Revisiting the Dexamethasone Suppression Test in unipolar major depression: an exploratory study

Background

Important methodological questions still exist concerning the Dexamethasone Suppression Test (DST), including the possibility of a better way of interpreting it. The aim of the present study was to explore the feasibility of an alternative way of interpreting DST results.

Methods

A total of 50 patients with major depression aged 41.0 ± 11.4 years old participated in the study. Past and present suicide attempts were recorded. Psychometric assessment included the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Scale (HAS), the Newcastle Depression Diagnostic Scale (NDDS), the Diagnostic Melancholia Scale (DMS) and the General Assessment of Functioning (GAF) scale. The 1 mg DST protocol was used. Analysis methods included the chi square test and analysis of covariance (ANCOVA) with Fisher least significant difference (LSD) as post hoc tests.

Results

In all, 34 patients (68%) were suppressors, 16 (32%) were non-suppressors and 14 patients had cortisol values above 5 μg/dl at baseline. Baseline cortisol level did not influence the classical DST interpretation. A total of 18 patients (36%) showed an increase of their cortisol levels after dexamethasone administration and 32 patients (64%) showed a decrease. Reducers had less melancholic features, similar levels of depression, better sleep and less suicidal thoughts in comparison to increasers. No relationship of DST to suicidality was found.

Discussion

The present study explored the pattern of cortisol response to dexamethasone suppression and suggested an alternative way of coding and interpreting the DST on the basis of whether the cortisol levels remain stable or increase vs decrease after the administration of cortisol. The results put forward a complex way of understanding the relationship of the DST results with clinical symptoms.     

Five cases of pseudomyxoma peritonei underwent abdominal lavage and administering CDDP

We examined five cases of pseudomyxoma peritonei with treatments of cytoreduction surgery, abdominal lavage and intraperiotoneal administration of cisplatin (CDDP). These primary lesions contained one case of pancreas and four cases of appendix. Histological types contained one case of well differentiated adenocarcinoma and four cases of signet ring cell carcinoma. All cases underwent a resection of primary lesion and muconodule, abdominal lavage with saline and 5% glucose or low molecule dextran solution. CDDP was administered into the abdominal space during and after the surgery, a total amount of 100 to 400 mg/body. There were no cases of collected ascites within one year, except one case that we could not follow. There was a possibility that a short-term quality of life was improved by multidiciplinary therapy containing cytoreduction surgery and intraperiotoneal administration of CDDP.     

Force exerted on maxillary anterior teeth in mandibular unilateral and bilateral distal extension partial edentulous situation

Odontology - The purpose of this study was to determine the influence of mandibular unilateral and bilateral distal extension partial edentulous situation and the use of removable partial dental...     

Influence of leukotriene pathway polymorphisms on clinical responses to montelukast in Japanese patients with asthma

What is known and Objective: Montelukast, a cysteinyl leukotriene receptor 1 antagonist, is safe and efficacious in patients with asthma. The mechanisms underlying the significant interpatient variability in response to montelukast are not clear but are believed to be, in part, because of genetic variability. Methods: To examine the associations between polymorphisms in candidate genes in the leukotriene pathway and outcomes in patients with asthma on montelukast for 4–8 weeks, we evaluated the changes in peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV_1·0) and patients’ subjective symptom before and after montelukast treatment. DNA was collected from 252 Japanese participants. Results and Discussion: Two single‐nucleotide polymorphisms (SNPs) in the ALOX5 (rs2115819) and LTA4H (rs2660845) genes were successfully typed. There was no difference between members of the general population (n = 200) and patients (n = 52) in each genotype frequency. Significant associations were found between SNP genotypes in the LTA4H gene and changes in PEF and FEV_1·0. The PEF and FEV_1·0 responses to montelukast in the A/A genotypes (n = 4) for the LTA4H SNP were significantly higher than those in the G allele carriers (A/G+G/G) (n = 17). What is new and Conclusion: Despite the small sample size, our results suggest that genetic variation in leukotriene pathway candidate genes contributes to variability in clinical responses to montelukast in Japanese patients with asthma.     

Treatment of joint cartilage lesions with cell therapy

Articular cartilage lesions which do not affect the integrity of subchondral bone, they are not able to repair it expontaneously. The asymptomatic nature of these lesions induces articular cartilage degeneration and development of an arthrosic process. To avoid the necessity to receive joint replacement surgery, it has been developed different treatments of cellular therapy which are focused to create new tissues whose structure, biochemistry composition and function will be the same than native articular cartilage. Approaches used to access the stream produce a fibrocartilaginose tissue which is not an articular cartilage. Implantation of autologous chondrocytes and autologous mosaicplasties induces a quality better articular cartilage. Furthermore both techniques involve damage in the sane cartilage; because of trying to get a big amount of chondrocytes or because of extraction osteochondral cylinder which will be implanted in the injured joint. The stem cells are a promising toll to repair articular cartilage, however they are in a previous experimentation step yet. Although the present studies using cellular therapy improves clinically and functionally, it is not able to regenerate an articular cartilage which offer resistance the degeneration process.     

Quantitative analysis of p53 expression and cell proliferation in gastric carcinomas. An immunohistochemical study

BACKGROUND/AIMS: Adenocarcinoma of the stomach is still among the leading malignancies in human morbidity and mortality statistics in spite of endoscopic screening of the high-risk patients. Investigation of prognostic factors of gastric cancer disease seems to be still very important. The authors present a clinicopathological study based on the analysis of 49 gastric carcinomas. METHODOLOGY: P53 overexpression and proliferation activity of the cells were examined by immunohistological method with peroxidase-antiperoxidase technique. The percentage of the positive cells was calculated after counting of 300 tumor cells in each case. The rate of the labeled cells was related to different pathological characteristics of the carcinomas i.e., TNM stage of the tumor, histological subtypes of Ming's as well as Laurén's and Goseki's classification respectively, grade of differentiation and lymph node status. RESULTS: According to the above-mentioned parameters, p53 overexpression was significantly higher in carcinomas of the cardiac region than in those of the distal parts of the stomach. These findings are consistent with results published in the literature: cell proliferation rate alone is not an independent prognostic factor, but the degree of cell proliferation activity and p53 expression are changing usually parallel with each other and with other prognostic markers as well. CONCLUSIONS: The assessment of p53 activity and cell proliferation rate in gastric carcinoma is of prognostic value especially if evaluated together with other clinical and histopathological characteristics. The examination of these markers is useful in detecting early gastric cancer, in selecting high-risk patients and in planning proper individual treatment.     

Absence of cytotoxic antibody to human immunodeficiency virus-infected cells in humans and its induction in animals after infection or immunization with purified envelope glycoprotein gp120.

The presence of antibody-dependent complement-mediated cytotoxicity (ACC) was assessed in humans and chimpanzees, which are capable of infection with human immunodeficiency virus isolate HTLV-IIIb, and examined in the goat after immunization with the major viral glycoprotein (gp120) of HTLV-IIIb. In infected humans no antibody mediating ACC was observed regardless of the status of disease. Even healthy individuals with high-titer, broadly reactive, neutralizing antibodies had no ACC. In contrast, chimpanzees infected with HTLV-IIIb, from whom virus could be isolated, not only had neutralizing antibody but also antibodies broadly reactive in ACC, even against distantly related human immunodeficiency virus isolates, as well as against their own reisolated virus. In the goat, the gp120 of HTLV-IIIb induced a highly type-specific response as measured by both ACC and flow cytofluorometry of live infected H9 cells. Normal human cells were not subject to ACC by animal anti-HTLV-III gp120-specific sera. Induction of ACC and neutralizing antibody were closely correlated in the animal experimental models but not in humans. The presence of ACC in gp120-inoculated goats and HTLV-III-infected chimpanzees represents a qualitative difference that may be important in the quest for the elicitation of a protective immunity in humans.     

Serological responses in chimpanzees inoculated with human immunodeficiency virus glycoprotein (gp120) subunit vaccine.

The major envelope glycoprotein of a human immunodeficiency virus (HIV) has been purified and was utilized as a prototype vaccine in chimpanzees. The 120,000-dalton glycoprotein (gp120) was purified from membranes of human T-lymphotropic virus (HTLV)-IIIB-infected cells and the final preparation contained low levels to no detectable HTLV-IIIB core antigen (p24) and low levels of endotoxin. Chimpanzees inoculated with gp120 responded by developing antibodies that precipitated radiolabeled gp120 and neutralized in vitro infection of HTLV-IIIB. Antibodies to HTLV-IIIB p24 were not detected in the gp120-immunized chimpanzees. Peripheral blood leukocytes from the vaccinated animals were examined for T4+ and T8+ cells, and no decrease in the T4/T8 ratio was found, indicating that immunization with a ligand (gp120) that binds to T4 has no detectable adverse effect on the population of T4+ cells. The only current animal model that can be reproducibly infected with HIV is the chimpanzee. Immunization of chimpanzees with HIV proteins will provide an experimental system for testing the effectiveness of prototype vaccines for preventing HIV infection in vivo.     

Diagnostic and therapeutic biomarkers in pancreaticobiliary malignancy

Pancreatic ductal adenocarcinoma(PDAC) and cholangiocarcinoma(CCA) are two malignancies that carry significant morbidity and mortality. The poor prognoses of these cancers are strongly related to lack of effective screening modalities as well as few therapeutic options. In this review, we highlight novel biomarkers that have the potential to be used as diagnostic, prognostic and predictive markers. The focus of this review is biomarkers that can be evaluated on endoscopically-obtained biopsies or brush specimens in the pre-operative setting. We also provide an overview of novel serum based markers in the early diagnosis of both PDAC and CCA. In pancreatic cancer, the emphasis is placed on prognostic and theranostic markers, whereas in CCA the utility of molecular markers in diagnosis and prognosis are highlighted.