Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - findings from the Munich Antidepressant Response Signature (MARS) project

Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode, recurrent or bipolar depression were thoroughly characterized with respect to demographic factors, clinical history, and the degree of HPA-axis dysregulation evaluated by means of combined dex/CRH tests, and the predictive value of these factors for treatment outcome is investigated. 80.8% of patients responded to treatment (i.e., improvement in symptom severity of at least 50%) and 57.9% reached remission (i.e., near absence of residual depressive symptoms) at discharge after a mean treatment period of 11.8 weeks. Regression analysis identified early partial response (within 2 weeks) as the most important positive predictor for achieving remission. Previous ineffective treatment trials in the current episode and presence of a migration background are potent negative predictors for treatment outcome. In addition, remitters were characterized by a more pronounced normalization of an initially dysregulated HPA-axis. We could show that a large majority of inpatients suffering from depression benefits from antidepressant treatment during hospitalization. However, a considerable number of patients failed to achieve remission. We demonstrated that this subgroup can be characterized by a set of demographic, clinical and neuroendocrine variables allowing to predict unfavorable outcome at an early stage of treatment.     

Antihyperalgesic effects of intrathecally administered magnesium sulfate in rats

Intrathecal administration of MgSO(4) is reported to cause paralysis. However, the characteristic sensory disturbances have not been thoroughly investigated. We examined the effect of intrathecally administered MgSO(4) on the nociceptive threshold, using three different nociceptive measures, formalin test, hot plate test and paw pressure test in rats. The dose of MgSO(4) was 30, 100 or 300 microg. In acute nociceptive tests, intrathecal MgSO(4) did not cause any significant changes in the pain threshold. However, phase 2 of the formalin test was suppressed dose-dependently. It is known that spinal NMDA receptors are involved in the changes seen during the second (tonic) phase of the formalin test and in vitro studies showed that Mg(2+) can cause voltage-dependent blockade of NMDA receptor channel in the neurons of spinal dorsal horn. Thus, the suppressive effect of intrathecally administered MgSO(4) on the tonic inflammation-evoked behavior is mediated by the spinal NMDA receptors. Our results suggest that intrathecal administration of MgSO(4) may be therapeutically beneficial for patients with tonic pain involving the spinal NMDA receptors.     

Non-isotopic microtitre plate-based assay for detecting products of polymerase chain reaction amplification: application to detection of the tdh gene of Vibrio parahaemolyticus.

A non-isotopic microtitre plate-based assay method was devised for detection of products of the polymerase chain reaction. This assay involves affinity immobilization of the biotinylated amplification products in microtitre plate wells and their fluorescence detection by their hybridization with an oligonucleotide probe linked to alkaline phosphatase. An advantage of this procedure is that the immobilization and hybridization are carried out simultaneously in the wells, thus shortening the assay time. The assay method was applied to the detection of the tdh gene of Vibrio parahaemolyticus. Seven copies of the target chromosome could be detected in about 45 min after 35 cycles of amplification.     

Protein-losing gastropathy with hypertrophic gastric folds: endosonographic findings

We present a case of protein-losing gastropathy with hypertrophic gastric folds. A 38-year-old man was hospitalized for severe epigastric pain suggestive of hypoproteinemia. Endoscopic and radiologic examination revealed enlarged gastric folds on the greater curvature of the stomach. Endoscopic sonography revealed marked thickening of the second layer on the greater curvature of the stomach. Endoscopic mucosal resection was performed, and the diagnosis was hypertrophic gastritis. After prednisolone treatment, hypoproteinemia and the enlarged gastric folds of the stomach resolved.     

Inhibition of cyclooxygenases reduces complement-induced glomerular epithelial cell injury and proteinuria in passive Heymann nephritis

In the passive Heymann nephritis (PHN) model of rat membranous nephropathy, complement induces glomerular epithelial cell injury and proteinuria, which is partially mediated by eicosanoids. Glomerular cyclooxygenase (COX)-1 and -2 are up-regulated in PHN and contribute to prostanoid generation. In the current study, we address the role of COX isoforms in proteinuria, using the nonselective COX inhibitor indomethacin and the COX-2-selective inhibitor 5,5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulphonyl)phenyl-2(5H)-furanone (DFU). Four groups of rats with PHN were treated twice daily, from day 7 through 14 with vehicle, 1 mg/kg DFU, 10 mg/kg DFU, or 2 mg/kg indomethacin. Vehicle-treated rats with PHN showed significant proteinuria on day 14 (163 +/- 15 mg/d, n = 19), compared with normal rats (10 +/- 4 mg/d, n = 3, p < 0.001). Treatment with DFU (1 or 10 mg/kg) reduced proteinuria significantly (by ~33%), compared with vehicle, but to a lesser extent than indomethacin (56% reduction). Glomerular eicosanoid generation was reduced significantly in the DFU and indomethacin groups, compared with vehicle. There were no significant differences among vehicle- or DFU-treated groups in [(3)H]inulin clearance, or in glomerular expression of COX-1 and -2. DFU did not affect the autologous immune response. In cultured rat glomerular epithelial cells, COX inhibition reduced complement-induced cytotoxicity, and this reduction was reversed by the thromboxane A(2) analog 9,11-dideoxy-9alpha,11alpha-methanoepoxyprostaglandin F(2alpha) (U46619). Thus, in experimental membranous nephropathy, selective inhibition of COX-2 reduces proteinuria, without adversely affecting renal function. However, inhibition of both COX-1 and -2 is required to achieve a maximum cytoprotective and antiproteinuric effect.     

Surface binding and intracellular uptake of gentamicin in the cultured kidney epithelial cell line (LLC-PK1).

Aminoglycoside antibiotics such as gentamicin are taken up by renal proximal tubular cells, yet little is known regarding the biochemical characteristics of the transport process at the cellular level. In this report, cellular handling of gentamicin was studied in the cultured kidney epithelial cell line LLC-PK1. After 2 days of incubation of the cells with gentamicin, cell-associated gentamicin decreased rapidly during the first 30 min when the cells were incubated in gentamicin-free medium, then decreased slowly. The apparent half-life of the latter phase, which should represent release from the intracellular compartment, was about 2.0 days. The rapid release of gentamicin should consist of two components, one is a release from the cell surface membrane and the other from domes. Cell surface binding of gentamicin was dependent on the ambient ionic strength. The intracellular uptake was inhibited by low temperature, neomycin, metabolic inhibitors and reagents which interact with the cytoskeleton. On the other hand, the uptake was not affected by d-glucose, organic cations and an organic anion. Thus, by estimating the intracellular gentamicin separately from the drug localized in other compartments, it is concluded that gentamicin is taken up by LLC-PK1 cells via an adsorptive endocytosis. The endocytosis of gentamicin should be dependent on metabolic energy and cytoskeletal function.