ECT practice in Japan

OBJECTIVES: We sought to determine the characteristics of electroconvulsive therapy (ECT) practice in Japan. Only by knowing practice patterns can standards of care be successfully developed and implemented. METHODS: From September 1, 2001, to August 31, 2003, a questionnaire was sent to 248 institutions. RESULTS: A total of 100 institutions (40.3%) completed the questionnaire. ECT was available in 83 institutions. A total of 1,210 patients received 11,146 ECTs from 895 psychiatrists. Brief-pulse device was used in 21 institutions. EEG monitoring was used routinely in 15 institutions. Bilateral ECT was always used. Patients who received ECT were diagnosed schizophrenia (48.9%), major depression (37.4%), catatonia (6.8%), mania (4.4%), and dysthymia (0.8%). The majority of patients who received ECT were in the age group 45-64 years (40.4%) and 65 years and older (39.3%). A total of 670 patients received a total of 6364 unmodified ECT at 60 institutions. There were no ECT-related deaths during the survey. CONCLUSION: ECT use in Japan is low. More than half of ECTs instituted were unmodified. The majority of patients who received ECT were diagnosed with schizophrenia and major depression.     

Improvement of postoperative analgesia during cancer surgery with Limoge's current: a personal experience

BACKGROUND: The anesthesiologist took advantage of a personal experience to determine whether transcutaneous cranial electrical stimulation using Limoge's current (TCES-LC) improved the level of postoperative analgesia by potentiating anesthetic agents used during the intra- and postoperative phases. Included were analgesics injected through an epidural thoracic catheter (T8-T9) positioned at the end of an esophagectomy. Another reason for a self-experimentation was to be able to evaluate the psycholeptic effects of TCES-LC to gain a better understanding of the problems linked with pain during treatment. METHODS: The Limoge' current is bidirectional and consists of a high-frequency biphasic asymmetrical wave composed of modulated, high-frequency (166-kHz) pulse trains with a repetition cycle of 100 Hz. TCES-LC was initiated 2 hours before anesthetic induction without any tranquilizer or other medication. TCES-LC was continuously applied during the entire surgical procedure and continued 48 hours postoperatively in the intensive care unit (ICU). As the objective was not to obtain electrical anesthesia, the usual anesthetic protocol was used during surgery. RESULTS: During the initial 48 postoperative hours with continuous application of TCES-LC (D0-D1), a decrease of the epidural anesthetic dose requirement was observed for ropivacaine, and sufentanil (-25% and -60% respectively). A similar decrease in these medications was also measured on day 2 (D2), while TCESLC was terminated. This decrease was amplified day 3 (D3) for both ropivacaine and sufentanil (-50% and -73% respectively). On day 4 (D4) the epidural anesthetics were totally suppressed (1 day before the normal conventional schedule planned for by the ICU physician with this type surgery). CONCLUSION: Future clinical trials need to be conducted to show the significant advantages of TCES-LC in alternative and complementary medicine.     

Evidence for the existence of [3H]-trimetazidine binding sites involved in the regulation of the mitochondrial permeability transition pore

1. Trimetazidine is an anti-ischaemic drug effective in different experimental models but its mechanism of action is not fully understood. Data indicate that mitochondria could be the main target of this drug. The aim of this work was to investigate the binding of [³H]-trimetazidine on a purified preparation of rat liver mitochondria.
2. [³H]-trimetazidine binds to two populations of mitochondrial binding sites with K_d values of 0.96 and 84 μM. The total concentration of binding sites is 113 pmol mg⁻¹ protein. Trimetazidine binding sites are differently distributed. The high-affinity ones are located on the outer membranes and represent only a small part (4%) of total binding sites, whereas the low-affinity ones are located on the inner membranes and are more abundant (96%) with a B_max=108 pmol mg⁻¹ protein.
3. Drug displacement studies with pharmacological markers for different mitochondrial targets showed that [³H]-trimetazidine binding sites are different from previously described mitochondrial sites.
4. The possible involvement of [³H]-trimetazidine binding sites in the regulation of the mitochondrial permeability transition pore (MTP), a voltage-dependent channel sensitive to cyclosporin A, was investigated with mitochondrial swelling experiments. Trimetazidine inhibited the mitochondrial swelling induced by Ca²⁺ plus tert-butylhydroperoxide (t-BH). This effect was concentration-dependent with an IC₅₀ value of 200 μM.
5. Assuming that trimetazidine effectiveness may be related to its structure as an amphiphilic cation, we compared it with other compounds exhibiting the same chemical characteristic both for their ability to inhibit MTP opening and to displace [³H]-trimetazidine bound to mitochondria. Selected compounds were drugs known to interact with various biological membranes.
6. A strong correlation between swelling inhibition potency and low-affinity [³H]-trimetazidine binding sites was observed: r=0.907 (n=24; P<0.001).
7. These data suggest that mitochondrial sites labelled with [³H]-trimetazidine may be involved in the MTP inhibiton.

     

Muscularizing tissues in the endocardial cushions of the avian heart are characterized by the expression of h1-calponin.

Muscularization of mesenchymal tissues in the developing heart is an important event in the morphogenesis of the valvuloseptal complex in four-chambered hearts. Perturbation of muscularization has been implicated in the pathogenesis of cardiac malformations in several animal models for congenital heart disease, including the Trisomy 16 mouse and the TGFbeta2 knockout mouse. Studies to unravel the mechanism of muscularization, as well as studies to determine the extent of the process in frequently used animal-model systems for cardiac development, have, thus far, been hampered by the lack of useful differentiation markers for muscularizing tissues, albeit that it had been demonstrated that, in the mouse, muscularizing cells are characterized by an elevated level of smooth muscle actin expression. In this study, we investigated whether muscularization of endocardial cushions in the avian heart is also accompanied by the expression of smooth muscle cell markers. The results presented in this study demonstrate that, in quail and chick, a specific population of muscularizing cells is recognized by the expression of smooth muscle h1-calponin. Interestingly, other genes typically found in smooth muscle cells (e.g., smooth muscle actin and caldesmon) are not expressed in muscularizing tissues. We conclude that muscularization of cushion-derived mesenchymal tissues is associated with a discrete genetic program reflected by the expression of h1-calponin and predict that h1-calponin will prove an invaluable tool in elucidating the regulation of muscularization and other aspects related to this event.     

Togavirus-like particles in renal epithelium of patients with systemic lupus erythematosus

Summary Virus-like particles, about 45 nm in diameter, were present in renal epithelium (tubules and podocytes) of 12 patients with confirmed systemic lupus erythematosus (SLE) and in 2 patients with probable SLE. They were not detected in renal biopsies from non-SLE patients. Morphologically, they suggest togavirus-like particles.     

Human papillomavirus testing following loop electrosurgical excision procedure identifies women at risk for posttreatment cervical intraepithelial neoplasia grade 2 or 3 disease.

BACKGROUND: Loop electrosurgical excision procedure (LEEP) is the predominant treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN2+) in the United States, yet following treatment approximately 10% of women are diagnosed again with CIN2+, necessitating close follow-up of such patients. METHODS: Surveillance strategies using cytology and/or human papillomavirus (HPV) testing were compared among women who underwent LEEP (n = 610) in the Atypical Squamous Cells of Undetermined Significance (ASCUS) Low-Grade Squamous Intraepithelial Lesion (LSIL) Triage Study. Cervical specimens, collected at 6-month visits for 2 years, were used for cytology, Hybrid Capture 2 (HC2) detection of carcinogenic HPVs, and PCR for genotyping of carcinogenic and noncarcinogenic HPV types. At exit, women had colposcopy for safety and disease ascertainment. RESULTS: At the visit post-LEEP (median time: 4.5 months after LEEP), 36.9% [95% confidence interval (95% CI), 32.7-41.1%] of women were positive for carcinogenic HPV by PCR and 33.7% (95% CI, 29.7-37.9) had ASCUS or more severe (ASCUS+) cytology. The overall 2-year cumulative incidence of histologically confirmed posttreatment CIN2+ was 7.0%; this could be further stratified by the HPV risk category detected at the 6-month visit after LEEP. The 2-year risk associated with HPV16 positivity was 37.0%, significantly higher than for other carcinogenic HPV types (10.8%, P < 0.001), noncarcinogenic types (1.5%, P < 0.001), or testing HPV negative (0%). Post-LEEP cytology (using a positive threshold of ASCUS+) was 78.1% (95% CI, 60.0-90.7%) sensitive for detection of posttreatment CIN2+. By comparison, PCR for carcinogenic HPV and combination testing (using a positive result from carcinogenic HPV testing or cytology as the test threshold with HPV-negative ASCUS not referred) were significantly more sensitive (96.9% for each, P = 0.03); HC2 alone was nonsignificantly more sensitive (90.6%, P = 0.3). Specificity was similar for ASCUS+ cytology (69.1%, 95% CI, 64.6-73.3%) and PCR for carcinogenic HPV (67.1%, P = 0.5), yet was lower for HC2 (63.8%, P = 0.048) and combination testing (62.9%, P = 0.02). CONCLUSION: Women who tested positive after LEEP for carcinogenic HPV types, especially HPV16, had high risk of subsequent CIN2+. HPV-based detection methods, alone or in combination with cytology, may be useful to incorporate in post-LEEP management strategies.     

Opening cerebrospinal fluid pressure guides the management of cerebrospinal fluid leakage after acoustic neuroma surgery.

OBJECTIVE: To assess the value of cerebrospinal fluid pressure as a decisional factor for immediate surgical revision in cerebrospinal fluid leakage after acoustic neuroma removal. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. PATIENTS: Between 1998 and 2001, 220 patients were operated on for acoustic neuroma by different transpetrosal approaches. Among 24 patients (12%) presenting postoperative cerebrospinal fluid leakage, those with meningitis or with hydrocephalus were excluded. Fifteen patients were included in this study. METHODS: Each patient had initial conservative treatment with serial depletive lumbar punctures and cerebrospinal fluid pressure measurements associated with oral acetazolamide. Surgical revision was decided on in case of persistent cerebrospinal fluid leakage. RESULTS: In eight patients with high cerebrospinal fluid pressure (18+/-1.4 cm H2O; range, 14-28 cm H2O), cerebrospinal fluid leak disappeared in 3 days after conservative treatment. Seven other patients required surgical revision for persistent cerebrospinal fluid leakage. Revision surgery was efficient in six patients with low cerebrospinal fluid pressure (8+/-1.3 cm H2O, range, 3-12 cm H2O). In the remaining patient with high cerebrospinal fluid pressure (18 cm H2O), cerebrospinal fluid leakage continued despite surgical revision, requiring lumboperitoneal shunting. CONCLUSION: The cerebrospinal fluid pressure value may be used as a decisional indicator for cerebrospinal fluid leakage treatment after acoustic neuroma surgery. Low cerebrospinal fluid pressure leakage would imply a revision surgery procedure without delay, whereas high cerebrospinal fluid pressure leakage would imply conservative treatment.