The Patient in Your Alzheimer's Disease Study May be in Another: Duplication and Deception in Clinical Trials of Alzheimer's Disease

Duplicate and deceptive subjects, a significant issue in CNS studies, are not often considered in Alzheimer's Disease (AD) clinical trials. However, AD patients and their study partners may be motivated to take advantage of different mechanisms of action, increase odds of receiving active treatment, and/or obtain financial compensation, which may lead them to participate in multiple studies. CTSdatabase reviewed memory loss subjects (n=1087) from January 2017 through May 2019 to determine how many attempted to screen at multiple sites. 117 subjects (10.8%) visited more than one site within two years. When these potential AD subjects went to additional sites, it was predominantly for non-memory indications (often MDD or schizophrenia). For those that participated in studies, the rate of duplication approached 4% of screened AD subjects. This data indicates that significant numbers of AD subjects attempt to enroll at multiple sites, which confounds efficacy and safety signals in clinical trials.

Terrorismus aus psychiatrischer Sicht

Hintergrund

Terrorismus gehört zu den Extremformen von Gewalt, die bisher in der deutschsprachigen psychiatrischen Fachliteratur kaum Beachtung fanden. Nach Terroranschlägen oder Attentaten kommt jedoch regelhaft die Frage auf, ob die Mentalität der Täter noch im Bereich psychischer Normalität liegt.

Fragestellung und Methode

Ziel dieser Übersichtsarbeit ist es, das multidimensionale Ursachengefüge von Terrorismus mit besonderer Beachtung psychopathologischer Gegebenheiten bei den Tätern darzustellen. Hierzu wurde neben einer kurzen Zusammenfassung des historischen Hintergrundes eine Literatursuche in PubMed, SCOPUS, PsychInfo, und PsychARTICLES durchgeführt.

Ergebnisse

Aus psychiatrischer Sicht ist eine Unterscheidung von Einzel- und Gruppentätern essenziell, wobei erstere eine deutlich höhere Prävalenz an krankheitswertigen Psychosyndromen, insbesondere an psychotischen, anhaltenden wahnhaften, aber auch affektiven Störungen, aufweisen. Bei der Mehrzahl der untersuchten terroristischen Gruppentäter konnten keine derartigen psychiatrischen Diagnosen (nach Achse I, DSM-IV) festgestellt werden. Bei diesen Tätern spielen neben biografischen, Sozialisierungs-, gruppendynamischen sowie ideologischen Aspekten Persönlichkeitsakzentuierungen bis hin zu Persönlichkeitsstörungen (vor allem narzisstischer und paranoid-fanatischer Prägung) eine Rolle. Es wird dargelegt, warum Terrorismus ein vorwiegend männliches Phänomen ist.

Schlussfolgerungen

Es liegt ein komplex interagierendes Bedingungsgefüge aus biographischen, biologischen, psychopathologischen, soziologischen und ideologischen Komponenten vor, das bei Einzeltätern und Gruppenterroristen unterschiedlich gewichtet ist. Die Ursachen für Terrorhandlungen sind weniger in gewaltaffinen Ideologien selbst zu suchen als darin, dass Individuen mit vorbestehender hoher Gewaltaffinität, sei sie persönlichkeitsinhärent oder biografisch herleitbar, sich Ideologien anschließen, mit denen sich terroristische Gewaltakte rechtfertigen lassen. Die Möglichkeiten der Psychiatrie in Früherkennung und Prävention sind begrenzt. Auf neu entwickelte Skalen zur Beurteilung eines Risikos für extreme Gewalttaten wird hingewiesen.

Melatonin induces transcriptional regulation of Bim by FoxO3a in HepG2 cells

Background:

Melatonin induces apoptosis in many different cancer cell lines, including hepatocellular carcinoma cells. However, the responsible pathways have not been clearly elucidated. A member of the forkhead transcription factors' family, FoxO3a, has been implicated in the expression of the proapoptotic protein Bim (a Bcl-2-interacting mediator of cell death). In this study, we used human HepG2 liver cancer cells as an in vitro model to investigate whether melatonin treatment induces Bim through regulation by the transcription factor FoxO3a.

Methods:

Cytotoxicity of melatonin was compared in HepG2 hepatoblastoma cells and primary human hepatocytes. Proapoptotic Bim expression was analysed by reverse transcriptase–polymerase chain reaction and western blot. Reporter gene assays and chromatin immunoprecipitation assays were performed to analyse whether FoxO3a transactivates the Bim promoter. Small interfering RNA (siRNA) was used to study the role of FoxO3a in Bim expression. Immunofluorescence was performed to analyse FoxO3a localisation in HepG2 cells.

Results:

Melatonin treatment induces apoptosis in HepG2 cells, but not in primary human hepatocytes. The proapoptotic effect was mediated by increased expression of the BH3-only protein Bim. During melatonin treatment, we observed increased transcriptional activity of the forkhead-responsive element and could demonstrate that FoxO3a binds to a specific sequence within the Bim promoter. Furthermore, melatonin reduced phosphorylation of FoxO3a at Thr³² and Ser²⁵³, and induced its increased nuclear localisation. Moreover, silencing experiments with FoxO3a siRNA prevented Bim upregulation.

Conclusion:

This study shows that melatonin can induce apoptosis in HepG2 hepatocarcinoma cells through the upregulation of proapoptotic Bim mediated by nuclear translocation and activation of the transcription factor FoxO3a.

[Appendicitis necessitatis: appendicitis perforating the abdominal wall]

Perforation of the appendix through the anterior abdominal wall is a rare complication of a frequent disorder. We report on a 37-year old patient presenting with purulent secretion from the right lower abdomen. The CT scan of the abdomen revealed a perityphlitic abscess with perforation of the anterior abdominal wall. The patient underwent laparotomy with appendectomy and subsequent revision of the abdominal wall. Appendicocutaneous fistula due to perforation through the abdominal wall is a rarity. In analogy to empyema necessitatis, which would require the pleural empyema to penetrate the thoracic wall, the entity was denoted appendicitis necessitatis.

Tissue inhibitors of metalloproteinases in liver and serum/plasma in chronic active hepatitis C and HCV-induced cirrhosis

BACKGROUND/AIMS

The development of liver cirrhosis can be described as a process of tissue remodeling, which involves increased matrix turnover. In order to determine whether the expression of tissue inhibitors of metalloproteinases (TIMPs) reflects these changes and can be used as a marker for the activity of ongoing fibrosis, we studied TIMP-1, 2 and -3 in liver and serum/plasma of patients with chronic hepatitis C, hepatitis C virus-induced cirrhosis and healthy controls.

METHODOLOGY

Northern and Western blot analysis, reverse transcriptase polymerase chain reaction and ELISA measurements were performed.

RESULTS

Reverse transcriptase polymerase chain reaction showed transcripts of all 3 TIMPs in liver tissue. TIMP-1 and -2 were also detectable in lymphocytes and granulocytes, which did not contain any TIMP-3. mRNA for TIMP-1 and -3, but not for TIMP-2, was detectable by Northern blot in normal human liver and increased in fibrosis and cirrhosis. Western blotting demonstrated the presence of all 3 TIMP proteins in healthy liver. TIMP-1 and TIMP-2 levels increased, but TIMP-3 was unchanged in cirrhosis compared to normal tissue. ELISA studies showed that the increase of TIMP-1 occurred only in advanced cirrhosis, while levels did not elevate in chronic hepatitis with or without fibrosis. In plasma, some of the cirrhotic patients had very high TIMP-1 values, while mean circulating TIMP-1 levels were not significantly different between controls, hepatitis C and cirrhotic patients. Serum TIMP-2 levels were higher in chronic hepatitis and cirrhosis than in controls, but did not differ between patients with or without histologic fibrosis.

CONCLUSIONS

In normal human liver there is expression of all 3 TIMPs studied. The amount of hepatic TIMP-1 protein increases late in the fibrotic process, and there is a weak correlation between the activity of fibroproliferation and hepatic or circulating amounts of TIMP-1. Currently there is no evidence that measurement of TIMP-2 and TIMP-3 in liver or blood improves diagnosis of fibroproliferation in chronic hepatitis C.

Induction of DNA double-strand breaks by 1H and 4He lons in primary human skin fibroblasts in the LET range of 8 to 124 keV/microm

Yields of DNA double-strand breaks were determined in primary human skin fibroblasts exposed to 1H and 4He ions at various linear energy transfers (LETs) and to 15 MeV electrons as the reference radiation. The values obtained for the relative biological effectiveness (RBE) were 2.03, 1.45 and 1.36 for 1H ions at LETs of 35, 23 and 7.9 keV/microm, respectively, and 1.2, 1.18, 1.38 and 1.31 for 4He ions at LETs of 124, 76, 35 and 27 keV/microm, respectively. The data were obtained using pulsed-field gel electrophoresis of DNA released from cells using the chromosomes of the yeast Saccharomyces cerevisiae as length markers and fitting the experimental mass distributions of fragmented DNA to those obtained by computer simulation of the random breakage of human chromosomes. The RBE values for induction of DSBs in mammalian cells cannot be fitted to a common RBE-LET relationship for electrons and 1H, 4He and light ions. Comparison of the RBEs for mammalian cells with the corresponding RBEs obtained for yeast cells shows similar RBEs of electrons for yeast and mammalian cells; however, for 4He and light ions in the LET range of 100 to 1000 keV/microm, the RBEs for yeast are significantly higher compared with mammalian cells. These characteristics of the RBE-LET relationships for yeast and mammalian cells are attributed to the fraction of small DNA fragments induced by particles when traversing the higher-order chromatin structures which are different to some extent in these two cell types.

Latex allergy in hospital employees

To investigate the incidence of latex IgE-mediated hypersensitivity, 224 hospital employees were interviewed and prick skin tests were performed to six common aeroallergen extracts, one non-latex "synthetic" glove extract, and four different latex glove extracts. Of the 224 subjects, there were 136 nurses, 41 laboratory technicians, 13 dental staff, 11 physicians, 6 respiratory therapists, and 17 housekeeping and clerical workers. All 224 subjects tested negative for the nonlatex glove (Tactylon) extract but 38 (17%) tested positive for latex extracts. The incidence ranged from 0% in housekeeping staff to 38% in dental staff. Eighty-four percent of the latex skin test-positive employees complained of itching and 68% of rash upon exposure to latex, whereas the latex skin test-negative employees reported these symptoms in 29% and 17%, respectively. Urticaria was a symptom in 55% of the latex skin test-positive and 0.5% of the skin test negative-subjects. Anaphylaxis occurred in 10.5% of the skin test-positive and in none of the skin test-negative employees. Symptoms of sneezing (34% vs 7%), nasal congestion (39% vs 7%), and lacrimation and ocular itching (45% vs 6%) were also significantly different between the latex skin test-positive and latex skin test-negative subjects. We conclude that the incidence of latex IgE-mediated allergy in hospital employees is 17%. The symptoms of anaphylaxis and hives when using latex gloves are sensitive predictors of IgE-mediated latex allergy.

Evaluation of latex allergy in patients with meningomyelocele

Seventy-six patients with meningomyelocele were evaluated for latex sensitivity by medical history and epicutaneous skin testing. Four different latex glove extracts, two nonlatex glove extracts, cornstarch, selected inhalant antigens, and negative and positive controls were used for skin testing. Forty-nine patients (64.5%) were skin test positive to latex extracts (latex-positive group). Twenty-four patients (49%) of the latex-positive group and none of the latex-negative group had histories of immediate reactions to latex products (P less than .001). The latex-positive group had a higher mean number of surgical procedures, 12.67 +/- 11.27, compared with 6.89 +/- 6.55 (P less than .001) in the latex-negative group. Twenty-three of the latex-positive patients (47%) used latex products daily compared to seven patients (26%) in the latex-negative group (P = .073). Twenty latex-positive patients (41%) had atopy compared with five patients (19%) of the latex negative group (P = .041). There was no significant difference between the two groups in age, sex, daily catheterization, or positive skin tests to cornstarch. All 76 patients tested negative to the nonlatex glove extracts. Ten control subjects tested negative for all latex and nonlatex glove extracts.