genes. Thus, the probability of detecting major disease-causing genes might be increased by focusing on families with early-onset BPAD type I probands. This study was conducted as part of the European Collaborative Study of Early Onset BPAD (France, Germany, Ireland, Scotland, Switzerland, England, Slovenia). We performed a genome-wide search with 384 microsatellite markers using non-parametric linkage analysis in 87 sib-pairs ascertained through an early-onset BPAD type I proband (AAO of 21 years or below). Non-parametric multipoint analysis suggested eight regions of linkage with P-values<0.01 (2p21, 2q14.3, 3p14, 5q33, 7q36, 10q23, 16q23 and 20p12). The 3p14 region showed the most significant linkage (genome-wide P-value estimated over 10 000 simulated replicates of 0.015 [0.01-0.02]). After genome-wide search analysis, we performed additional linkage analyses with increased marker density using markers in four regions suggestive for linkage and having an information contents lower than 75% (3p14, 10q23, 16q23 and 20p12). For these regions, the information content improved by about 10%. In chromosome 3, the non-parametric linkage score increased from 3.51 to 3.83. This study is the first to use early-onset bipolar type I probands in an attempt to increase sample homogeneity. These preliminary findings require confirmation in independent panels of families.

The completed suicide as interplay of genes and environment

The review will tackle the interplay of genetic and environmental risk factors behind the completed suicide. First, individual differences in suicidal behaviour in relation to heritability are presented followed by a brief discussion of genetic methods currently used to investigate candidate genes for the completed suicide. Further along the polygenetic, multi-factorial model of genetic proneness to suicidal behaviour is presented as interplay of genes and environment. Finally, the future implications in this quickly blossoming field of research are discussed.

[Registration of clinical trials: a statement from the International Committee of Medical Journal Editors]

Altruistic motives and trust are central to scientific investigations involving people. These prompt volunteers to participate in clinical trials. However, publication bias and other causes of the failure to report trial results may lead to an overly positive view of medical interventions in the published evidence available. Registration of randomised controlled trials right from the start is therefore warranted. The International Committee of Medical Journal Editors has issued a statement to the effect that the 11 journals represented in the Committee will not consider publication of the results of trials that have not been registered in a publicly accessible register such as www.clinicaltrials.gov. Patients who voluntarily participate in clinical trials need to know that their contribution to better human healthcare is available for decision making in clinical practice.

High bifurcation of common carotid artery, anomalous origin of ascending pharyngeal artery and anomalous branching pattern of external carotid artery

We present a rare case of combined high bifurcation of the common carotid artery, anomalous origin of the ascending pharyngeal artery and unusual branching pattern of the external carotid artery. The right common carotid artery bifurcated at the level between the second and the third cervical vertebrae, giving rise to the ascending pharyngeal artery just below the bifurcation. The right external carotid artery branched directly at its origin into the superior thyroid, lingual and occipital arteries and the distal part of the external carotid artery. The latter gave rise to the right facial artery and finally bifurcated into the maxillary and superficial temporal arteries. The right posterior auricular artery arose from the right occipital artery. The finding was unilateral and other vascular anomalies were not observed. The embryogenesis of such a combination of anomalies is not clear, but the anatomic consequences may have important clinical implications.

What can psychiatric genetics offer suicidology?

There is good evidence from recent studies that depression is familial, and that a substantial proportion of the variation in liability is explained by genes. Suicidal behavior, including completed suicide, also seems to cluster in families. First-degree relatives of individuals who have committed suicide (included dizygotic twins) have more than twice the risk of the general population. For identical co-twins of suicides, the relative risk increases to about 11. Applying a simple structural equation model to the published data suggests a heritability for completed suicide of about 43% (95% confidence intervals 25-60). It is not known at present whether the genes predisposing to suicide are identical with those predisposing to affective disorder, but since only about half of those committing suicide have a diagnosis of depression, it seems probable that the overlap is incomplete. The mode of inheritance of suicidal behavior is almost certain to be complex, involving many genes. There have already been some initial studies of allelic association with polymorphisms in candidate genes such as those involved in serotonergic transmission. Further progress is likely to come from candidate gene and linkage disequilibrium studies that are capable of detecting multiple genes of small effect.

What can psychiatric genetics offer suicidology?

There is good evidence from recent studies that depression is familial, and that a substantial proportion of the variation in liability is explained by genes. Suicidal behavior, including completed suicide, also seems to cluster in families. First-degree relatives of individuals who have committed suicide (included dizygotic twins) have more than twice the risk of the general population. For identical co-twins of suicides, the relative risk increases to about 11. Applying a simple structural equation model to the published data suggests a heritability for completed suicide of about 43% (95% confidence intervals 25-60). It is not known at present whether the genes predisposing to suicide are identical with those predisposing to affective disorder, but since only about half of those committing suicide have a diagnosis of depression, it seems probable that the overlap is incomplete. The mode of inheritance of suicidal behavior is almost certain to be complex, involving many genes. There have already been some initial studies of allelic association with polymorphisms in candidate genes such as those involved in serotonergic transmission. Further progress is likely to come from candidate gene and linkage disequilibrium studies that are capable of detecting multiple genes of small effect.

Suicide in Croatia and in Croatian immigrant groups in Australia and Slovenia

AIM

To compare suicide rates in Australia, Slovenia, and Croatia with suicide rates in Croatian immigrant groups in Australia and Slovenia in a 10-year period.

METHOD

We analyzed records for completed suicides of the residents of Australia in a decade between 1988 and 1997 and Croatia and Slovenia in a decade between 1985 and 1994. The Croatian Catholic Centers in Australia had 31 completed suicides reported in their Parish Registries in the decade between 1985 and 1994. In Slovenia, 141 completed suicides of Croats were reported in the same decade by the Institute of Public Health of Republic of Slovenia.

RESULTS

The suicide rate and method of suicide in the Croatian immigrant group in Slovenia (26.01/100,000/year; 60% of hanging) converged towards those of the host country (31.43/100,000/year; 76% of hanging), perhaps as a function of the years since migration from Croatia (22.53/100,000/year; 42% of hanging). Somewhat higher male-female ratio in this immigration group (3.55) could be explained by their lower social status. Surprisingly low suicide rate was calculated for the immigration group in Australia (3.10/100,000/year).

CONCLUSION

Croat immigrants to Australia have the lowest suicide rate, but the highest male-female suicide ratio, which could be a consequence of underreporting of suicides by Croatian Catholic Centers in Australia. Different suicide data sources can be a source of significant bias in cross-cultural comparison of suicide behavior.

Extracranial branches of the middle meningeal artery

We present a case of unusual extracranial branches of the middle meningeal artery. The middle meningeal artery originated from the medial side of the maxillary artery and entered the skull through the foramen spinosum. The posterior superior alveolar artery originated from the middle meningeal artery, gave rise to the pterygoid branch, and entered the maxilla. In addition, the bifurcation of the common carotid artery was at the level of the second cervical vertebra. The embryogenesis of such rare branching pattern of the middle meningeal artery is not clear, but the anatomical consequences may have clinical implications.

Injury proneness and personality

The aim of this research was to investigate some personality factors among groups of 43 physically injured inpatients and 43 non-injured hospital-based controls. The participants completed the Eysenck Personality Questionnaire (EPQ) and the Coping Styles Questionnaire (CSQ). Logistic regression was used to compare the two groups on six psychological risk factors. The univariate regression models suggested three possible risk factors: extraversion, sensitization, and avoidance coping style. The multivariate regression model supported only extraversion and sensitization of emotion. Next, patients in the experimental group were questioned about whether they had considered preventive measures before the accident and whether they felt responsible for their injuries. Correlation analysis showed that introverted subjects felt more responsible for the sustained injuries than their extraverted counterparts. Sensitizers and subjects who scored high on psychoticism, neuroticism, and emotional coping had not considered preventive measures as often as others. Finally, the principal component analysis of risk factors was used to extract two correlates of injury-prone behaviour: extraversion and sensitized avoidance. It was concluded that psychological factors play an important role in predicting injury that is significant enough to require inpatient treatment. Two potential mechanisms of psychological impact have been suggested, notably distraction in extraverted subjects and overestimation in sensitizing avoiders.

Immunohistological and flow cytometric analysis of glycosphingolipid expression in mouse lymphoid tissues

Expression of neutral glycosphingolipids (GSLs) and gangliosides in normal lymphoid tissues and cells has been studied mostly by biochemical and immunochemical analysis of lipid extracts separated by thin-layer chromatography. GSLs and gangliosides involved in the GM1b biosynthetic pathway were assigned to T-lymphocytes, whereas B-cell gangliosides and GSLs have been poorly characterized in former publications. We used specific polyclonal antibodies in immunohistochemistry and flow cytometry to analyze the distribution of globotriaosylceramide (Gb(3)Cer), globoside (Gb(4)Cer), gangliotriaosylceramide (Gg(3)Cer), gangliotetraosylceramide (Gg(4)Cer), and gangliosides GM3 and GalNAc-GM1b in the mouse thymus, spleen, and lymph node. Immature thymocytes expressed epitopes recognized by all antibodies, except for anti-Gb(4)Cer. Mature thymocytes bound only antibodies to GalNAc-GM1b, Gg(4)Cer, and Gb(4)Cer. In secondary lymphoid organs, antibodies to globo-series GSLs bound to vascular spaces of secondary lymphoid organs, whereas the ganglio-series GSL antibodies recognized lymphocyte-containing regions. In a Western blotting analysis, only GalNAc-GM1b antibody recognized a specific protein band in all three organs. Flow cytometric analysis of spleen and lymph node cells revealed that B-cells carried epitopes recognized by all antibodies, whereas the T-cell GSL repertoire was mostly oriented to ganglio-series-neutral GSLs and GM1b-type gangliosides. The results of immunohistochemistry and flow cytometry were not always identical, possibly because of crossreactivity to glycoprotein-linked oligosaccharides and/or differences between cell surface carbohydrate profiles of isolated cells and cells in a tissue environment.

Role of B lymphocytes in new bone formation

Although there may be a close relationship between B lymphocytes and osteoclasts, or bone resorbing cells, little is known about the role of B lymphocytes in bone formation. We compared in vivo new bone induction in mice homozygous for the B-cell deficient (microMT) gene knockout, which lack functional B lymphocytes, with bone induction in control wild-type (C57BL/6) mice. Our comparison used two models of new bone induction in vivo: endochondral osteoinduction by subcutaneous implantation of recombinant human bone morphogenetic protein (rhBMP-2) and osteogenic regeneration after tibial bone marrow ablation. The expression of bone-specific proteins (bone sialoprotein, osteopontin, and osteocalcin) and inflammatory/immunomodulatory cytokines (interleukin-1alpha and -1beta, interleukin-6, and tumor necrosis factor-alpha) was assessed by Northern blot analysis or reverse transcription-polymerase chain reaction, respectively. Ossicles induced by rhBMP-2 were larger in volume and mass in microMT knockout mice, but relative volumes of the newly induced bone, cartilage, and bone marrow were similar in the two groups. Six days after tibial bone marrow ablation, microMT knockout mice resorbed the initial blood clot faster and formed more trabecular bone, paralleled by greater levels of bone sialoprotein mRNA than in the wild-type mice. microMT knockout and wild-type mice also differed in the expression pattern of inflammatory/immunomodulatory cytokines during the development of the newly induced bone, suggesting that a genetic lack of B lymphocytes may create a change in the immunological milieu at the site of new bone induction, which stimulates the initial accumulation and proliferation of mesenchymal progenitor.

Croatia: legal regulation of doctors

Accompanying changes in the way health services in Croatia are organised has been a significant change in the way the medical profession is regulated. In 1995 the Croatian Medical Chamber was established, with legal powers. The responsibilities of physicians to their patients are spelled out in considerable detail. Most of these responsibilities are matched by provisions in Croatia's criminal law. Croatia has about 10,000 doctors and dentists and since 1998 19 cases have been resolved by the Medical Chamber and its commissions. Public health providers offer protection in medical negligence cases but this could change as more market-oriented health-care provision is introduced. In 1997 and 1998 only 60 malpractice claims under the criminal law were brought and most of those were dismissed.

Factor analysis of risk for coronary heart disease: an independent replication

Eleven risk factors for coronary heart disease were measured on 187 patients with and 187 patients without this disease. Next, factor analysis was performed to identify underlying variables, or factors, that explain the pattern of correlations within a set of observed risk factors. The factor analysis disclosed four factors that explained almost 55% of the variance: a dyslipidaemic and haemostatic complex, a pure hypercholesterolaemia, the metabolic syndrome X, and positive family and medical histories. The four extracted patterns of risk factors did not replicate previous factor analyses of coronary heart disease risk factors, in which the family history of coronary disease on one side and a generalised lack of self-control on the other were suggested. They, however, generated some understanding regarding coronary heart disease risk factors' interactions. Also, results of the present study do encourage efforts to explore new methods designated to bring about more basic forms of personality reorganisation in the realm of self-control, which could in turn have a positive impact on risk factors profile, health status and mortality.

Search for the CP forbidden decay eta-->4pi(0)

We report the first determination of the upper limit for the branching ratio of the CP forbidden decay eta-->4pi(0). No events were observed in a sample of 3.0x10(7) eta decays. The experiment was performed with the Crystal Ball multiphoton spectrometer installed in a separated pi(-) beam at the AGS (Alternating Gradient Synchrotron). At the 90% confidence limit, B(eta-->4pi(0))</=6. 9x10(-7).

Small scientific journals from small countries: breaking from a vicious circle of inadequacy

In this editorial we describe the confounding factors that contribute to the poor international recognition of small journals: author pool, review process, finances, language, and visibility. These factors originate from relative scientific inadequacy of the local environment and close a positive feedback loop (vicious circle) of journal inadequacy. We argue that small journals may provide important information and outline the ways in which they can be assisted.

Suicide mortality in Slovenia: regional variation

Different medical, social, and environmental regional characteristics were investigated as possible predictors of suicide rates in 60 self-governing communes in Slovenia. The distribution pattern of regional suicide rates for Slovenia shows some similarity to that of the rest of Europe, especially in terms of the substantial variation of suicide density within the country. On the basis of the multivariate analysis, prevalence of alcohol psychosis, percentage of Catholics, and low duration of sunshine appeared to be the most important predictors of regional suicide rates in Slovenia. The rate of murders was proven to be a highly useful clue of suicide potential among younger groups, whereas income per capita of population was associated with suicide risk in old age. The principal component analysis provided three suicide risk patterns: a socio-economic risk pattern (Catholic religion in poor community), a behavioral one (antisocial features, including heavy drinking), and a depression-related risk pattern with a climatic component (lack of sunshine). Different approaches are necessary for the different risk patterns listed above. Psychiatry, especially clinical psychiatry, can only deal with components of two of the patterns, namely, depression and antisocial behavior.

Rape, torture, and traumatization of Bosnian and Croatian women: psychological sequelae

The first 25 Bosnian women admitted to the Zagreb Obstetrics and Gynaecological Clinic or its associated regional psychiatric centers were assessed using both clinical and post-traumatic stress disorder interviews. Most of the women had been multiply traumatized; all had been repeatedly raped. Psychological status was assessed for those women who were not impregnated, for those impregnated who received abortions, and for those impregnated who carried the fetus to term.

Rapid high-performance liquid chromatographic determination of vancomycin in human plasma

A rapid simple and robust reversed-phase HPLC method was developed for rapid screening in bioavailability studies or comparative bioequivalence studies. The method is specific for vancomycin as no interference from acetylsalicylic acid, paracetamol and caffeine was observed. The mean intra-day precision was from 11.7% (low concentration) to 0.3% (high concentration) and the within-day precision from 15.0 to 0.3%, determined on spiked samples. The accuracy of the method was 106.4-99.8% (intra-day) and 103.5-100.2% (inter-day).

HPLC method for determination of ergot alkaloids and some derivatives in human plasma

Ergot alkaloids and their dihydrogenated methanesulphonate (ms) salts were determined and measured in human plasma. High-performance liquid chromatography (HPLC) with fluorometric detection was used for separation of ergot alkaloids in plasma. Several ergot alkaloids and their derivatives, including lysergide (LSD), can be identified in cases of poisoning.