Heart disease treatment and mortality in schizophrenia and bipolar disorder - Changes in the danish population between 1994 and 2006

Persons with schizophrenia and bipolar disorder have much higher heart disease mortality rates than the general population. The objective was to compare the general population with persons with schizophrenia, bipolar disorder or other psychiatric disorders in terms of rates of somatic hospitalization and invasive heart disease procedures, and in terms of heart disease mortality during the period 1994 to 2006. Survival analysis was used to analyze heart disease mortality and somatic care trends in a cohort of all persons residing in Denmark. During the study period, heart disease mortality rose significantly among persons with schizophrenia: compared with the general population, the rise in the mortality rate ratio equalled 1.12 (95% confidence interval (CI) 1.08-1.15) every second year. This was not the case for persons with bipolar disorder [1.02 (0.98-1.05), not significant] or other psychiatric disorders [1.00 (0.99-1.01), not significant]. The entire period saw a lower hospitalization rate and fewer invasive cardiac procedures among persons with schizophrenia than among the general population. The higher mortality (with increasing trends) from heart disease in persons with schizophrenia compared to the rest of the cohort members can be explained partly by low rates of invasive cardiac procedures. However, other reasons, such as antipsychotic-induced weight gain, primary prevention, and difficulty following smoking cessation advice could also be part of the explanation. The results call for a greater focus on improvement in somatic care and lifestyle factors for this group of patients.     

Protoporphyrin IX formation and photobleaching in different layers of normal human skin: Methyl‐ and hexylaminolevulinate and different light sources

Topical photodynamic therapy (PDT) is used for various skin disorders, and selective targeting of specific skin structures is desirable. The objective was to assess accumulation of PpIX fluorescence and photobleaching within skin layers using different photosensitizers and light sources. Normal human skin was tape‐stripped and incubated with 20% methylaminolevulinate (MAL) or 20% hexylaminolevulinate (HAL) for 3 h. Fluorescence microscopy quantified PpIX accumulation in epidermis, superficial, mid and deep dermis, down to 2 mm. PpIX photobleaching by light‐emitting diode (LED, 632 nm, 18 and 37 J/cm²), intense pulsed light (IPL, 500–650 nm, 36 and 72 J/cm²) and long‐pulsed dye laser (LPDL, 595 nm, 7.5 and 15 J/cm²) was measured using fluorescence photography and microscopy. We found higher PpIX fluorescence intensities in epidermis and superficial dermis in HAL‐incubated skin than MAL‐incubated skin (P < 0.001). In mid and deep dermis, fluorescence intensities were higher (37%) in HAL‐treated skin than MAL‐treated skin, although not significant (P = ns). At skin surface, photobleaching was significantly higher (90–98%) after LED illumination (18 and 37 J/cm²) than IPL (29–53%, 36 and 72 J/cm²) and LPDL (43–62%, 7 and 15 J/cm²) (P < 0.001). Within the skin, photobleaching was steady from epidermis to deep dermis by LED illumination (37 J/cm², P = ns), but declined from epidermis to mid and deep dermis for IPL‐treated skin and LPDL‐treated skin (IPL 72 J/cm²: 26–15%; LPDL 15 J/cm²: 37–23%) (P < 0.04). Clinically, erythema correlated linearly with MAL and HAL‐induced photobleaching (r² = 0.175, P < 0.001). In conclusion, selective PpIX accumulation indicates HAL as an alternative to MAL for epidermal‐targeted PDT. In clinically relevant doses, PpIX photobleaching throughout the skin was more profound following LED than LPDL and IPL exposure.     

Fractional nonablative 1,540-nm laser resurfacing of atrophic acne scars. A randomized controlled trial with blinded response evaluation

The efficacy of nonablative fractional laser resurfacing of acne scars has been described in case reports and uncontrolled trials. The present study is the first randomized controlled trial in this field. The aim of this study was to examine the efficacy and adverse effects of 1,540-nm nonablative fractional laser treatment of acne scars. Ten patients with acne scars were included. Two intraindividual areas of similar size and appearance within contralateral anatomical regions were randomized to (1) 3-monthly laser treatments with a StarLux 1,540-nm fractional handpiece, and (2) no treatment. Blinded on-site clinical evaluations were performed before treatment, and at 4 and 12 weeks after the final treatment. End-points were overall change in scar texture (from score 0, even texture, to 10, worst possible scarring), adverse effects, change in skin colour (from score 0, absent, to 10, worst possible), and patient satisfaction (from score 0, no satisfaction, to 10, best imaginable satisfaction). Before treatment, scars were moderately atrophic and uneven in texture on both treated and untreated sides (median score 6.5, interquartile range 4.5–8; P=1). After treatment, laser-treated scars appeared more even and smooth than untreated control areas (4.5, 2–6.5, versus 6.5, 4.5–8, P=0.0156, at 4 weeks; 4.5, 2.5–6.5, versus 6.5, 4.5–8, at 12 weeks; P=0.0313). Patients were satisfied with the treatment (5.5, 1–7, after 12  weeks) and five of the ten patients evaluated their acne scars as moderately or significantly improved. No differences were found in skin redness or pigmentation between before and after treatment. Patients experienced moderate pain, erythema, oedema, bullae, and crusts. No adverse effects were seen in untreated control areas. The nonablative 1,540-nm fractional laser improves acne scars with a minimum of adverse effects.     

Minimal erythema dose in UV-shielded and UV-exposed skin predicted by skin reflectance measured pigmentation

Aims: To investigate the relationships between epidermal thickness, age, skin pigmentation and UV sensitivity in sun-exposed skin and skin not exposed to the sun in healthy people without skin cancer or skin diseases. Methods: Phototesting with a xenon arc solar simulator was performed in 137 healthy Caucasians in buttock skin un-exposed to UV (27 children, 34 young adults and 32 older adults) and in skin of the back exposed to UV (44 young adults). The pigmentation of the phototest sites was measured objectively by a skin reflectance spectrometer before phototesting. Thickness of the stratum corneum and the cellular epidermis were measured in skin biopsies from the phototest sites. All measurements were performed in the winter and spring months. Results: Stratum corneum and cellular epidermis were thinner at the back than at the buttocks (P<0.01). Thickness of the stratum corneum at the back or the buttocks was not related to the degree of skin pigmentation (P=0.62 and P=0.20, respectively). Thickness of the stratum corneum at the buttocks was unaffected by gender (P=0.42) and age (P=0.83) whereas cellular epidermis decreased with age (P<0.01) and was thinner in females than in males (P<0.01). In spite of the higher pigmentation at the back than at the buttocks, the minimal erythema dose (MED) was lower at the back than at the buttocks (x=2.7 and x=2.2 SED's, respectively; P=0.04). Given the same degree of skin pigmentation, there was no difference in the MED in buttock skin in children, young adults and older adults un-exposed to UV (P= 0.61). Prediction of the MED in un-exposed buttock skin and in exposed skin of the back by a theoretical model based on an exponential function of the measured skin pigmentation was found to provide good estimates of the MED determined by phototest. Conclusion: Skin pigmentation at un-exposed buttock skin can reliably predict the constitutive UV sensitivity in healthy Caucasian children and adults and is recommended in surveys where phototesting cannot be performed.     

Evaluation of coagulation kinetics using thromboelastometry—methodologic influence of activator and test medium

Renewed interest has arisen in the use of thromboelastography/thromboelastometry in evaluating coagulation kinetics. The test medium, type of activator, and its concentration may influence the interpretation of coagulation kinetics. This study aimed to investigate methodologic influences of activator and test medium on thromboelastometric parameters of coagulation kinetics. Dynamic clot formation was evaluated by thromboelastometry using whole blood (WB), platelet-rich plasma, or platelet-poor plasma employing different concentrations of extrinsic (tissue factor) and contact activator (synthasil) and with variable concentrations of phospholipids. Plasma samples displayed prolonged clot initiation and enhanced clot propagation compared with WB. Clot firmness was markedly reduced in platelet-poor plasma as compared with platelet-rich plasma and WB. Increasing concentration of activator shortened the clot initiation and increased the velocity of clot propagation, whereas terminal clot firmness remained unaffected. Platelets accelerated clot propagation and raised clot firmness. Phospholipids shortened the time of clot initiation and increased velocity of propagation, while clot firmness remained unchanged. Our results demonstrate that evaluation of coagulation kinetics using thromboelastometry varies according to the composition of the test medium, type, and concentration of activator, as well as the presence and concentration of phospholipids in the test reagent.     

The benefit of molecular characterization during a measles upsurge in Denmark

Molecular characterization of measles virus was part of the epidemiological investigation of 27 measles cases reported in Denmark in 2006. RT-PCR detected measles virus RNA from various types of clinical specimens in 24 cases. Virus genotypes were determined by sequencing the nucleocapsid (N) gene. Four different genotypes, B3, D4, D5 and D9 were identified including two variants of the D4 genotype. In combination with the epidemiological data four clusters of measles cases and three sporadic cases were revealed. Our study showed that measles in Denmark resulted from imported measles virus strains. The limited duration and short chain of transmission of the identified clusters ascertain that the interruption of measles virus circulation is being sustained. However, measles transmission still has a potential to occur. To minimise the development of pools of susceptible individuals high (>/=95%) routine vaccination coverage with two doses of measles-containing vaccine needs to be attained. Molecular epidemiological studies have proved to be both a useful and a necessary component of an enhanced surveillance system required in the measles elimination phase.