Prognostic scale for chronic schizophrenia

Although prognostic scales are available for schizophrenia, these focus on acute or subacute populations where premorbid functioning and established chronicity are the best predictors of outcome. Their usefulness in chronic schizophrenia is limited. The authors describe a simple and reliable 5-item, 12-point prognostic scale for chronic schizophrenia independent of chronicity. It measures prognosis as the product of a dynamic interplay between the highest level of adaptive occupational and social functioning ever achieved by the individual and the "invasiveness" of the Axis I disorder as manifest by genetic loading (family history of schizophrenia), erosion of reality testing (psychotic assaultiveness), and preservation of affect in psychopathology (depressed mood). Among chronic schizophrenic patients in the Chestnut Lodge Followup Study (n = 163), the prognostic score (based on history and admission clinical picture) allowed strong probabilistic statements to be made about long-term outcome. Tables present the conditional probability or risk of specific outcomes in the domains of institutionalization, work functioning, social relations, and global outcome for patients at varying levels along the prognostic spectrum. Close examination of these predictor-outcome relationships suggests that prognosis in chronic schizophrenia may be thought of as the variability (as opposed to fixedness) remaining in the individual's future life course, and poor outcome can be predicted with greater sensitivity than good outcome.     

Serum and follicular fluid sex hormone-binding globulin in stimulated and unstimulated cycles

Background It is wellknown that sex hormone-binding globulin (SHBG) concentrations in the follicle are relatively low in comparison with the corresponding estradiol (E₂) levels, which are extremely high. A direct comparison of these data in stimulated and unstimulated cycles, as well as the relationship of SHBG with testosterone (T) and E₂ in serum and follicular fluid (FF), is assessed.Methods SHBG was measured in serum and FF in 42 cycles stimulated by GnRH agonists and gonadotropins and in 15 unstimulated cycles. The levels of SHBG were compared to the corresponding total estradiol and total testosterone concentrations. The analyzed FFs of 42 women, 12 of whom conceived, were randomly selected from 90 patients participating in an in vitro fertilization program. Mature oocytes were retrieved from all follicles from which FFs were analyzed.Results Markedly elevated SHBG was found in both the serum and the FF of stimulated cycles compared to unstimulated cycles. In contrast, serum T and E₂ were significantly higher in induced than in unstimulated cycles, while there was no significant difference in FF T or E₂ between the two groups of cycles. No correlation was found between serum and FF SHBG in either stimulated or unstimulated cycles. In stimulated cycles, only in FF, SHBG was significantly correlated with both E₂ and T. In unstimulated cycles, no correlation was found between SHBG and either one of the corresponding steroids either in serum or in FF.Conclusions The fraction of non-SHBG bound, biologically active sex steroids may be lower in the FF of stimulated than that of unstimulated cycles.Presented in part at the VIIIth World Congress on in Vitro Fertilization and Alternate Assisted Reproduction, Kyoto, Japan, 1993.     

Schizophrenia as a disorder of developmentally reduced synaptic connectivity

Recent postmortem and neuroimaging studies of schizophrenia delineate changes in brain structure and volume that appear to arise from a reduction of neuritic processes (such as dendrites and synapses) rather than loss of neuronal or glial cell bodies. To account for these findings, we propose a pathophysiological model of reduced synaptic connectivity arising from disturbances of brain development active during perinatal and adolescent periods. We review a computer simulation of the elimination of the synaptic connections that models normal cognitive development and psychotic symptom formation. We describe the model's key parameters and discuss how they can account for important aspects of schizophrenia, including its unique symptoms, short- and long-term course, typical age of onset, neurodevelopmental deficits, limited neurodegenerative progression, sex differences, and more. We discuss some of the model's predictions and questions raised for basic research, early detection, and preventive intervention.     

Acid-Base and Electrolyte Changes during Exchange Transfusion

In connection with blood exchange transfusions carried out on forty newborn infants it has been found that the majority of the newborns requiring exchange transfusion have metabolic acidosis increasing to possibly critical severity by the end the exchange transfusion. The acidosis, however, is soon normalized spontaneously. Pretreatment with sodium bicarbonate infusion normalizes the pretrans fusion shift in acid-base balance and vents the development of a severe acidosis following the exchange transfusion without risking a subsequent alkalosis. Before exchange transfusion a slight hypernatraemia has often been observed and this increases transiently after blood exchange. Pretreatment with infusion did not modify this phenomenon. In our material no hyperpotassaemia has been encountered by the end of ex- change transfusion. I n response to pre-treatment with sodium bicarbonate infusion the plasma K⁺ level decreased slightly. By promoting the conjugation of bilirubin to proteins, pretreatment with sodium bicarbonate may presumably improve also the efficiency of the exchange transfusion; this, however, requires further proof.     

Relation of maternal and cord blood serum ferritin

Serum ferritin was measured in 51 term normal pregnant mothers and the corresponding cord blood samples. All of the mothers had received prophylactic oral iron and folate during pregnancy. The mean (+/-SD) maternal serum ferritin at the end of pregnancy was 58 +/- 42.9 microgram/l (range 16-201 microgram/l), compared to a mean of 183.2 +/- 61.2 microgram/l (range 62-313 microgram/l) in these newborns. No correlation was found between the serum ferritin of mothers and babies, nor between the serum ferritin and serum iron of mothers at the end of pregnancy or between these parameters in the newborn.     

Articular chondrocytes express connexin 43 hemichannels and P2 receptors – a putative mechanoreceptor complex involving the primary cilium?

Mechanical loading is essential for the health and homeostasis of articular cartilage, although the fundamental mechanotransduction pathways are unclear. Previous studies have demonstrated that cyclic compression up‐regulates proteoglycan synthesis via an intracellular Ca²⁺ signalling pathway, mediated by the release of ATP. However, the mechanism(s) of ATP release has not been elucidated. The present study examines expression of the putative mechanosensitive ATP‐release channel, connexin 43 and whether it is expressed on the chondrocyte primary cilium, which acts as a mechanosensor in a variety of other cell types. In addition the study characterized the expression of a range of purine receptors through which ATP may activate downstream signalling events controlling cell function. Bovine articular chondrocytes were isolated by sequential enzyme digestion and seeded in agarose constructs. To verify the presence of functional hemichannels, Lucifer yellow (LY) uptake into viable cells was quantified following treatment with a hemichannel agonist (EGTA) and antagonist (flufenamic acid). LY uptake was observed in 45% of chondrocytes, increasing to 83% following EGTA treatment (P < 0.001). Treatment with the hemichannel blocker, flufenamic acid, significantly decreased LY uptake to less than 5% with and without EGTA. Immunofluorescence and confocal microscopy confirmed the presence of primary cilia and the expression of connexin 43. Approximately 50% of bovine chondrocyte primary cilia were decorated with connexin 43. Human chondrocytes in situ within cartilage explants also expressed connexin 43 hemichannels. However, expression was confined to the upper 200 µm of the tissue closest to the articular surface. Immunofluorescence revealed the expression of a range of P2X and P2Y receptor subtypes within human articular cartilage. In conclusion, the expression of functional hemichannels by articular chondrocytes may represent the mechanism through which mechanical loading activates ATP release as part of a purinergic mechanotransduction pathway. Furthermore, the expression of connexin 43 on the chondrocyte primary cilium suggests the possible involvement of the cilium in this pathway.     

A nationwide study on hospital admissions due to dehydration in exclusively breastfed infants in the Netherlands: its incidence, clinical characteristics, treatment and outcome

Aims: To estimate the incidence and clinical characteristics in hospital admissions due to dehydration or undernutrition and their laboratory evaluation and treatment outcome in exclusively breastfed infants.
Methods: All hospital admissions during the first 3 months of life assessed by the Dutch Paediatric Surveillance Unit (DPSU) between mid 2003 and mid 2005.
Results: Nationwide 158 cases reported, correspond to an incidence of 58/y/100 000 breastfed infants; it is lower for severe dehydration at risk for hypernatraemia; 20/y/100 000. Sixty-five per cent of cases were <2 weeks old, their median weight loss was 9.3% and median age at admission 5 days; Serum sodium value was measured in only 12% of all cases. Insufficient volume intake and inadequate growth were most frequently reported (61% and 41%). Lethargy, jaundice or clinical dehydration was scored in 11–25%, seizures or shock in 3%. A breast pump at home was used in only 31%. In the hospital breast pumps were available (82%) as lactation consultants (73%). For treatment 65% was offered formula, in 30% by nasogastric drip. Most admissions lasted up to 3 days, all recovered fully and 33% were breastfed exclusively at discharge.
Conclusion: The incidence of severe dehydration in the Netherlands is relatively low. With extended use of breast pumps at home it could be lower. To prevent complications, we recommend applying a reference weight chart, a full clinical examination and more extensive screening of serum sodium and glucose.