[Acute management of spontaneous intracerebral hemorrhage]

Intracerebral hemorrhage accounts for approximately 15% of the 115,000 strokes occurring each year in France. Although therapeutic strategies are more limited than for ischemic stroke, major points in the management of intracerebral hemorrhage can reduce short term morbidity and mortality by limiting the expansion of the hematoma and the occurrence of early complications, and long term patients' outcome by reducing the risk of recurrence. This article aims to update the key elements that contribute to improve of the prognosis of intracerebral hemorrhage patients.

[Management of ischemic stroke in the acute phase]

Ischemic stroke accounts for 80% of overall stroke, and is one of the leading causes of death, disability and dementia in worldwide. Management of patients with acute ischemic stroke dramatically improved over time with the implementation of intensive care stroke units, the development of acute recanalization strategies, the optimization of the management of post-stroke complications, and the prevention of early stroke recurrence. The objective of this article is to provide a general overview of the current management of patients with acute ischemic stroke aiming at improving post-stroke outcome.

Analysing livestock network data for infectious disease control: an argument for routine data collection in emerging economies

Livestock movements are an important mechanism of infectious disease transmission. Where these are well recorded, network analysis tools have been used to successfully identify system properties, highlight vulnerabilities to transmission, and inform targeted surveillance and control. Here we highlight the main uses of network properties in understanding livestock disease epidemiology and discuss statistical approaches to infer network characteristics from biased or fragmented datasets. We use a 'hurdle model' approach that predicts (i) the probability of movement and (ii) the number of livestock moved to generate synthetic 'complete' networks of movements between administrative wards, exploiting routinely collected government movement permit data from northern Tanzania. We demonstrate that this model captures a significant amount of the observed variation. Combining the cattle movement network with a spatial between-ward contact layer, we create a multiplex, over which we simulated the spread of 'fast' ( R₀ = 3) and 'slow' ( R₀ = 1.5) pathogens, and assess the effects of random versus targeted disease control interventions (vaccination and movement ban). The targeted interventions substantially outperform those randomly implemented for both fast and slow pathogens. Our findings provide motivation to encourage routine collection and centralization of movement data to construct representative networks. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.

Increasing self-esteem: Efficacy of a group intervention for individuals with severe mental disorders

Background

Individuals with psychosis are known to have a lower self-esteem compared to the general population, in part because of social stigma, paternalistic care, long periods of institutionalization and negative family interactions. This study aimed at assessing the efficacy of a self-esteem enhancement program for individuals with severe mental illness and at analyzing the results in their European context.

Method

A randomized cross-over study including 54 outpatients with a diagnosis of schizophrenia from Geneva, Switzerland, was conducted. Twenty-four were recruited from an outpatient facility receiving traditional psychiatric care whereas 30 came from an outpatient facility with case-management care. Psychosocial, diagnostic and symptom measures were taken for all the subjects before treatment, after treatment, and at 3-months' follow-up.

Results

Results indicated significant positive self-esteem module effects on self-esteem, self-assertion, active coping strategies and symptom for the participants receiving case-management care. Results were not significant for those receiving traditional care. However, 71% of all participants expressed satisfaction with the module.

Conclusion

Individuals with schizophrenia appear to be benefit from the effects of the self-esteem module, particularly when they are involved in a rehabilitation program and followed by a case manager who liaises with the other partners of the multidisciplinary team. This encourages reconsidering the interventions' format and setting in order to ensure lasting effects on the environment and in turn on coping, self-esteem and overall empowerment.

Air pollution and stroke. A new modifiable risk factor is in the air

Evidence from epidemiological studies has demonstrated that outdoor air pollution is now a well-known major problem of public health, mainly in low and middle income countries. Contrasting with myocardial infarction, there are few data on the association of air pollution and stroke.

METHODS

We propose a narrative literature review of the effects and the underlying biological mechanisms of short- and long-term exposure to air pollutants on stroke risk and mortality, using the following key-words: stroke, cerebrovascular events, ischemic and haemorrhage stroke, transient ischaemic attack, mortality, air pollution and air pollutants.

RESULTS

Twenty-one papers were selected. Air pollution, of which whose small particulate matter are the most toxic, contributes to about one-third of the global burden of stroke. We can identify vulnerable patients with classical neuro-vascular risk factors or a prior history of stroke or transient ischemic attack or persons living in low-income countries. Biological mechanisms of this new morbid association are discussed.

CONCLUSION

Air pollution should be recognized as a silent killer inducing stroke whose mortality rates remain elevated by its role as a new modifiable neurovascular risk factor, needing public health policies.

A review of psychosocial factors and stroke: A new public health problem

The role of psychosocial factors (PSF) in increased risk of stroke is a novel public health challenge, but unclear definitions for PSF and the multiple stroke subtypes have led to inconsistent reports. A review of this issue is therefore warranted.

METHODS

Several databases were used for this narrative systematic review (Medline, Embase and Cochrane Library). Two independent reviewers evaluated articles from between 2001 and 2018 on the themes of PSF and stroke/transient ischemic attack (TIA). PSF criteria were job strain, psychological interpersonal and behavioral stress, and social deprivation. Ischemic and hemorrhagic stroke and TIA subtypes were also identified.

RESULTS

Forty-five cohorts, five case-control studies and two meta-analyses were included. Despite mixed results, PSF were associated with an increased risk of ischemic and hemorrhagic stroke in populations of all ages, and more predominantly in women.

CONCLUSION

This broad review shows that the presence of PSF is associated with an increased risk stroke and TIA. As such, PSF must figure in both public health policy and stroke prevention programs, similar to other established metabolic and environmental factors.

[The assessment of spirituality and religiousness in patients with psychosis]

OBJECTIVES

There is evidence that psychiatrists are rarely aware of how religion may intervene in their patient's life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion.

PATIENTS AND METHODS

This paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up.

RESULTS

Spiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months' outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective.

CONCLUSIONS

Spiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way.

Printing medicines as orodispersible dosage forms: Effect of substrate on the printed micro-structure

We present our recent advancements in developing a viable manufacturing process for printed medicine. Our approach involves using a non-contact printing system that incorporates both piezoelectric- and solenoid valve-based inkjet printing technologies, to deliver both active and inactive pharmaceutical materials onto medical-graded orodispersible films. By using two complimentary inkjet technologies, we were able to dispense an extensive range of fluids, from aqueous drug solutions to viscous polymer coating materials. Essentially, we demonstrate printing of a wide range of formulations for patient-ready, orodispersible drug dosage forms, without the risk of drug degradation by ink heating and of substrate damages (by contact printing). In addition, our printing process has been optimized to ensure that the drug doses can be loaded onto the orally dissolvable films without introducing defects, such as holes or tears, while retaining a smooth surface texture that promotes patient adherence and allows for uniform post-coatings. Results show that our platform technology can address key issues in manufacturing orodispersible drug dosage forms and bring us closer to delivering personalized and precision medicine to targeted patient populations.

[An exploration of sexual desire and sexual activities of women with psychosis]

Most clinicians avoid discussing sexuality with patients with severe mental disorders. Sexual disturbances can be related to medication, to psychological issues such as self-stigma and anhedonia, and to the social context. We studied desire and sexual practices in women suffering from schizophrenia, in comparison with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. This finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.

Glyceria maxima as new test species for the EU risk assessment for herbicides: a microcosm study

In its recent guidance document on tiered risk assessment for plant protection products for aquatic organisms, the European Food Safety Authority (EFSA) proposed to use Glyceria maxima as monocotyledonous grass species for the testing of special herbicide groups. However, published toxicity data for this species is very limited and there is no test guideline for Glyceria sp. For this reason a microcosm study was conducted in order to gain experience on the degree of sensitivity of G. maxima to the herbicidal substances clodinafop-propargyl (grass herbicide) and fluroxypyr (auxin) in comparison to the already established test organism water milfoil Myriophyllum spicatum and the duckweed species Landoltia punctata. Five concentrations without replicates were tested for each test substance using 10 microcosms and three microcosms served as controls. The experiment was run for 8 weeks. Morphological endpoints were used to determine growth and EC50 values. The results show that M. spicatum was most sensitive to fluroxypyr (37 days EC50 for roots: 62 µg/L) and G. maxima most sensitive to clodinafop-propargyl (22 days EC50 for total shoot length: 48 µg/L) whereas the duckweed species was considerable less sensitive. Hence, G. maxima turns out to be a good candidate for testing grass specific herbicides, supporting its inclusion as an additional macrophyte test for the risk assessment of herbicides as proposed by the EFSA.

Effects of toxicants with different modes of action on Myriophyllum spicatum in test systems with varying complexity

At the international workshop Aquatic Macrophyte Risk Assessment for Pesticides (AMRAP), it was noted that the EU risk assessment under the directive 91/414/EEC for herbicides, based only on algae and the monocotyledonous duckweed species Lemna sp., offers no certain protection against some growth regulating auxins. Therefore, AMRAP members proposed the introduction of the dicotyledonous water milfoil Myriophyllum as additional test species. This study was aimed to compare toxicity results from three test systems (TS) with varying complexity, namely Water TS, Sediment TS and Microcosm TS using Myriophyllum spicatum as test organism. As test substances, the photosynthesis inhibiting herbicide isoproturon, the growth regulating auxins fluroxypyr and 2,4-dichlorophenoxyacetic acid (2,4-D), and the non-specific acting toxicant 3,5-dichlorophenol (3,5-DCP) were chosen. It was assessed if and why the sensitivity of M. spicatum towards the four toxicants varied in the different test systems and if the addition of sucrose to the medium used in the Water TS had an effect on the sensitivity of Myriophyllum. All TS were suitable for detecting negative effects of toxicants with different modes of action on M. spicatum. The lowest variability of endpoints was found in the Water TS with lowest experimental complexity. For auxins, the endpoint weight did not result in robust EC50 values in all TS, whereas root related endpoints, which are also ecologically relevant, turned out to be very sensitive with low variance. Sucrose in the medium of the Water TS did not seem to influence the sensitivity of M. spicatum towards isoproturon and 3,5-DCP but may have increased the sensitivity of M. spicatum roots when exposed to 2,4-D. However, the findings of all TS resulted in similar risk estimations if root endpoints were not considered.

Closer to reality--the influence of toxicity test modifications on the sensitivity of Gammarus roeseli to the insecticide imidacloprid

Laboratory toxicity test designs are far from reality and therefore extrapolations to field situations may be more difficult. In laboratory experiments with the amphipod Gammarus roeseli exposed to the insecticide imidacloprid it was investigated if test conditions closer to reality influences its sensitivity and if it is possible to extrapolate results from these laboratory tests to results from a stream mesocosm study. Experiments were run by varying medium, temperature, size, and seasonal origin of gammarids. Age and seasonal aspects had strongest effects with juveniles and animals taken from a spring population being most sensitive with an EC₅₀ (96 h) of 14.2 μg L⁻¹ imidacloprid. The test designs closest to the conditions in the stream mesocosms reflected best the results in mesocosms study on basis of LOEC values. However, the EC(x) extrapolation failed to predict the effects of short term imidacloprid pulses in the field.

IGF-1 deficiency in combination with a low basic hBD-2 and hBD-3 gene expression might counteract malignant transformation in pleomorphic adenomas in vitro

This study investigated the IGF-1-influence on oncological relevant genes in pleomorphic adenomas. Therefore A64-tumor cells were stimulated by recombinant IGF-1. After RNA-extraction, transcript levels of hBD-1, hBD-2, hBD-3, DEFA1/3, DEFA4, S100A4, Psoriasin, DOC-1, EGF, EGFR, and IGFR were analyzed by qRT-PCR at t = 0, 4, 8, 24, 48, and 72 hr. The gene-products were visualized by immunostaining. A64-tumor-cells were deficient for hBD-1 and IGF-1. IGF-1 downregulates hBD-2 and hBD-3 without influencing hBD-1-expression. IGF-1 only slightly affects DEFA1/3-, DEFA4-, S100A4-, Psoriasin-, DOC-1-, EGF-, EGFR-, and IGFR-gene-expression. IGF-1-deficiency combined with low basic hBD-2-gene-expression and hBD-3-gene-expression might counteract, whereas hBD-1-deficiency promotes malignant transformation in pleomorphic adenomas.

Religious explanatory models in patients with psychosis: a three-year follow-up study

BACKGROUND/AIMS

Spirituality and religiousness have been shown to be highly prevalent in patients with psychosis. Yet the influence of religious denomination as it affects coping methods and/or as an explanatory model for illness and treatment remains to be determined. This study aims (1) to investigate if religious denomination is associated with explanatory models, (2) to assess the evolution over time of these explanatory models, and (3) to examine the relationship between these explanatory models and the spiritual vision of treatment and adhesion to such treatment.

SAMPLING AND METHODS

Of an initial cohort of 115 outpatients, 80% (n = 92) participated in a 3-year follow-up study. The evolution of their religious explanatory models was assessed in order to evaluate if religious denomination, as a meaning-making coping tool, is associated with the patients' explanatory models. Finally, we examined the relationship between these representations and the patients' spiritual visions of treatment and treatment adhesion.

RESULTS

A spiritual vision of the illness (as part of an explanatory model) was more frequent in patients with psychosis for whom the subjective dimension of religion was important. However, there was no association between the patients' religious denomination and their spiritual vision of the illness. The analyses showed that the various contents of spiritual visions of illness were not positive or negative per se; instead, they depended on how this religious vision was integrated into the person's experience. Examining longitudinal aspects of coping showed that the spiritual vision sometimes changed, but was not associated with clinical or social outcome.

CONCLUSIONS

For patients with psychosis, explanatory models frequently involve a religious component which is independent of denomination and likely to change over time. Clinicians should address this issue on a regular basis, by asking patients about their explanatory model before trying to build a bridge with the medical model.

Long-term effects of the antifouling booster biocide Irgarol 1051 on periphyton, plankton and ecosystem function in freshwater pond mesocosms

Irgarol is a highly effective biocide used in antifouling coatings to prevent the growth of periphyton. Environmental concentrations of Irgarol in marine and freshwater have often exceeded the effect concentrations of autotrophic organisms tested in the laboratory and give reason for concern that natural periphyton communities may be endangered. A 150 days freshwater mesocosm study in 8 indoor ponds was conducted at nominal concentrations between 0.04 and 5 microgL(-1) in order to investigate the effects of Irgarol on periphyton and plankton. The results demonstrated that periphyton communities were strongly affected after single applications of 1 and 5 microgL(-1) Irgarol. For these concentrations no recovery was observed in the course of the study. For chlorophytes, the EC(50) (nominal, 135 days) was 0.34 microgL(-1). Phytoplankton also decreased in abundance directly after Irgarol application but recovered after a few weeks, as Irgarol concentrations rapidly decreased in the water body and nutrient levels increased due to lack of competition with periphyton and macrophytes. Zooplankton was indirectly affected by Irgarol. Principle response curve analysis revealed a species shift from macrophyte associated zooplankton species to free-swimming species. For species of cyclopoid copepods and ostracods the EC(50) was, respectively, 0.09 and 0.11 microgL(-1). The study simulated a best-case scenario since the mesocosms were dosed only once. Under field conditions, however, permanent exposure of organisms to Irgarol is more likely due to permanent leaching from painted ship hulls. Therefore, the effects presented in this study most likely underestimate the effects under natural conditions.

Response of plankton communities in freshwater pond and stream mesocosms to the herbicide metazachlor

Metazachlor is a frequently used herbicide with concentrations in surface waters up to 100 microg L(-1). A long-term mesocosm study was performed in order to investigate effects on stream and pond communities also regarding recovery. Single metazachlor doses of 5, 20, 80, 200, and 500 microg L(-1) were given and the aquatic communities monitored for 140 days. In this paper, special attention is paid to the plankton response and the results of the entire study are summarised. Metazachlor strongly affected the stream and pond mesocosm communities at concentrations higher than 5 microg L(-1). Direct negative effects were most prominent for chlorophytes whereas diatoms and cryptophytes seemed insensitive. The effects on zooplankton were caused by changes in habitat structure due to the strong decline of macrophytes. The slow degradation of metazachlor combined with the absence of recovery in both chlorophytes and macrophytes is likely to cause long-lasting effects on aquatic ecosystems.

Religious beliefs in schizophrenia: their relevance for adherence to treatment

The study examined how religious beliefs and practices impact upon medication and illness representations in chronic schizophrenia. One hundred three stabilized patients were included in Geneva's outpatient public psychiatric facility in Switzerland. Interviews were conducted to investigate spiritual and religious beliefs and religious practices and religious coping. Medication adherence was assessed through questions to patients and to their psychiatrists and by a systematic blood drug monitoring. Thirty-two percent of patients were partially or totally nonadherent to oral medication. Fifty-eight percent of patients were Christians, 2% Jewish, 3% Muslim, 4% Buddhist, 14% belonged to various minority or syncretic religious movements, and 19% had no religious affiliation. Two thirds of the total sample considered spirituality as very important or even essential in everyday life. Fifty-seven percent of patients had a representation of their illness directly influenced by their spiritual beliefs (positively in 31% and negatively in 26%). Religious representations of illness were prominent in nonadherent patients. Thirty-one percent of nonadherent patients and 27% of partially adherent patients underlined an incompatibility or contradiction between their religion and taking medication, versus 8% of adherent patients. Religion and spirituality contribute to shaping representations of disease and attitudes toward medical treatment in patients with schizophrenia. This dimension should be on the agenda of psychiatrists working with patients with schizophrenia.

Effects of the herbicide metazachlor on macrophytes and ecosystem function in freshwater pond and stream mesocosms

The chloroacetamide metazachlor is a commonly used pre-emergent herbicide to inhibit growth of plants especially in rape culture. It occurs in surface and ground water due to spray-drift or run-off in concentrations up to 100 microgL(-1). Direct and indirect effects of metazachlor on aquatic macrophytes were investigated at oligo- to mesotrophic nutrient levels employing eight stream and eight pond indoor mesocosms. Five systems of each type were dosed once with 5, 20, 80, 200 and 500 microgL(-1) metazachlor and three ponds and three streams served as controls. Pronounced direct negative effects on macrophyte biomass of Potamogeton natans, Myriophyllum verticillatum and filamentous green algae as well as associated changes in water chemistry were detected in the course of the summer 2003 in both pond and stream mesocosms. Filamentous green algae dominated by Cladophora glomerata were the most sensitive organisms in both pond and stream systems with EC(50) ranging from 3 (streams) to 9 (ponds) microgL(-1) metazachlor. In the contaminated pond mesocosms with high toxicant concentrations (200 and 500 microgL(-1)), a species shift from filamentous green algae to the yellow-green alga Vaucheria spec. was detected. The herbicide effects for the different macrophyte species were partly masked by interspecific competition. No recovery of macrophytes was observed at the highest metazachlor concentrations in both pond and stream mesocosms until the end of the study after 140 and 170 days. Based on the lowest EC(50) value of 4 microgL(-1) for total macrophyte biomass, it is argued that single exposure of aquatic macrophytes to metazachlor to nominal concentrations >5 microgL(-1) is likely to have pronounced long-term effects on aquatic biota and ecosystem function.

Optical leaky waveguide biosensors for the detection of organophosphorus pesticides

Organophosphorus (OP) pesticides can be rapidly detected by integrating organophosphorus hydrolase with an optical leaky waveguide biosensor. This enzyme catalyses the hydrolysis of a wide range of organophosphorus compounds causing an increase in the pH. Thus, the direct detection of OP is possible by monitoring of the pH changes associated with the enzyme's activity. This article describes the use of an optical, leaky waveguide clad with absorbing materials for the detection of OP pesticides by measuring changes in refractive index, absorbance and fluorescence. In the most effective configuration, a thick sensing layer was used to increase the amount of immobilized enzyme and to increase the light interaction with the sensing layer, resulting in a greatly enhanced sensitivity. The platforms developed in this work were successfully used to detect paraoxon and parathion down to 4 nM concentrations.

[Spirituality, religious practices and schizophrenia: relevance for the clinician]

Religion (spirituality and religiousness) is salient in the lives of many people suffering from schizophrenia. In order to assess religious coping in schizophrenia, we developed a clinical grid, as no validated questionnaire exists for this population. Religion had a positive effect for 71% and a negative effect for 14% of the 115 patients interviewed. Religion influences the sense of self, symptoms, social functioning, the comorbidity of substance abuse, suicidal attempts and adherence to treatment. Then religion is relevant for treatment and should be evaluated systematically. The forementioned clinical grid is suitable for this purpose. It proved its applicability to a broad diversity of religious beliefs, even pathological ones. Inter-judge reliability and construct validity were high and specific training is not required.

McArdle's disease and anaesthesia: case reports. Review of potential problems and association with malignant hyperthermia

BACKGROUND

McArdle's disease of isolated deficiency in glycogen degradation in skeletal muscles has the potential of creating perioperative anaesthesiological problems; such as hypoglycaemia, rhabdomyolysis, myoglobinuria, acute renal failure and possibly malignant hyperthermia.

METHODS

Eight patients with McArdle's disease were asked about previous surgery, anaesthesia and perioperative problems, and available hospital records were reviewed. Existing literature was reviewed for reports on McArdle's disease and anaesthesia.

RESULTS

The eight patients had 35 anaesthesias (23 general anaesthesias, three regional anaesthesias and nine local anaesthesias). Perioperative problems of a non-specific nature were mentioned in three cases of general anaesthesia: two with postoperative nausea/vomiting, and one with an episode of tachycardia and low blood pressure. Three patients were tested for malignant hyperthermia (MH) using the in vitro contracture test (IVCT); two of them with a positive result. The literature search revealed seven case reports of McArdle's disease and anaesthesia. Apart from one report of hyperthermia, pulmonary oedema and rhabdomyolysis; probably not associated with MH, no problems were encountered from the literature search.

CONCLUSION

McArdle's disease does not seem to cause severe perioperative problems in routine anaesthetic care. However, measures for preventing muscle ischaemia and rhabdomyolysis should be kept in mind, as well as the potential for these patients to develop postoperative fatigue, myoglobinuria and renal failure. Although no clinical association with malignant hyperthermia has been established, many of these patients can have a positive in vitro contracture test, and simple prophylactic measures, as with malignant hyperthermia, may be recommended if otherwise not contraindicated.

Immune Signature of Malignant Pleural Mesothelioma as Assessed by Transcriptome Analysis

Malignant pleural mesothelioma (MPM) is a highly malignant tumor arising in patients previously exposed to asbestos fibers. Its increasing incidence and its social, financial and human impact have become a frequent problem in many industrialized countries. The unresponsiveness of malignant mesothelioma to conventional therapies has led clinicians to develop new treatments. As immunotherapy has been shown to offer promising and targeted treatment of MPM patients, the knowledge of the immunoresistance level of MPM may be a valuable tool for "à la carte" therapy. In a previous work, we profiled the gene expression of two MPM tissues compared to healthy mesothelial cells using a 10K cDNA microarray. Subsequent clustering analysis identified several clusters of differentially-expressed genes among those that are functionally-related to the immune system. In this report, we focus on genes with expression changes that may facilitate tumor escape from immune-mediated rejection. We also analyzed the immune reaction by staining the immunocompetent cells surrounding the tumor. Interestingly, the tumor with the strongest escape response, as shown by the expression of numerous immunoresistance-associated genes, displayed the strongest T cell infiltrate. The main genes conferring immunoresistance are CD74, HLADOA, HLADMB, PTGS1, IGFBP7 and TGFB3, by favoring immune tolerance, and CFLAR, DFFA, TNFRSF6, BNIP3L by impairing apoptosis. These observations have fundamental consequences in the understanding of immunological properties of MPM, and offer a new insight into the mechanisms whereby MPM may circumvent host-mediated immune activities and promotes its own development. For an immunomodulation strategy to cure mesothelioma, it is crucial to characterize the MPM "immune signature" to design adapted immunotherapies.

Divergent cell cycle kinetics underlie the distinct functional capacity of mucosal T cells in Crohn's disease and ulcerative colitis

BACKGROUND

Different abnormalities of T cell effector function distinguish Crohn's disease (CD) from ulcerative colitis (UC). Because cell cycling determines effector function, pathogenic events in CD and UC may depend on cell cycle changes unique to each condition.

METHODS

Cell cycle kinetics, cycle regulatory molecule expression, apoptosis, caspase and telomerase activity, and cellular expansion were evaluated in CD2 and CD3 activated control, CD, and UC lamina propria T cells.

RESULTS

Compared with normal cells, CD T cells cycle faster, express increased phosphorylated Rb and decreased phosphorylated p53 levels, display less caspase activity but more telomerase activity, die less, and undergo vigorous cellular expansion. In contrast, UC T cells cycle slower, express normal levels of phosphorylated Rb and p53, display more caspase activity but have no telomerase activity, die more, and have a limited capacity to expand.

CONCLUSIONS

T cell cycle abnormalities in CD indicate a state of hyperreactivity compatible with loss of tolerance, but a hyporeactive state compatible with anergy in UC. Thus distinct and divergent T cell cycle characteristics underlie the pathogenesis of the two main forms of inflammatory bowel disease.

Pharmacogenomics and drug response in cardiovascular disorders

There are a total of 17 families of drugs that are used for treating the heterogeneous group of cardiovascular diseases. We propose a comprehensive pharmacogenomic approach in the field of cardiovascular therapy that considers the five following sources of variability: the genetics of pharmacokinetics, the genetics of pharmacodynamics (drug targets), genetics linked to a defined pathology and its corresponding drug therapies, the genetics of physiologic regulation, and environmental–genetic interactions. Examples of the genetics of pharmacokinetics are presented for phase I (cytochromes P450) and phase II (conjugating enzymes) drug-metabolizing enzymes and for phase III drug transporters. The example used to explain the genetics of pharmacodynamics is glycoprotein IIIa and the response to antiplatelet effects of aspirin. Genetics linked to a defined pathology and its corresponding drug therapies is exemplified by ADRB1, ACE, CETP and APOE and drug response in metabolic syndrome. The examples of cytochrome P450s, APOE and ADRB2 in relation to ethnicity, age and gender are presented to describe genetics of physiologic regulation. Finally, environmental–genetic interactions are exemplified by CYP7A1 and the effects of diet on plasma lipid levels, and by APOE and the effects of smoking in cardiovascular disease. We illustrate this five-tiered approach using examples of cardiovascular drugs in relation to genetic polymorphism.

Validation de la version française du Profil des compétences de vie (Life Skills Profile) chez des personnes atteintes de schizophrénie

INTRODUCTION

Since the discovery of neuroleptics and the reintegration of people with schizophrenia in the community, psycho-social reeducation became an essential part of the treatment. The Life Skills Profile is a tool of reference for assessment of the dimensions, which have an impact on the adaptation in community. Each item describes an observable behavior, written in common language, to allow the care-givers and the family to evaluate it without having a specific formation. The long version (39 items) is recommended for therapeutic interventions with a person and the short one (20 items) for large scale studies on outcome in community.

AIM OF THE STUDY

In order to dispose of a measure of function and disability in schizophrenia, we have translated the Life Skills Profile (LSP) in French and tested the validity of this translation for the long version (39 items) and the short ones (16 and 20 items). The 4 dimensions of the 16-items version--"withdrawal", "self-care", "compliance" and "antisocial"--were used for people with mental disorders and the 20-items version enhanced with a fifth dimension "bizarre", especially useful for people with schizophrenia.

METHOD

175 people suffering of schizophrenia (DSM IV, codes F20.0 to F20.5) were evaluated by their caregivers in 3 settings: psychiatric hospital, ambulatory care and sheltered homes. Confirmatory factorial analyses were performed to test the dimensional models and their psychometric characteristics were established.

RESULTS

The original structure in 5 dimensions of the long version (39 items) is not confirmed. However, the short versions in 16 and 20 items were confirmed, without any modification. The required psychometric qualities of reliability and validity of the 20-items version were fulfilled. The inter-rater reliability ranged from 0.65 to 0.75 for the 5 dimensions; the test-retest reliability ranged from 0.80 to 0.91 and the internal consistency from 0.67 to 0.81. The validity was evaluated by comparison of the LSP scores upon living arrangements (people living in sheltered homes had lesser scores) and pathologies (19 people with severe major depression had higher scores).

CONCLUSION

The 39-items version of the Life Skills Profile was not validated in French. However, for clinical practice of social rehabilitation, this tool remains useful for a single person to check specific behaviors, which could hinder his/her integration into the community, to plan specific interventions and to evaluate changes, in addition with other scales. By the validation of the short version of the Life Skills Profile, an instrument is at disposal in French for outcome studies which allow to: 1) quickly assess the social functioning of person suffering of schizophrenia by a caregiver or a family member; 2) to detect insufficient skills in specific domains; and 3) to evaluate therapeutic efficiency.

Sevoflurane-induced malignant hyperthermia during cardiopulmonary bypass and moderate hypothermia

A 56-year old man was admitted for elective mitral valve repair and coronary artery bypass surgery due to mitral valve leakage and unstable angina. After induction of anaesthesia he developed a combined metabolic and respiratory acidosis. Different diagnosis were considered and we decided to treat the patient with dantrolene due to suspicion of malignant hyperthermia (MH). The patient received one dose of dantrolene 2,5 mg/kg during cardiopulmonary bypass (CPB) and a second dose of dantrolene 2,5 mg/kg during weaning from CPB. The first arterial blood gas sample taken in the intensive care unit showed relapse of the acidosis and we administered an infusion of 150 mg dantrolene over 3 hours. The patient gradually recovered without sequel and MH was verified by muscle biopsy testing.

Comparison of transcutaneous and endtidal CO2-monitoring for rigid bronchoscopy during high-frequency jet ventilation

OBJECTIVE

To compare endtidal and transcutaneous respiratory monitoring of high-frequency jet ventilation (HFJV) in rigid bronchoscopy. Both techniques provide a noninvasive measurement of pCO2.

METHODS

High-frequency jet ventilation was applied via a rigid bronchoscope. Driving pressure (DP) was initially adapted to ensure normal ventilation. It was then changed twice by +/- 30% from the initial value. Endtidal and transcutaneous data were compared with arterial blood gas monitoring (ABG).

RESULTS

Results were analyzed separately for the time just after changing the driving pressure (10 min) and the remaining time until the next change of the driving pressure (4 min). The first part was called the dynamic phase, and the second part the steady-state phase. Correlation coefficient between endtidal capnography and ABG was 0.96 for the steady state and 0.94 for the dynamic phase, respectively. Bland-Altman analysis revealed a bias of -0.21 kPa with limits of agreement (LOA) 1.63 kPa for the steady state and -0.25 kPa, 2.08 kPa for the dynamic phase, respectively. Correlation coefficient between transcutaneous monitoring and ABG for the steady state phase was 0.83, and was 0.72 for the dynamic phase. Bland-Altman analysis resulted in a bias of -0.89 kPa with LOA - 3.84 kPa during steady state and 0.92 kPa, 4.06 kPa for the dynamic phase, respectively.

CONCLUSION

Endtidal capnography offers accurate respiratory monitoring of HFJV. Transcutaneous monitoring showed a good correlation to ABG only during steady-state conditions. For the dynamic phase the accuracy was significantly lower. Thus, we cannot recommend transcutaneous respiratory monitoring for the specific indication of rigid bronchoscopy using HFJV.

Is executive function associated with symptom severity in schizophrenia?

This paper reports on a study that was designed to investigate the relationship between psychopathology and executive functions in schizophrenia. Correlations were sparse and mostly weak. The most robust finding was the association between letter fluency and negative symptoms; however, most other applied tasks were not associated with symptom level. Our results support previous findings of differential relationships between impaired executive functions and symptom level.

Non-uniform distribution of lesions and biochemical abnormalities within the retina of diabetic humans

OBJECTIVE

Microaneurysms, acellular capillaries, pericyte ghosts, and thickening of retinal capillary basement membrane are characteristic of diabetic retinopathy, and are believed to be sequelae of excessive blood glucose. Previous studies by us in dogs demonstrated that lesions of diabetic retinopathy were not uniformly distributed across the retina, but were significantly more numerous in the superior/temporal areas of the retina. In the present study, the distribution of these lesions and the biochemical abnormalities postulated to play a role in their pathogenesis have been evaluated in retinas collected at autopsy from diabetic patients.

METHODS

Retinas were divided into quadrants (nasal, temporal, superior, inferior), the vasculature exposed by the trypsin-digest method, and the frequency of the lesions compared among the quadrants. Homogenates taken from the mid-retina of nasal and temporal quadrants of retina were used to explore regional differences in expression of Glut1, PKCbeta, and iNOS (Western blots) and caspases (enzymatic activity).

RESULTS

Microaneurysms, acellular capillaries and pericyte ghosts were not uniformly distributed across the retina, and were significantly more numerous in the temporal retina than in the nasal retina (P < 0.05). In contrast, the thickness of retinal capillary basement membrane was not found to differ significantly across the retina. In our limited study, activity of the pro-inflammatory protease, caspase 1, was the only biochemical abnormality where there was both a significant diabetes-induced alteration in activity and also a significant difference between retinal quadrants. Expression of the glucose transporter, Glut1, was significanlty decreased in diabetes, but there was no significant difference in expression between the quadrants. Expression of iNOS was increased only in temporal retina in diabetes (but no significant difference between quadrants), and PKCbeta tended to be greater than normal in both temporal and nasal retina.

CONCLUSIONS

Retinal microvascular disease does not develop uniformly across the retina of diabetic patients, even though the different regions are exposed to the same level of hyperglycemia.

Factors and motives associated with drop-out in an ambulatory service for patients with psychotic disorders

The aim is to study motives and factors associated with treatment drop-out in an ambulatory psychiatric service, which integrates medical, social, familial and rehabilitation treatments. Only 9% of the psychotic patients dropped out, whose motives were non-compliance with medication and unawareness of illness, and the associated factors were comorbidity of substance abuse, social isolation and male gender.

Diode-pumped Yb:Sr(3)Y(BO(3))(3) femtosecond laser

We have developed a diode-pumped Yb(3+)Sr(3)Y(BO(3))(3) (Yb:BOYS) laser generating 69-fs pulses, at a central wavelength of 1062 nm. This laser is mode locked by use of a semiconductor saturable-absorber mirror and emits 80 mW of average power at 113 MHz. This is, to our knowledge, the first mode-locked Yb:BOYS laser and the shortest duration obtained from an ytterbium laser with a crystalline host. The central wavelength can be tuned from 1051 to 1070 nm, for sub-100-fs pulses. We have also achieved an average power as high as 300 mW with pulse duration of 86 fs at 1068 nm.

Are African-American nuclear workers at lower mortality risk than Caucasians?

This study investigated disparities in worker mortality across race at the Savannah River site (SRS) nuclear facility in Aiken, South Carolina. Standardized mortality ratios were calculated stratified by race (Caucasian, African-American) and gender for specific causes of death, and by race, gender, duration of employment, and follow-up for overall mortality. Race-specific standardized mortality ratios for African-American male workers generally were lower than those for Caucasian male workers, although both groups showed strong healthy worker effects. Nevertheless, African-American male workers generally had higher absolute mortality rates. Understanding why SRS African-American male workers are substantially healthier than their reference population as compared with Caucasian male workers but are less healthy in absolute terms than the SRS Caucasian male workers may provide clues for prevention or intervention. Further, the standardized mortality ratios at the SRS were lower than at the Hanford and Oak Ridge nuclear facilities, which warrants investigation.

The human type 2 iodothyronine deiodinase is a selenoprotein highly expressed in a mesothelioma cell line

Types 1 and 3 iodothyronine deiodinases are known to be selenocysteine-containing enzymes. Although a putative human type 2 iodothyronine deiodinase (D2) gene (hDio2) encoding a similar selenoprotein has been identified, basal D2 activity is not selenium (Se)-dependent nor has D2 been labeled with (75)Se. A human mesothelioma cell line (MSTO-211H) has recently been shown to have approximately 40-fold higher levels of hDio2 mRNA than mesothelial cells. Mesothelioma cell lysates activate thyroxine (T(4)) to 3,5,3'-triiodothyronine with typical characteristics of D2 such as low K(m) (T(4)), 1.3 nm, resistance to propylthiouracil, and a short half-life ( approximately 30 min). D2 activity is approximately 30-fold higher in Se-supplemented than in Se-depleted medium. An antiserum prepared against a peptide deduced from the Dio2 mRNA sequence precipitates a (75)Se protein of the predicted 31-kDa size from (75)Se-labeled mesothelioma cells. Bromoadenosine 3'5' cyclic monophosphate increases D2 activity and (75)Se-p31 approximately 2.5-fold whereas substrate (T(4)) reduces both D2 activity and (75)Se-p31 approximately 2-3-fold. MG132 or lactacystin (10 microm), inhibitors of the proteasome pathway by which D2 is degraded, increase both D2 activity and (75)Se-p31 3-4-fold and prevent the loss of D2 activity during cycloheximide or substrate (T(4)) exposure. Immunocytochemical studies with affinity-purified anti-hD2 antibody show a Se-dependent increase in immunofluorescence. Thus, human D2 is encoded by hDio2 and is a member of the selenodeiodinase family accounting for its highly catalytic efficiency in T(4) activation.

Mania resulting from continuous positive airways pressure in a depressed man with sleep apnea syndrome

The authors report the case of a 50-year-old man, with no previous history of bipolar illness, hospitalized with a very severe depression and who was resistant to a 7-weeks treatment of venlafaxine and trazodone (the respective daily doses were 300 and 50 mg which were stable during the last 4 weeks). A diagnosis of sleep apnea syndrome led to the use of the continuous positive airways pressure technique (CPAP). A few days after starting CPAP, he presented a mood switch, first hypomanic, then mixed. The authors discuss the contribution of the sleep apnea syndrome to the appearance and the maintenance of the depressive disorder.

TP53 gene mutations, nuclear p53 accumulation, expression of Waf/p21, Bcl-2, and CD95 (APO-1/Fas) proteins are not prognostic factors in de novo glioblastoma multiforme

Glioblastoma multiforme (WHO grade IV; GBM) is the most common primary brain tumor with a median survival of less than one year despite multimodal treatment regimens. However, a small subgroup of GBM patients has a better clinical outcome, with a small number of patients surviving several years. Apoptosis, a genetically determined program of cell suicide, may be induced as a consequence of critical DNA damage. However, due to defects in the signaling pathways, cancer cells may escape apoptosis, despite carrying irreversible DNA damage. In the present study, we have analyzed tumors of two age-matched, equally treated groups of GBM patients with different postoperative time to tumor progression (TTP), defined as 'short-term' for TTP of less than 6 months (n = 54), and 'long-term' for TTP of more than 12 months (n = 39) for alterations in apoptosis regulatory pathways: Mutations of the TP53 tumor suppressor gene and/or nuclear accumulation of its gene product p53, expression of Waf/p21, CD95 (Apo1/Fas), and Bcl-2. TP53 mutations were found in 12 out of 54 (22%) GBMs of short-term survivors and 8 out of 35 (23%) tumors of long-term survivors; the respective numbers for nuclear p53 protein accumulation were 12/53 (23%) and 10/37 (27%). Waf1/p21 expression was found in 13/53 (25%) tumors of short-term survivors and 9/35 (26%) GBMs of long-term survivors. The respective numbers for Bcl-2 expression were 25/42 (60%) and 22/36 (61%) and for CD95 (Apo1/Fas) expression 20/49 (41%) and 14/36 (39%) GBMs. The percentage of alterations in genes/proteins involved in the apoptotic pathway investigated here was virtually identical in the two groups of clinically different GBM patients. Thus, our data imply that none of these alterations investigated per se has a strong impact on the overall survival of GBM patients.

[Gene expression profiling in human mesothelioma cells using DNA microarray and high-density filter array technologies]

Although the use of asbestos has been banned in most industrialized countries, it is still a major public health concern. Asbestos fibers are mutagenic and carcinogenic for humans, classified as "carcinogen category 1 (T, R45: can cause the cancer)" in the 25th adaptation of the directive 67/548/EEC. In France, asbestos is thought to be responsible each year for many pulmonary diseases: pleural plaque, bronchogenic carcinoma and mesothelioma (malignant tumor of pleura). In order to better understand the transformation process of pleural cells, we compared the gene expression of mesothelium cells (Met-5A) and mesothelioma cells (MSTO-211H) using high-density filter array (588 genes) and microarray (6.969 genes). Results of both technologies were compared and expression levels of several genes were confirmed by quantitative RT-PCR. Data analysis with GemtoolsTM 2.4 software allows us hierarchical classification of genes of known functions by enzyme, function and pathway clusters and leads to characterize both malignant and normal phenotypes. Finally, the comparison between the two cell lines provides new markers of mesothelioma and pleura. They could be useful for diagnostic, prognostic and therapeutic.

Protein thiol modification of glyceraldehyde-3-phosphate dehydrogenase and caspase-3 by nitric oxide

The regulation of enzyme activity function is a major factor in the cellular response to a changing environment. One mechanism of enzyme activity regulation includes post-translational protein thiol modification by nitric oxide (NO) or its redox species. Major routs used by NO to modify cysteine residues of proteins include S-nitrosation, oxidation, mixed disulfide formation with glutathione, and the covalent attachment of nucleotide cofactors, i.e NAD(+)/NADH. Critical thiol centers serve as recognition sites for NO, thus channeling the NO signal through post-translational modifications and oxidation into cellular functions. Here, we summarize current knowledge on active site thiol modification of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and caspase-3 by nitric oxide. Although very different in their cellular function, both enzymes contain highly reactive cysteines which represent sensitive targets for NO. Our studies are supportive of a potential role of S-nitrosation and mixed disulfide formation as a general signaling mechanism that allows sensing of nitrosative stress. At the same time, modification of GAPDH and caspase-3 by NO show the diversity of mechanisms (S-nitrosation versus oxidations) that we are confronted with as a result of NO delivery, especially comparing in vitro studies with cellular systems. In the future it will be challenging to dissect how nitrosative and oxidative signaling mechanisms overlap and how intracellular communication systems allow their activation in a selective way.

Differential gene expression in mesothelioma

To investigate the molecular events controlling malignant transformation of human pleural cells, we compared constitutive gene expression of mesothelioma cells to that of pleural cells. Using cDNA microarray and high-density filter array, we assessed expression levels of > 6500 genes. Most of the highly expressed transcripts were common to both cell lines and included genes associated with stress response and DNA repair, outcomes consistent with the radio- and chemo-resistance of mesothelioma. Interestingly, of the fewer than 300 genes that differed between cell lines, most functioned in (i) macromolecule stability, (ii) cell adhesion and recognition, (iii) cell migration (invasiveness), and (iv) extended cell division. Expression levels of several of these genes were confirmed by RT-PCR and could be useful as diagnostic markers of human mesothelioma.