Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up

BACKGROUND: Previous studies of the natural course of bipolar disorder have suggested that relapse and psychosocial impairment are more common than many would expect during treatment under routine conditions. The present research sought to identify patterns of consistency in longitudinal recovery after an index manic or depressive episode in patients formerly hospitalized for major affective disorders. The data extend prior findings from the Chicago Follow-up Study involving four successive assessments of course and outcome for bipolar and unipolar patients over a 10-year follow-up interval. METHODS: Thirty-four RDC bipolar I manic, 17 psychotic unipolar depressed, and 72 nonpsychotic unipolar depressed patients were assessed at index hospitalization and prospectively followed-up at 2, 4.5, 7.5 and 10 years. Psychosocial functioning, rehospitalization, and overall outcome were rated by standardized instruments. Patterns of consistent remission or impairment in functioning were compared across follow-up periods. RESULTS: Consistently good functioning was observed more often among patients with unipolar nonpsychotic depression than bipolar disorder or unipolar psychotic depression. Psychosis at index hospitalization was not associated with poorer outcomes for either the bipolar or unipolar groups, although it significantly predicted psychosis at follow-up more robustly for unipolar than bipolar patients. Less than half of the bipolar cohort had good work performance at each follow-up, while unipolar nonpsychotic depressed patients had consistently better work functioning. Rehospitalization was more common for the bipolar than unipolar patients at the 4.5- and 7.5-year assessments. Sustained remission across follow-ups was associated with remission at subsequent follow-ups regardless of diagnostic polarity at index hospitalization. LIMITATIONS: The observational design, small sample size, and naturalistic treatment of subjects in this protocol prompts caution when interpreting treatment outcome findings. The availability of a bipolar cohort with relatively low attrition over a 10-year period may limit the generalizability of the current findings to patients who remain engaged in sustained contact with a long-term research program. CONCLUSIONS: Over a 10-year follow-up period, about half of bipolar patients show sustained remissions or patterns of improvement, while 30-40% experience some functional decline. The degree of consistency in remission patterns over time may hold greater prognostic significance than the polarity of an index affective episode in anticipating subsequent levels of psychosocial adjustment in severe mood disorders.     

The dentino-enamel junction revisited

The dentino-enamel junction is not an simple inert interface between two mineralized structures. A less simplistic view suggests that the dentino-enamel junctional complex should also include the inner aprismatic enamel and the mantle dentin. At early stages of enamel formation, fibroblast growth factor (FGF)-2 is stored in and released from the inner aprismatic enamel, possibly under the control of matrix metalloproteinase (MMP)-3. The concentration peak for MMP-2 and -9 observed in the mantle dentin coincided with a very low labeling for TIMP-1 and -2, favoring the cross-talk between mineralizing epithelial and connective structures, and as a consequence the translocation of enamel proteins toward odontoblasts and pulp cells, and vice versa, the translocation of dentin proteins toward secretory ameloblasts and cells of the enamel organ. Finally, in X-linked hypophosphatemic rickets, large interglobular spaces in the circumpulpal dentin were the major defect induced by the gene alteration, whereas the mantle dentin was constantly unaffected. Altogether, these data plead for the recognition of the dentino-enamel junctional complex as a specific entity bearing its own biological characteristics.     

Biologic activities of antibodies to the neutral-polysaccharide component of the Pseudomonas aeruginosa lipopolysaccharide are blocked by O side chains and mucoid exopolysaccharide (alginate).

Virulent strains of Pseudomonas aeruginosa are either of a nonmucoid, lipopolysaccharide (LPS)-smooth or mucoid, LPS-rough phenotype, and immunity to these different variants is efficiently mediated by antibodies specific to O antigens or mucoid exopolysaccharide (also called alginate), respectively. In addition to O side chains and core polysaccharide components, the LPS of P. aeruginosa also contains neutral-polysaccharide components that express antigenic determinants common to many clinical isolates. We evaluated antibodies specific to neutral polysaccharides for the ability to mediate opsonic killing and protective immunity. Antibodies to these antigens mediated opsonic killing of poorly virulent nonmucoid LPS-rough isolates but not of isogenic strains with either a LPS-smooth or a mucoid phenotype. Antibodies to neutral-polysaccharide antigens also failed to protect neutropenic mice from challenge with modest doses of LPS-smooth P. aeruginosa strains (< 10(3) CFU per mouse), whereas O-antigen-specific antibodies were highly protective. Antibodies to neutral polysaccharides deposited significantly (P = 0.002) more C3 onto LPS-rough strains than did antibodies to O side chains, but this situation was reversed when isogenic LPS-smooth strains were tested. Given that protective immunity against P. aeruginosa must be directed against either nonmucoid LPS-smooth strains or mucoid LPS-rough strains, it appears that antibodies specific to neutral-polysaccharide antigens do not protect against P. aeruginosa infection. Lack of protection is likely due to the ability of both O side chains and mucoid exopolysaccharide (alginate) to interfere with the opsonic killing activity of neutral-polysaccharide-specific antibodies.     

A new species of <Emphasis Type="Italic">Aplectana</Emphasis> (Nematoda,Cosmocercidae) in <Emphasis Type="Italic">Platymantis boulengeri</Emphasis> (Anura,Ceratobatrachidae) from Papua New Guinea

Aplectana krausi sp. nov. (Ascaridida, Cosmocercidae) from the intestines of Platymantis boulengeri (Anura, Ceratobatrachidae) is described and illustrated. Aplectana krausi represents the 42nd species assigned to the genus, the 4th species reported from the Australo-Papuan region. It is easily separated from the three species previously reported from the region by the distribution pattern of male caudal papillae: A. macintoshii and A. novaezelandiae have irregular patterns; A. zweifeli and A. krausi have defined patterns. Aplectana zweifeli has 8–10 precloacal, no adcloacal, and 9 postcloacal pairs of papillae, there is a single median papillae just anterior to the cloaca; A. krausi has 5 precloacal, 1 adcloacal, and 5 postcloacal pairs of papillae, a median papillae is absent.     

Husbands' and wives' adjustment to pregnancy and first parenthood

There are conflicting reports regarding type and extent of the change in couples' lives due to the arrival of a 1st baby. The present short-term longitudinal study of 39 volunteer couples had 2 major objectives: 1) to examine changes in couples' division of labor during the transition to parenthood; and 2) to investigate husband-wife differences in the associations between indices of marital and parental adjustment during the early postpartum months. Individual questionnaires and interviews were administered in couples' homes on 3 occasions: early pregnancy, late pregnancy, and 3-4 months postpartum. The major findings were that changes in household division of labor from early pregnancy to late pregnancy to 3-4 months postpartum demonstrated a curvilinear pattern, such that late pregnancy was characterized by more egalitarian household roles than was found in early pregnancy or postpartum. Marital adjustment mean scores suggested that marriages were functioning well at 3-4 momnths postpartum. Fathers' greater involvement with the baby was associated with better marital and parental adjustment, whereas fathers' postpartum participation in feminine household tasks was correlated with lower adjustment. In contrast to father, mothers' greater participation in baby care tasks was associated with lower marital adjustment. Mothers usually perceived changes in marriage and lifestyle due to the baby as more bothersome than did fathers. Adjustment to parenthood and marital adjustment measures were more interrelated more frequently for fathers than mothers. These findings underscore the complex associations among husbands' and wives' household roles, marital adjustment, involvement with baby, and adjustment to parenthood.     

Paramagnetic macrocyclic complexes as contrast agents for MR imaging: proton nuclear relaxation rate enhancement in aqueous solution and in rat tissues

Paramagnetic macrocyclic chelates show promise as magnetic resonance (MR) imaging contrast agents due to stability and relaxivity comparable to those of DTPA-type chelates. For the three copper and manganese macrocyclic complexes studied in aqueous solution, T1 and T2 relaxivities ranged from 0.14 to 5.88 mM-1sec-1 at 6.25 MHz. In rats, the intravenous administration of 16 mumol/kg of Mn(cyclam) caused the liver T1 relaxation rate to double at 15 minutes after injection. T1 measurements by pulsed MR imaging and manganese analyses on excised tissue showed that both relaxation rate (1/T1) and manganese content of liver and kidney increase linearly with the dosage of Mn(cyclam). The linear relationship between 1/T1 and manganese content can be considered an "in tissue" relaxivity plot for the agent. The resulting relaxivity is 54 mM-1sec-1 in liver, compared with 3.1 mM-1sec-1 in aqueous solution. Although this work is preliminary, the implication for medical MR imaging applications is that macrocyclic contrast agents can be effective at approximately one-tenth the current typical dose used for gadolinium DTPA.     

Timing of Diosgenin Appearance in Suspension Cultures of Dioscorea deltoidea

Cycloheximide and compactin were added to cell suspension cultures of DIOSCOREA DELTOIDEA. Cycloheximide inhibited growth and diosgenin biosynthesis completely at 40 mg/l when added during the growth phase. Compactin partially inhibited growth and diosgenin production at 100 microg/l when added during the growth phase. [1- (14)C]-Acetate incorporation into diosgenin was about 20-fold higher when added during the early stages of growth as compared to addition in the stationary phase. Incorporation of [1- (14)C]-acetate into diosgenin was inhibited by compactin only during the early stages of growth. These results indicate the formation of an accumulating intermediary metabolite during the early stages of growth which is transformed into diosgenin when D. DELTOIDEA cells are in the stationary phase.