The impact of subclinical psychosis on the transition from subclinicial mania to bipolar disorder

BACKGROUND: In the general population, symptoms of mania and psychosis are more broadly distributed than their associated clinical syndromes. Little is known, however, about how these subclinical population phenotypes co-vary with and impact on each other. METHOD: In a representative population cohort of 7076 adults, prevalence of mania and psychosis symptoms and syndromes were assessed with the CIDI at baseline, at one (T1) and two years later (T2). The degree of comorbidity between subclinical mania and subclinical psychosis was examined, as well as the impact of subclinical comorbidity on social impairment and transition from subclinical mania to onset of bipolar disorder. RESULTS: The lifetime prevalence of at least one manic and one psychotic symptom was 4.1% and 4.2% respectively. Excluding individuals with any lifetime DSM-III-R bipolar or psychotic disorder (n=218), these prevalences were 2.3% (subclinical mania) and 2.8% (subclinical psychosis). Individuals with subclinical mania had a 17% risk of subclinical psychosis, compared with 2.3% in those without (P<0.000). Comorbid subclinical psychosis in individuals with subclinical mania was much more predictive of a future diagnosis of bipolar disorder (positive predictive values of 3% versus 10% respectively). CONCLUSION: Subclinical phenotypes of mania and psychosis are more prevalent than their clinical counterparts and cluster together. The risk factors for psychosis may facilitate the formation of more "toxic" combinations of subclinical mania and subclinical psychosis with a higher probability of transition to bipolar disorder. A better understanding of this pathway is crucial for the development of early interventions.     

RHD/CE typing by polymerase chain reaction using sequence-specific primers

BACKGROUND: Current DNA-based Rh system typing strategies may detect the two RH genes and their prevalent alleles, but they are known to fail sometimes, when rare RH alleles (e.g., D category phenotypes) are encountered. It is almost impossible to find a single DNA-based method that can accommodate the great heterogeneity within the human Rh system. STUDY DESIGN AND METHODS: An easy-to-perform DNA-based method for the detection of the two RH genes and their alleles, including variant RHD alleles, was developed. By the use of one RHD/C-, seven RHD-, and four RHCE-specific polymerase chain reactions, all triggered to work at identical thermocycling conditions, the DNA of 77 blood donors carrying weak D and that of 200 random donors with common D phenotype was investigated. In addition, 77 selected samples of ccDee and rare Rh system phenotypes were examined. RESULTS: Among 77 samples of weak D, one Rh33 and six DVI categories were detected, one of which showed new RHD-specific nucleotide patterns. In DFR and CCee samples, novel variant RHD alleles were found. RHD DNA types of 200 random donors were found to be concordant with their D phenotype. For RHE and RHe genotyping, a full correlation with serologic phenotypes was found. Our method for genotyping RHC and RHc failed in some cases, because of an already published RHc allelic variation, which we have called RHc(cyt48). An estimate of the frequency of this RHc(cyt48) allele in a white population was made. CONCLUSION: The presented exon-scanning RHD/CE polymerase chain reaction using sequence-specific primers complements current DNA-based Rh system typing strategies and is superior in the detection of variant RHD alleles.     

p63在皮肤发生发育及损伤修复中的作用

目的:皮肤的发生发育及损伤修复受到各种生长因子和细胞因子的综合调控。p63是近年发现的癌基因p53的同源基因,研究证实,p63在发育和肿瘤发生中都具有重要作用。文章对p63在皮肤发生发育和损伤修复中的作用及其研究进展作一综述。资料来源:应用计算机检索Pubmed数据库1999-01/2007-08期间的相关文章,检索词"p63,skin or cutis,development,epidermal ste m cells,healing or repair",限定文章语言种类为English。同时计算机检索中国期刊全文数据库、万方数据库1999-01/2007-08期间的相关文章,检索词"p63,皮肤,发生发育,表皮干细胞,修复",限定文章语言种类为中文。资料选择:对资料进行初审,选取符合研究要求的有关文章并查看每篇文献后的引文。纳入标准:有关p63在皮肤发生发育中作用的研究;有关p63在皮肤损伤修复中作用的研究。排除标准:重复或类似的研究、综述文献。资料提炼:共收集到61篇相关文献,28篇文献符合纳入标准,排除的33篇重复或类似的研究文献,其中25篇为p63与皮肤发生发育相关的研究,3篇为p63与皮肤创伤修复方面的研究。资料综合:①p63与皮肤发生发育相关的研究:p63为胚胎发育过程中最初上皮分层所必需,单层体表外胚层上皮层化的程序发动和执行需要不同p63异构体的有序激活,p63的异构体蛋白均来自于同一个基因,由于在转录水平有不同的启动子参与和剪切的不同形成,不同的异构体蛋白作用不同并有相互作用;p63可能激活人类角质形成细胞中的各种分化基因启动子,从而最终调控角质细胞的分化方向;p63基因在角质形成细胞增殖和凋亡过程中具有重要的平衡作用;p63在发育过程中的主要作用在于促使外胚层分化和增生;p63在成熟上皮中维持表皮干细胞的潜在增殖力,是首个能明确将表皮干细胞同短暂扩充细胞区别的基因。②p63与皮肤创伤修复方面的研究:p63在皮肤的发育和损伤愈合中时间上有规律,部位上有选择性地表达;p63是皮肤损伤修复过程中高增殖潜能角质形成细胞的标志并对皮肤损伤病理进程进行调控。结论:p63为胚胎发育过程中最初的上皮分层所必需,在成熟上皮中有维持表皮干细胞的潜在增殖力的作用,是皮肤损伤修复过程中高增殖潜能角质形成细胞的标志并对皮肤损伤病理进程进行调控。     

无机活性元素骨组织工程支架材料修复山羊颌骨缺损

目的:应用无机活性元素骨组织工程支架材料,对山羊的下颌骨角部大型箱状缺损施行骨重建,观察支架材料骨构建效能和生物相容性的情况。方法:实验于2004-02/12在安徽医科大学附属省立医院实验中心及相关实验室完成。①实验材料:无机活性元素骨组织工程支架材料由美国波士顿大学分子生物相容学研究室研制提供;21只雌性健康山羊由安徽医科大学动物实验中心(皖医实动准字01号)提供,实验过程中动物处置符合动物伦理学标准。②实验方法:取山羊15只,按4,8,12周3个时间点分为3组,位下颌角部手术制备30 mm×25 mm×10 mm的大型箱状缺损。采用自身配对设计,左侧置入支架材料为实验组,右侧空白对照为对照侧;剩余6只山羊为对照组,不手术。③观察指标:术后4,8,12周应用X射线片、组织学和放射性核素显像观察缺损区新骨形成情况;并测定骨密度;应用血液学检查及骨髓基质细胞体外复合细胞培养评价材料的生物相容性。结果:①一般观察:实验山羊无手术死亡,创口Ⅰ期愈合。②X射线片:实验侧有渐进性骨密度增高,阻射影逐级增强,对照侧呈透光阴影。③放射性核素显像:实验侧有较明显的核浓聚和再生血管化现象,对照侧无骨重建,故无骨代谢变化。④骨密度测量系数:实验侧呈递增式上升,对照侧维持较低水平,提示无自发性成骨。⑤组织学观察:实验侧呈时间递增性骨重建现象,在12周时新骨已完全形成并钙化基本完成,而对照侧直到12周仍无成骨现象。⑥生物相容性:各组的血常规、细胞形态、生化和相关酶学指标均在正常范围内。结论:无机活性元素骨组织工程支架材料有良好的成骨和再血管化功能,且生物相容性好,提示由该支架材料诱导的组织工程化骨构建有望成为临床骨组织大型缺损的替代材料。     

Dramatic decrease in the pulmonary artery systolic pressure and disappearance of the interatrial shunt with sildenafil treatment in a patient with primary pulmonary hypertension with atrial septal aneurysm and a severe right to left shunt through the patent foramen ovale

This report describes a patients with PPH with atrial septal aneurysm and a severe right to left shunt through the patent foramen ovale who showed a dramatic decrease in the pulmonary artery systolic pressure and interatrial shunt disappeared after sildenafil treatment.     

Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis

Objective  

The purpose of the present study was to compare the current diagnostic clinical and laboratory approaches to women with vulvovaginal discharge complaint. The secondary outcomes were to determine the prevalence of infections in our setting and to look for the relation between vulvovaginal infections and predisposing factors if present.     

Frontal sinus osteoma associated with pneumocephalus

The most common causes of intracranial air are head trauma and neurosurgical procedures. Less common etiologies include infection due to gas-forming organisms, mucoceles, tumours, congenital neuroenteric cysts, and dural defects. Here, we present a case of a frontal sinus osteoma associated with longstanding pneumocephalus.     

Spinal,epidural or propofol anaesthesia for out–patient knee arthroscopy?

Background : We have compared three different methods of anaesthesia for out–patient knee arthroscopy in terms of perioperative conditions, postoperative pain, time taken and economy.
Methods : 91 ASA I–II patients scheduled for elective knee arthroscopy were included. After premedication with diazepam 10 mg and naproxene 500 mg orally, they were randomly assigned into one of three groups: Group S (n=32) received spinal anaesthesia with lidocaine 50 mg/ml 1.5–2 ml in 7.5% glucose through a 27–G Quincke needle, Group E (n=29) received epidural anaesthesia with mepivacaine 20 mg/ml and epinephrine 5 μg/ml, 15–20 ml, and Group P (n=30) received propofol anaesthesia with a bolus induction of 2 mg/kg followed by infusion.
Results : The time from start of anaesthesia until start of operation was significantly less in Group P than in the two other Groups: 7.45.4 min as compared to 23.04.8 min in Group S and 31.09.1 min in Group E (meanSD, P<0.05). After end of surgery, the duration of the postoperative regional block was 7528 min in Group S and 125 79 min in Group E (P<0.05). In Group S and Group E the postoperative pain was significantly less than in Group P at admission to the recovery unit and 60, 120 and 180 min later (P<0.05). The overall incidence of postoperative nausea or vomiting was less than 5% with no differences between the groups. One patient in Group E had block failure and one patient in Group S had a post–spinal headache. The perioperative costs of drugs and disposables were highest in Group P (30 USD) and lowest in Group S (6.5 USD).
Conclusion : Propofol anaesthesia results in the shortest stay in the operation theatre but a higher degree of postoperative pain and a higher cost of drugs and disposables.