Mood disorders and serotonin transporter density in ecstasy users—the influence of long-term abstention, dose, and gender

Rationale Neurotoxic effects of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) on the serotonin (5-HT) system have been described in animals and humans, but little is known about long-term effects of ecstasy use on mood.Objectives To investigate short-term and long-term effects of ecstasy use on mood and its association with 5-HT neurotoxicity, dose, and gender in humans.Methods Fifteen moderate ecstasy users, 23 heavy ecstasy users, 16 former heavy ecstasy users and 15 drug-using, but ecstasy-naive controls were included. Mood was assessed using the Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory (BDI). Outcomes were correlated with 5-HT transporter (SERT) density, assessed with [¹²³I]-CIT single photon emission computed tomography (SPECT).Results The prevalence of mood disorders assessed by CIDI did not differ between all groups. The overall test for differences in BDI scores between groups was near significance (P=0.056), with BDI scores higher in former heavy ecstasy users than in ecstasy-naive controls (P=0.045). BDI scores were correlated with the total number of ecstasy tablets used (r=0.310; P=0.021). No associations between CIDI or BDI outcomes and SERT density or gender were observed.Conclusions These results suggest that ecstasy use is not associated with clinical depression (CIDI). However, the number of ecstasy tablets taken lifetime was associated with higher BDI scores for depressive mood, and this relationship seemed to persist after ecstasy use had stopped. We did not find that depressed mood in ecstasy users was associated with decrease in SERT density. Prospective studies are needed to establish the causal relationship between ecstasy use and depressed mood.     

Development of antibodies against pneumococcal proteins alpha-enolase, immunoglobulin A1 protease, streptococcal lipoprotein rotamase A, and putative proteinase maturation protein A in relation to pneumococcal carriage and Otitis Media

Surface associated pneumococcal proteins alpha-enolase (Eno), immunoglobulin A1 protease (Iga), streptococcal lipoprotein rotamase A (SlrA), and putative proteinase maturation protein A (PpmA) have potential as candidates for future protein-based anti-pneumococcal vaccines. The immunogenicity of these proteins were studied in a cohort of 329 children during their first two years of life. During the first recorded episode of otitis media, acute and convalescent phase sera were available from 151 children. Concentrations of antibodies against Eno, Iga, SlrA and PpmA were measured by EIA and detected in 99% (300/302), 95% (288/302), 95% (288/302), and 83% (251/302) of the sera, respectively. There were no statistically significant differences between the groups of children with and without a history of pneumococcal contact or with respect to the type of pneumococcal contact. Despite a mean overall decrease in the antibody titers in the convalescent sera following AOM, several children were able to respond with a more than twofold increase in antibody titer in response to AOM. The majority of the children with increased antibody concentrations appeared in the groups, which were colonized with pneumococci at the time of serum collection, but were recorded as having no prior contact with pneumococci. In conclusion, SlrA, PpmA, Eno and Iga are immunogenic proteins that elicit antibody responses early in life. No significant correlation between antibody titers to these proteins and pneumococcal carriage or infection was found. Presumably, this results from the presence of cross-reactive epitopes on commensal bacteria.     

"The good life" for demented persons living in nursing homes

BACKGROUND: This study investigated which concepts regarding "the good life" are used in mission statements of nursing homes providing care for demented patients. METHOD: All 317 Dutch nursing homes caring for demented patients were asked to participate; of these, 69% responded. Their mission statements were qualitatively analyzed on content. Whether different types of nursing home differed significantly in the content of their mission statements was investigated by means of chi2 analyses. RESULTS: Six main concepts were found that are considered important for a good life: 1) autonomy and freedom, 2) individuality and lifestyle, 3) relationships and social networks, 4) warmth and safety and familiarity, 5) developing capacities and giving meaning to life and 6) subjective experience and feelings of well-being. It was found that mission statements specifically developed for demented patients attach less importance to the concepts 1) autonomy and freedom and 2) individuality and lifestyle, than mission statements which are also aimed at non-demented residents. Most mission statements turned out to be highly eclectic in content. CONCLUSION: Nursing homes with a separate statement for demented residents seem to acknowledge the special position of demented residents and the tension between dementia and the ideal of autonomy. Although the eclecticism found in mission statements is understandable, a coherent view on the good life for demented residents should aim for a sound internal structure, and make choices between values. Only then can mission statements provide real guidance for everyday care.     

Monoclonal antibodies to P2 basic protein and their use in the investigation of some aspects of the Guillain-Barré syndrome

The production and characterization of two mouse monoclonal antibodies (MAbs) raised against human basic protein P2 is described. The two MAbs recognise two non-overlapping epitopes on P2. Using these two MAbs as a probe, a search was made for the presence of anti-idiotype (Ab2) antibodies directed against anti-P2 (Ab1) autoantibodies in sera of patients with Guillain-Barré syndrome (GBS). In sera of twenty GBS patients no such Ab2 antibodies could be demonstrated. Epitopes present on cytomegalo virus- or Epstein-Barr virus-infected cells, which may play a part in triggering GBS, were not recognised by the two MAbs.     

Angioplasty for stable versus unstable angina pectoris: Are unstable patients more likely to get restenosis?

Summary Current evidence with regard to the possible association between clinical expression of coronary disease prior to the time of angioplasty, and the subsequent risk of restenosis following successful dilatation, remains inconclusive.To prospectively compare the incidence of restenosis in stable versus unstable angina pectoris patients, follow-up angiography was performed in 85 percent of patients from a consecutive series with a successful PTCA, irrespective of presence or absence of recurrent ischemic symptoms. Furthermore, changes in lesion severity were assessed quantitatively by an automated edge-detection technique rather than visual analysis. Employing such a study design and follow-up protocol, it was found that the incidence of restenosis in patients with stable coronary artery disease was similar to that of patients with unstable rest angina, irrespective of the type of angiographic definition used.H.E. Luijten, MD, is the recipient of a Research Fellowship from the Dutch Heart Foundation (no. 85–118).K.J. Beatt, MD, MRCP, is the recipient of a Research Fellowship from the British and Dtuch Heart Foundations.     

Plantar lipomatosis, unusual facies, and developmental delay: confirmation of Pierpont syndrome

In 1998, Pierpont et al. reported on two unrelated boys with plantar lipomatosis, unusual facial phenotype, and developmental delay as a possible new MR/MCA syndrome. Here we report on a 2-year-old boy with similar manifestations: axial hypotonia in the first few months, prolonged feeding problems, moderate developmental delay, no speech development, deep palmar and plantar grooves, fat pads at the anteromedial aspect of the heels, and a distinct facial phenotype (high forehead, high anterior hairline, mild midfacial hypoplasia, remarkably narrow and upward slanted palpebral fissures, broad nasal ridge and tip, broad philtrum, bowed upper lip, "pouting" lower lip, full cheeks, and flat occiput). Brain MRI and MR spectroscopy studies showed relatively small frontal lobes, some widening of the lateral and third ventricles, and increased choline levels in the frontal white matter. Cytogenetic studies in lymphocytes and skin fibroblasts and whole genome micro-array CGH failed to show abnormalities. The present patient has a phenotype almost identical to that of the earlier reported children (Pierpont et al. [1998]: Am J Med Genet 75:18-21), which thereby validates this as a separate MR/MCA syndrome, appropriately designated Pierpont syndrome. The cause of the entity remains uncertain, the most likely etiologies being X-linked recessive or autosomal dominant genes.     

Inequalities in oncology care: Economic consequences of high cost drugs

The expenditures for hospital drugs are continuously increasing, and grow much faster than the global hospital budgets do. This explosive growth is caused mainly by a few so-called 'expensive drugs' of which the oncolytics form the main part. The global budgets should stimulate more effective provision of care ('technical efficiency'), however the room for technical efficiency is decreasing. Hospitals thus have to make impossible choices, so that eventually equal access can no longer be guaranteed. If no other policies are applied, health care goals will no longer be met. This paper tries to map the contours of the current problem and its possible solutions. It is time governments take up their responsibility and take back control.