Coping with symptoms of relapse in schizophrenia

Summary A pilot study is reported of 30 chronic schizophrenic patients at the psychiatric out-patient facility of Government General Hospital, Madras, India. The objectives of the study were to assess the patients' perception of prodromata of relapse and their coping mechanisms. Patients were questioned on these aspects, using a semi-structured interview guide. The study showed a high degree of perception of prodromal signs amongst the cohort. Only 4 patients were unable to perceive any prodromata of relapse. Most commonly noted prodromal symptoms were disturbed sleep and slowness and underactivity. Patients had also resorted to various coping measures such as internal dialogue and talking to a close relative or friend. The study has clearly proved that Indian schizophrenic patients are perceptive of prodromata of relapse and developed self-help methods. These methods, if properly identified, could be incorporated in psychosocial intervention programmes.     

Changes in frictional coefficient with increased tendon surface tear—An experimental animal model

Aim

Surface tribological properties of a tendon in terms of coefficient of friction and lubrication mechanism are expected to change with the progression of surface tears which can affect the optimal function of the tendon. This study investigated whether coefficient of friction proportionally increases with the progression of a surface tear in a bovine tendon model.

The aging of elastic and muscular arteries: a comparison of diabetic and nondiabetic subjects

OBJECTIVE: To compare age-related changes in the mechanical properties of different arterial segments in normal volunteers and subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: In 169 subjects (diabetic n = 57 and nondiabetic n = 112), we assessed the mechanical properties of three arterial segments of differing wall composition. Pulse wave velocity (PWV) was measured noninvasively in a thoraco-abdominal segment (carotid femoral PWV [PWV(cf)]), in an upper limb muscular artery (carotid radial PWV [PWV(cr)]), and from the aorta to the finger (PWV from the aorta to the finger [PWV(fin)]). Central aortic compliance (CAC) was also measured. RESULTS: Average CAC was lower (0.662 vs. 0.850, P < 0.05) and all measures of PWV tended to be faster in diabetic subjects despite the fact that they were, on average, 10 years younger. However, these measures were not related to age in diabetic subjects. After correcting for blood pressure, only PWV(cf) was associated with age in nondiabetic subjects (P < 0.001). Expressing results as ratios of nonelastic to elastic arterial segments (i.e., PWV(cr)-to-PWV(cf) and PWV(fin)-to-PWV(cf)) improved the relationship with age. Both PWV(cr)-to-PWV(cf) and PWV(fin)-to-PWV(cf) were significantly associated with age in nondiabetic subjects (r = -0.59, P < 0.001; r = -0.57, P < 0.001) but not in diabetic subjects (r = -0.15, P = 0.302; r = -0.24, P = 0.129). Multivariate analysis showed that the ratios were not associated with systolic blood pressure. CONCLUSIONS: There are significant differences in the rate of age-related decline in vascular stiffness in elastic arteries of nondiabetic compared with diabetic arteries. Diabetic arteries appear to age at an accelerated rate at an earlier age and then reach a functional plateau.     

Improved survival in multiple myeloma and the impact of novel therapies

Treatments for myeloma have expanded in the last decade, but it is not clear if the introduction of novel therapies and the increased use of high-dose therapy have translated into better outcome for patients with myeloma. We examined the outcome of 2 groups of patients seen at a single institution, one from time of diagnosis and the other from the time of relapse, to examine the survival trends over time. Among 387 patients relapsing after stem-cell transplantation, a clear improvement in overall survival from the time of relapse was seen, with those relapsing after 2000 having a median overall survival of 23.9 versus 11.8 months (P < .001) for those who relapsed prior to this date. This improvement was independent of other prognostic factors. Patients treated with one or more of the newer drugs (thalidomide, lenalidomide, bortezomib) had longer survival from relapse (30.9 vs 14.8 months; P < .001). In a larger group of 2981 patients with newly diagnosed myeloma, those diagnosed in the last decade had a 50% improvement in overall survival (44.8 vs 29.9 months; P < .001). In this study, we demonstrate improved outcome of patients with myeloma in recent years, both in the relapsed setting as well as at diagnosis.     

Prognostic value of angiogenesis in solitary bone plasmacytoma

Angiogenesis plays an important role in the biology of multiple myeloma (MM) and has prognostic importance in this disease. Solitary plasmacytoma is a localized plasma cell malignancy that progresses to MM in a significant number of patients. We examined if angiogenesis is increased in solitary plasmacytoma and if it can help identify patients likely to progress to myeloma. We studied angiogenesis in plasmacytoma biopsy samples and bone marrow biopsies from 25 patients. High-grade angiogenesis was present in 64% of plasmacytomas. In contrast, bone marrow angiogenesis was low in all patients. Patients with high-grade angiogenesis in the plasmacytoma sample were more likely to progress to myeloma and had a shorter progression-free survival compared with patients with low-grade angiogenesis (P =.02). Angiogenesis is increased in solitary plasmacytoma and is a significant predictor of progression to myeloma and provides further evidence of its importance in the pathogenesis of myeloma.     

Acute Aortic Valve Rupture Secondary to Blunt Chest Trauma

Abstract Cardiac valve injury after blunt chest trauma is rare. We present a case of blunt chest trauma resulting in an isolated aortic valve rupture treated with aortic valve replacement . (J Card Surg 2010;25:381‐382)     

The Pattern of Hydatid Disease—A Retrospective Study from Himachal Pradesh,India

Hydatid disease is a common but little studied disease in Himachal Pradesh, India. This is a retrospective study from the Lady Willingdon Hospital, Manali. 115 patients presenting from April 1996 to March 2007 were included. Outcome measures were mortality and morbidity. 70 patients were female and 46 were male. (One female patient was operated on twice). 78% (n = 90) of the occurrences were hepatic. There were other varied sites. There were fourteen pulmonary hydatids. All patients underwent surgical cystectomy. An “AIR Technique” (Aspiration, Injection, Reaspiration) is described for scolicidal deactivation after March 2003 utilized in thirty two patients. There was no mortality. There were five documented recurrences in our series all of which occurred in cystectomy done without the AIR (Aspiration, Injection, Reaspiration) technique. Hydatid disease is a common disease in Himachal Pradesh warranting a high index of suspicion leading to an early diagnosis. A simple technique called the “AIR TECHNIQUE” (Aspiration, Injection, Reaspiration) is described.     

How best to use new therapies in multiple myeloma

Advances in the molecular understanding of myeloma have led to the development of novel agents such as immunomodulatory drugs (IMiDs) and proteasome inhibitors (bortezomib). When used alone, these agents have significant activity against myeloma and responses increase significantly when they are combined with additional agents including glucocorticosteroids and chemotherapeutic agents such as alkylators. There is a drive to use these novel agents in patients with newly diagnosed myeloma, where they lead to impressive response rates with increasing duration of responses. In addition, novel agents are now the mainstays of therapy for relapsed disease. In the following paper, we summarize the key observations from recent completed and ongoing studies that determined the effect of these novel therapies both in the setting of newly diagnosed myeloma and for relapsed disease. We also discuss our approach to the use of these agents in specific myeloma settings.     

TG101209, a novel JAK2 inhibitor,has significant in vitro activity in multiple myeloma and displays preferential cytotoxicity for CD45+ myeloma cells

Interaction of myeloma cells with the bone marrow microenvironment is mediated in large part through different cytokines, especially VEGF and IL6. These cytokines, especially IL6, leads to upregulation of the JAK/STAT pathway in myeloma cell, contributing to increased proliferation, decreased apoptosis, and acquired drug resistance. Here, we examined the preclinical activity of a novel JAK2 inhibitor TG101209. TG101209 induced dose‐ and time‐dependent cytotoxicity in a variety of multiple myeloma (MM) cell lines. The induction of cytotoxicity was associated with inhibition of cell cycle progression and induction of apoptosis in myeloma cell lines and patient‐derived plasma cells. Evaluation of U266 cell lines and patient cells, which have a mix of CD45 positive and negative cells, demonstrated more profound cytotoxicity and antiproliferative activity of the drug on the CD45+ population relative to the CD45? cells. Exploring the mechanism of action of TG101209 indicated downregulation of pJak2, pStat3, and Bcl‐xl levels with upregulation of pErk and pAkt levels indicating cross talk between signaling pathways. TG101209, when used in combination with the PI3K inhibitor LY294002, demonstrated synergistic cytotoxicity against myeloma cells. Our results provide the rationale for clinical evaluation of TG101209 alone or in combination with PI3K/Akt inhibitors in MM. Am. J. Hematol., 2010. © 2010 Wiley‐Liss, Inc.