Glucocorticoid receptor gene haplotype structure and steroid therapy outcome in IBD patients

AIM: To study whether the glucocorticoid receptor (GR/ NR3C1) gene haplotypes influence the steroid therapy outcome in inflammatory bowel disease (IBD). METHODS: We sequenced all coding exons and flanking intronic sequences of the NR3C1 gene in 181 IBD patients, determined the single nucleotide polymorphisms, and predicted the NR3C1 haplotypes. Furthermore, we investigated whether certain NR3C1 haplotypes are significantly associated with steroid therapy outcomes. RESULTS: We detected 13 NR3C1 variants, whi...     

Mental disorders among acute burn patients

Objective

To investigate mental disorders among acute hospitalized burn patients.

Method

Consecutive acute adult burn patients (n = 107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered.

Results

The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q = 6.40, df = 1, p = 0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q = 13.00, df = 1, p < 0.001) in acute care.

Conclusions

Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium.     

Multistage audiovisual integration of speech: dissociating identification and detection

Speech perception integrates auditory and visual information. This is evidenced by the McGurk illusion where seeing the talking face influences the auditory phonetic percept and by the audiovisual detection advantage where seeing the talking face influences the detectability of the acoustic speech signal. Here, we show that identification of phonetic content and detection can be dissociated as speech-specific and non-specific audiovisual integration effects. To this end, we employed synthetically modified stimuli, sine wave speech (SWS), which is an impoverished speech signal that only observers informed of its speech-like nature recognize as speech. While the McGurk illusion only occurred for informed observers, the audiovisual detection advantage occurred for na?ve observers as well. This finding supports a multistage account of audiovisual integration of speech in which the many attributes of the audiovisual speech signal are integrated by separate integration processes.     

Risk factors for mortality and morbidity related to radical cystectomy

OBJECTIVES

To evaluate the risk factors for mortality and morbidity related to radical cystectomy (RC) in a medium‐sized academic centre, and to analyse the rate and trends of perioperative morbidity and mortality, as although complications related RC to are lower in modern than historic series, RC is still associated with marked risks.

PATIENTS AND METHODS

The study included 258 patients undergoing RC for bladder cancer in Turku University Hospital in 1986–2005. Basic patient characteristics and in‐hospital, early (from hospital discharge to 3 months) and combined morbidity and mortality were analysed. Risk analysis included 16 risk factors for complications. Trends were analysed by comparing the two study decades (1986–1995 vs 1996–2005).

RESULTS

The total complication rate was 34%, with minor and major complications in 26%, and 11% of patients, respectively. There were no significant changes in total morbidity, but the number of myocardial infarctions and atrial fibrillations decreased significantly (P = 0.045). Operative mortality was 2.7%, with an insignificant decrease (4.2% to 0.9%, P = 0.11) over time. Salvage RC, high American Society of Anesthesiologists (ASA) score (≥3), extensive blood loss (>3 L), a high number of transfusions (five or more), several comorbidities (two or more), age (≥65 vs <65 years), and extravesical tumours were significant risk factors for major complications. An ASA score of ≥3 and five or more transfusions were the only factors associated with mortality. A high ASA score (odds ration 3.25, 95% confidence interval 1.08–9.74) and high number of transfusions (2.74, 1.05–7.15) were independent risk factors for major complications.

CONCLUSION

Although RC is associated with acceptable morbidity, attention should be given to risk factors identified at the time of patient selection, and to meticulous haemostasis at the time of surgery. A predictable outcome comparable to that in high‐volume centres is also possible in a medium‐sized hospital.     

Physical ill health and risk of psychosis

Patients with psychosis have been found to suffer from physical illnesses more commonly than the general population. In this report, self-reported physical ill health and its correlates among subjects with and without vulnerability to psychosis in a sample of first-degree relatives, help-seekers and controls were investigated. Perceived physical health was statistically significantly poorer among subjects with minor symptoms on the Structured Interview for Prodromal Symptoms and those vulnerable to psychosis than among those without symptoms measured by 13 somatoform symptom sum scores of the Symptom Checklist-90. Those at current risk of psychosis had a significantly higher mean sum score on the 13 somatic items (mean=21.1) than others (mean=9.6). Having physical symptoms or a self-reported physician-diagnosed illness was significantly associated with vulnerability to psychosis (odds ratio=3.05). The subjects with a mood disorder (odds ratio=4.33) had significantly more commonly physician-diagnosed illnesses than those who had no diagnosis or any other diagnosis. Physical ill health seems to be common among those vulnerable to psychosis.     

Elective surgery for recurrent diverticulitis

BACKGROUND/AIMS: After two documented episodes of uncomplicated diverticulitis, elective colon resection is recommended to prevent complications of the disease but the nature of symptoms in non-operated patients requires specification. METHODOLOGY: A detailed questionnaire concerning clinical variables was mailed to two hundred and sixty patients admitted into our hospital for symptoms of acute sigmoid diverticulitis between 1981 and 2002. One hundred and seventy-one patients (70 percent) answered the questions adequately. Based on the clinical symptoms reported by the patients on the questionnaires, three patient groups set up, i.e. patients treated non-operatively or operatively for recurrent diverticulitis and patients operated on for diverticular perforation. The results of the patients treated non-operatively were analyzed with special reference to readmissions and age. RESULTS: The need for treatment by a physician, the need for hospital treatment, the presence of abdominal cramps, the presence of febrile left lower abdominal pain, the need for antibiotics and the need for NSAIDs were more common in the patients treated non-operatively for recurrent diverticulitis. When the patients treated non-operatively for recurrent diverticulitis were compared in a logistic regression model in relation to the number of admissions, the need for treatment by a physician and the presence of left lower abdominal pain were significantly more common in the patients admitted twice or more often. The same variables remained significantly different when the patients admitted once or twice were compared. Age did not correlate with any of the variables tested. CONCLUSIONS: On the basis of our results, we recommend that patients with recurrent uncomplicated diverticulitis should be operated on after two documented episodes to reduce the symptoms of the patients.     

11-Year Experience with Laparoscopic Adjustable Gastric Banding for Morbid Obesity—What Happened to the First 123 Patients?

Background Few long-term studies regarding the outcome of laparoscopic adjustable gastric banding for morbid obesity have so far been published. We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years (mean 86 months) of follow-up. Methods Data have been collected prospectively among 280 patients operated since March 1996. Until March 2002 (minimum 5-year follow-up), 123 patients have been operated laparoscopically with the Swedish band. We report major late complications, reoperations, excess weight losses (EWL) and failure rates among these patients, with a mean (range) follow-up time of 86 months (60–132). EWL < 25% or major reoperation was considered as a failure. EWL > 50% was considered a success. Results Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21–44). Mean (range) preoperative weight was 130 kg (92–191). Mean (range) preoperative body mass index was 49.28 kg/m² (35.01–66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years. Conclusions Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.     

Increased gene expression levels of collagen receptor integrins are associated with decreased survival parameters in patients with advanced melanoma

Expression of collagen receptor integrins alpha1beta1 and alpha2beta1 has been associated with progression and metastatic potential of malignant melanoma. Integrin alpha2beta1 was originally characterized as a melanoma progression antigen. We have used real-time quantitative PCR to study the mRNA expression levels of three collagen receptor integrin chains, that is alpha1, alpha2 and alpha11 in metastases from 26 patients with melanoma. Interestingly, we find that survival after initiation of chemoimmunotherapy was significantly decreased in all patients whose tumours expressed high mRNA levels of alpha1 integrin, alpha2 integrin or alpha11 integrin when compared with lower tumour expression levels (P<0.05, log rank test). Moreover, those patients with high mRNA levels of all studied integrins had a significantly shorter survival from the appearance of the first metastasis than the patients with low levels of integrins (P<0.05). Furthermore, a high mRNA expression level of integrin alpha2 was found to be associated with poorer overall survival. High alpha2 mRNA levels (n=6) were associated with median survival of 35 months and low alpha2 mRNA levels (n=20), with median survival of 53 months (P=0.033). We conclude that collagen receptor integrins are important in the progression and prognosis of metastatic melanoma, and their measurements might be used as predictive markers when assessing disease progression.     

Association of serotonin transporter promoter regulatory region polymorphism and cerebral activity to visual presentation of food

Recent functional magnetic resonance imaging (fMRI) studies have revealed links between genetic polymorphisms and cognitive and behavioural processes. Serotonin is a classical neurotransmitter of central nervous system, and it is connected to the control of appetite and satiety. In this study, the relationship between the functional variation in the serotonin transporter gene and the activity in the left posterior cingulate cortex (PCC), a brain area activated by visual food stimuli was explored. Thirty subjects underwent serial fMRI studies and provided DNA for genetic analyses. Subjects homozygous for the long allele exhibited greater left PCC activity in the comparison food > non-food compared with individuals heterozygous or homozygous for the short allele. The association between genotype and activation was linear, the subjects with two copies of the long allele variant having the strongest activation. These results demonstrate the possible genetically driven variation in the response of the left PCC to visual presentation of food in humans.