Temporally resolved single cell transcriptomics in a human model of amniogenesis.

Amniogenesis is triggered in a collection of pluripotent epiblast cells as the human embryo implants. To gain insights into the critical but poorly understood transcriptional machinery governing amnion fate determination, we examined the evolving transcriptome of a developing human pluripotent stem cell-derived amnion model at the single cell level. This analysis revealed five continuous amniotic fate progressing states with state-specific markers, which include a previously unrecognized CLDN10+ amnion progenitor state. Strikingly, we found that expression of CLDN10 is restricted to the amnion-epiblast boundary region in the human post-implantation amniotic sac model as well as in a peri-gastrula cynomolgus macaque embryo, bolstering the growing notion that, at this stage, the amnion-epiblast boundary is a site of active amniogenesis. Bioinformatic analysis of published primate peri-gastrula single cell sequencing data further confirmed that CLDN10 is expressed in cells progressing to amnion. Additionally, our loss of function analysis shows that CLDN10 promotes amniotic but suppresses primordial germ cell-like fate. Overall, this study presents a comprehensive amniogenic single cell transcriptomic resource and identifies a previously unrecognized CLDN10+ amnion progenitor population at the amnion-epiblast boundary of the primate peri-gastrula.

Rhodamine 6G derivative for the selective copper detection and remediation using nanoporous diatomaceous earth-engineered functional receptor.

A rhodamine-derived receptor was synthesized and comprehensively characterized for structural confirmation. The receptor was able to distinguish the copper ions (Cu2+) from other competing cations. The yellow color of the receptor changed to pink upon adding Cu2+ ions, however, other competing cations ions were impotent towards any color variation. The UV-visible titration studies revealed the binding stoichiometry of a 1:1 ratio with a detection limit of 9.663 × 10-8 M. Additionally, a novel idea of the work resides in the use of diatom for the practical application, where the receptor has been tethered on nanoporous diatomaceous earth microparticles (P2D) to remove Cu2+ ions. The results confirmed that 50 mg receptor functionalized DE could adsorb 10 mL of 1 ppm Cu2+ ions from water. Furthermore, a proof-of-concept device that is inexpensive, simple to operate, and continuously removes Cu2+ ions from water has been developed. The efficiency of the device in Cu2+ ion removal could be realized through the naked eye by observing the color change of P2D particles, which has excellent potential for application in remote locations where water contamination is a significant issue.

Ratiometric colorimetric detection of fluoride ions using a schiff base sensor: enhancing selectivity and sensitivity for naked-eye analysis.

A Schiff base receptor with an active -NH group was designed and synthesized for the selective and sensitive colorimetric detection of inorganic fluoride (F-) ions in an aqueous medium. The sensitivity of the receptor for F- ions was enhanced by the influence of two electron-withdrawing -NO2 groups at ortho and para positions which result in a vivid color change. The receptor underwent a remarkable color change from light yellow to violet, enabling naked-eye detection of F- ions without the need for spectroscopic equipment. To ensure the structural integrity of the synthesized receptors, prominent spectroscopic techniques such as 1H NMR, FTIR, and GCMS analysis were used for characterization. With a limit of detection (LoD) of 0.0996 ppm, a 1 : 2 stoichiometric binding ratio was observed for receptor and F- ions. The binding mechanism confirmed the deprotonation of the -NH group followed by the formation of -HF2, resulting in an intramolecular charge transfer (ICT) transition, which correlates with UV-vis and 1H NMR titration results. In addition, the proposed binding mechanism of F- ion interaction with the receptor was theoretically validated using DFT and TDDFT calculations. Furthermore, as a real-life implementation of the receptor, quantification of the F- ions present in a commercially available mouthwash was demonstrated. To assess the sensitivity performance, a paper-based dip sensor and a solid substrate sensor by functionalizing the receptor on diatomaceous earth were demonstrated. Finally, sensors were built into smartphones that could recognize the red, green, and blue percentages (RGB%) where each parameter defines the intensity of the color, which could also be used as a supplement to the colorimetric investigations.

Correlating decline in left ventricular ejection fraction and longitudinal strain in pediatric cancer patients.

PURPOSE: Left ventricular ejection fraction (LVEF) is routinely used to monitor cardiac function in cancer patients. Global longitudinal strain (GLS) detects subclinical myocardial dysfunction. There is no consensus on what constitutes a significant change in GLS in pediatric cancer patients. We aim to determine the change in GLS associated with a simultaneous decline in LVEF in pediatric cancer patients. METHODS: This is a retrospective longitudinal study of pediatric cancer patients treated with anthracyclines between October 2017 and November 2019. GLS was measured by 2-dimensional speckle tracking. The study outcome was a decline in LVEF, defined as a decrease in LVEF of ≥ 10% points from baseline or LVEF < 55%. We evaluated two echocardiograms per patient, one baseline, and one follow-up. The follow-up echocardiogram was either (1) the first study that met the outcome or (2) the last echocardiogram available in patients without the outcome. Statistical analyses included receiver operator characteristic curves and univariable and multivariable Cox proportional hazards regression. RESULTS: Out of 161 patients, 33 (20.5%) had a decline in LVEF within one year of follow-up. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% had sensitivities of 85% and 78%, respectively, and specificities of 86% and 83%, respectively, to detect LVEF decline. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% were independently associated with simultaneous LVEF decline [hazard ratio (95% confidence intervals): 16.71 (5.47-51.06), and 12.83 (4.62-35.63), respectively]. CONCLUSION: Monitoring GLS validates the decline in LVEF in pediatric cancer patients.

Facial profile of young indian women from Maharashtra-A cross-sectional pilot study.

Context: The anthropometric facial clinical proportions are used in the field of orthodontics, maxillofacial and plastic surgery for aesthetic or abnormality corrections. There is lack of enough literature on the facial profiles of Indians. Aim: To assess correlations between facial parameters and stature of young Maharashtrian women by using anthropometry. Settings and Design: It is a cross-sectional observational pilot study at Maharashtra Institute of Dental Sciences & Research, after approval from the Institutional Ethical Committee. Methods and Material: The study included 15 students of 21-23 years age selected by simple randomisation. The facial parameters were measured by sliding vernier calipers after identifying facial landmarks by stickers. Facial height (FH) in thirds; upper FH (UFH), middle FH (MFH) and lower FH (LFH); facial width (FW) and stature or overall height (OH) were calculated to define average facial features. Statistical Analysis: Multiple pairwise statistics and simple linear regression analyses were done for various dependent variables. Results: The means of UFH, MFH, LFH and total facial heights (TFH) were found to be 5.2 ± 0.54, 5.35 ± 0.34, 5.16 ± 0.44 and 15.7 ± 0.98 cm, respectively. The TFH showed a moderate correlation with stature (P ≤ 0.05, r = 0.64) and a strong correlation with lower lip length (P = 0.001, r = 0.78). Facial width showed a negative correlation with facial shape (P ≤ 0.05). Conclusions: The selected sample showed the statistically insignificant difference between UFH, MFH and LFH indicating equitable distribution among Indian women of Maharashtrian origin of 21-23 year age group. Longer TFH is positively correlated with higher stature and longer lower lip length.

Relationships between food-related behaviors, obesity, and medication use in individuals with Smith-Magenis syndrome.

BACKGROUND: Smith-Magenis syndrome (SMS) is a complex neurodevelopmental disorder that includes obesity and food-seeking/satiety-related behaviors. AIMS: This study examined associations between food-related/hyperphagic behaviors, weight, and medication use in individuals with SMS. METHODS/PROCEDURES: Caregivers of individuals with SMS in the Parents and Researchers Interested in SMS (PRISMS) Patient Registry completed a demographic/medication questionnaire, the Hyperphagia Questionnaire for Clinical Trials, and the Food Related Problems Questionnaire. OUTCOMES/RESULTS: Among 49 participants (Mage = 16.41 ± 12.73 years, range = 4-69 years, 55% girls/women), individuals with SMS with overweight/obesity (n = 22) had worse overall food-related problems including greater impaired satiety (p < 0.05), maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.01), and hyperphagia (p < 0.01) compared to individuals of normal/underweight (n = 27). Those taking anti-depressants/anxiolytics (n = 16) had greater maladaptive eating behaviors (p < 0.05), hyperphagic behaviors (p < 0.05), and hyperphagic severity (p < 0.05) than those not taking anti-depressants/anxiolytics (n = 33). Boys/men with SMS had greater maladaptive eating behaviors (p < 0.05), inappropriate response (p < 0.05), and hyperphagic drive (p < 0.01) than girls/women with SMS. CONCLUSIONS/IMPLICATIONS: Maladaptive food-related behaviors were higher in individuals with SMS with overweight/obesity, taking anti-depressants/anxiolytics, or who were male. Medications in this population should be chosen with weight-related side effects in mind.

Iridodialysis repair - A simplified approach.

BACKGROUND: Iris root is the thinnest and weakest portion of the iris stroma. It can detach easily due to blunt trauma or accidental engagement of the iris during intraocular surgery resulting in glare, photophobia and monocular diplopia. Multiple techniques described for iridodialysis repair such as hang back technique, stroke and dock technique and sewing machine technique are technically challenging. PURPOSE: To describe an simplified approach of iridodialysis repair using 9-0 prolene suture. SYNOPSIS: We demonstrate the technique of iridodialysis repair using animation for better understanding. Scleral flap is made adjacent to the iridodialysis area and a paracentesis is made oppsite to the iridodialysis. One arm of the double armed straight needle with 9-0 prolene suture is passed through the paracentesis into the iris root and docked in the 26G needle which is passed underneath the scleral flap 1.5mm posterior to the limbus. Then the needle is pulled out underneath the scleral flap and the manoeuvre is repeated for the second arm as well. The sutures are secured with 5-6 knots under the scleral flap. Intra-operative surgical videos of two patients with traumatic cataract and iridodialysis following blunt trauma are shown. After stabilizing the detached iris using iris hooks, phacoemlsification is done with implantation of foldable acrylic IOL, followed by iridodialysis repair as described above. Both the patients were relieved of their pre-operative symtoms and had good visual recovery. HIGHLIGHTS: We describe a simplified approach of iridodialysis repair that can significantly reduce the patient's troublesome symptoms such as glare and monocular double vision. ONLINE VIDEO LINK: https://youtu.be/-axYnSfWSb0.

Midline EEG Functional Connectivity As Biomarker for Conscious States in Sleep and Wakefulness.

Functional connectivity (FC) between different cortical regions of the brain has long been hypothesized to be necessary for conscious states in several modeling and empirical studies. The work presented herein estimates the FC between two bipolar midline electroencephalogram (EEG) recordings to evaluate its utility in discriminating consciousness levels across wakefulness and sleep. Consciousness levels were defined as Low, Medium, and High depending upon the ability of a subject to self-report their experiences at a later stage. The sleep EDF [expanded] dataset available in the Physionet data repository was used for analyses. FC was estimated using the debiased estimator of the squared Weighted Phase Lag Index (dWPLI2) metric. A total of 40 features extracted from the FC spectra for 10 EEG sub-bands were considered. FC trends demonstrated the highest alpha synchrony in the 'Low' conscious state. While the 'Medium' conscious state demonstrated superior phase synchronization in the low-gamma band, the 'High' conscious state was characterized by comparatively lower phase synchronization in all frequency bands. A Multi-Layer Perceptron (MLP) framework using a combination of 7 features yielded the highest cross-validation accuracy of 95.15% in distinguishing these conscious states. The study results provide a pertinent validation for the hypothesis that midline EEG FC is a reliable and robust signature of conscious states in sleep and wakefulness.

Brain Functional Connectivity as Biomarker for Propofol-Induced Alterations of Consciousness.

Understanding neural correlates of consciousness and its alterations poses a grand challenge for modern neuroscience. Even though recent years of research have shown many conceptual and empirical advances, the evolution of a system that can track anesthesia-induced loss of consciousness is hindered by the lack of reliable markers. The work presented herein estimates the functional connectivity (FC) between 21 scalp electroencephalogram (EEG) recordings to evaluate its utility in characterizing changes in brain networks during propofol sedation. The sedation dataset in the University of Cambridge data repository was used for analyses. FC was estimated using the debiased estimator of the squared Weighted Phase Lag Index (dWPLI2). Spectral FC networks before, during, and after sedation was considered for 5 EEG sub-bands. Results demonstrated significantly higher alpha band FC during baseline, mild and moderate sedation, and recovery stages. A striking association between frontal brain activity and propofol-sedation was also noticed. Furthermore, inhibition of frontal to parietal and frontal to occipital connections were observed as characteristic features of propofol-induced alterations in consciousness. A random subspace ensemble framework using logistic model tree as the base classifier, and 18 functional connections as features, yielded a cross-validation accuracy of 98.75% in discriminating baseline, mild and moderate sedation, and recovery stages. These findings validate that EEG-based FC can reliably distinguish altered conscious states associated with anaesthesia.

Cancer-associated mutations reveal a novel role for EpCAM as an inhibitor of cathepsin-L and tumor cell invasion.

BACKGROUND: EpCAM (Epithelial cell adhesion molecule) is often dysregulated in epithelial cancers. Prior studies implicate EpCAM in the regulation of oncogenic signaling pathways and epithelial-to-mesenchymal transition. It was recently demonstrated that EpCAM contains a thyroglobulin type-1 (TY-1) domain. Multiple proteins with TY-1 domains are known to inhibit cathepsin-L (CTSL), a cysteine protease that promotes tumor cell invasion and metastasis. Analysis of human cancer sequencing studies reveals that somatic EpCAM mutations are present in up to 5.1% of tested tumors. METHODS: The Catalogue of Somatic Mutations in Cancer (COSMIC) database was queried to tabulate the position and amino acid changes of cancer associated EpCAM mutations. To determine how EpCAM mutations affect cancer biology we studied C66Y, a damaging TY-1 domain mutation identified in liver cancer, as well as 13 other cancer-associated EpCAM mutations. In vitro and in vivo models were used to determine the effect of wild type (WT) and mutant EpCAM on CTSL activity and invasion. Immunoprecipitation and localization studies tested EpCAM and CTSL protein binding and determined compartmental expression patterns of EpCAM mutants. RESULTS: We demonstrate that WT EpCAM, but not C66Y EpCAM, inhibits CTSL activity in vitro, and the TY-1 domain of EpCAM is responsible for this inhibition. WT EpCAM, but not C66Y EpCAM, inhibits tumor cell invasion in vitro and lung metastases in vivo. In an extended panel of human cancer cell lines, EpCAM expression is inversely correlated with CTSL activity. Previous studies have demonstrated that EpCAM germline mutations can prevent EpCAM from being expressed at the cell surface. We demonstrate that C66Y and multiple other EpCAM cancer-associated mutations prevent surface expression of EpCAM. Cancer-associated mutations that prevent EpCAM cell surface expression abrogate the ability of EpCAM to inhibit CTSL activity and tumor cell invasion. CONCLUSIONS: These studies reveal a novel role for EpCAM as a CTSL inhibitor, confirm the functional relevance of multiple cancer-associated EpCAM mutations, and suggest a therapeutic vulnerability in cancers harboring EpCAM mutations.

Identification of Patterns of Cognitive Impairment for Early Detection of Dementia.

Early detection of dementia is crucial to devise effective interventions. Comprehensive cognitive tests, while being the most accurate means of diagnosis, are long and tedious, thus limiting their applicability to a large population, especially when periodic assessments are needed. The problem is compounded by the fact that people have differing patterns of cognitive impairment as they progress to different forms of dementia. This paper presents a novel scheme by which individual-specific patterns of impairment can be identified and used to devise personalized tests for periodic follow-up. Patterns of cognitive impairment are initially learned from a population cluster of combined normals and cognitively impaired subjects, using a set of standardized cognitive tests. Impairment patterns in the population are identified using a 2-step procedure involving an ensemble wrapper feature selection followed by cluster identification and analysis. These patterns have been shown to correspond to clinically accepted variants of Mild Cognitive Impairment (MCI), a prodrome of dementia. The learned clusters of patterns can subsequently be used to identify the most likely route of cognitive impairment, even for pre-symptomatic and apparently normal people. Baseline data of 24,000 subjects from the NACC database was used for the study.

Drug Repurposing Approaches: Existing Leads For Novel Threats And Drug Targets.

Drug Repurposing (DR) is an alternative to the traditional drug discovery process. It is cost and time effective, with high returns and low risk process that can tackle the increasing need for interventions for varied diseases and new outbreaks. Repurposing of old drugs for other diseases has gained a wider attention, as there have been several old drugs approved by FDA for new diseases. In the global emergency of COVID19 pandemic, this is one of the strategies implemented in repurposing of old anti-infective, anti-rheumatic and anti-thrombotic drugs. The goal of the current review is to elaborate the process of DR, its advantages, repurposed drugs for a plethora of disorders, and the evolution of related academic publications. Further, detailed are the computational approaches: literature mining and semantic inference, network-based drug repositioning, signature matching, retrospective clinical analysis, molecular docking and experimental phenotypic screening. We discuss the legal and economical potential barriers in DR, existent collaborative models and recommendations for overcoming these hurdles and leveraging the complete potential of DR in finding new indications.

Electrodermal Activity Based Pre-surgery Stress Detection Using a Wrist Wearable.

Surgery is a particularly potent stressor and the detrimental effects of stress on people undergoing any surgery is indisputable. When left unchecked, the pre-surgery stress adversely impacts people's physical and psychological well-being, and may even evolve into severe pathological states. Therefore, it is essential to identify levels of preoperative stress in surgical patients. This paper focuses on developing an automatic pre-surgery stress detection scheme based on electrodermal activity (EDA). The measurement set up involves a wrist wearable that monitors EDA of a subject continuously in the most non-invasive and unobtrusive manner. Data were collected from 41 subjects [17 females and 24 males, age: 54.8 ± 16.8 years (mean ± SD)], who subsequently underwent different surgical procedures at the Sri Ramakrishna Hospital, Coimbatore, India. A supervised machine learning algorithm that detects motion artifacts in the recorded EDA data was developed. It yielded an accuracy of 97.83% on a new user dataset. The clean EDA data were further analyzed to determine low, moderate, and high levels of stress. A novel localized supervised learning scheme based on the adaptive partitioning of the dataset was adopted for stress detection. Consequently, the interindividual variability in the EDA due to person-specific factors such as the sweat gland density and skin thickness, which may lead to erroneous classification, could be eliminated. The scheme yielded a classification accuracy of 85.06% on a new user dataset and proved to be more effective than the general supervised classification model.

Differential effects of physical and psychological stressors on electrodermal activity.

Stress being labelled by WHO as "the health epidemic of 21st century" need to be treated as a clarion call for devising strategies that aim at its early detection, for the reason that stress is the cause as well as the catalyst for several chronic human health disorders. The work reported here in is a progression towards the development of a stress detection system based on the electrodermal activity (EDA) in humans, which can further be incorporated into a wearable vital signs monitor. The utility of EDA as a potential physiological measure for classifying physical and psychological stressors is analyzed in this paper. A group of 12 subjects (8 males and 4 females, age: 25.4 ± 3.1 years, mean ± SD) volunteered to participate in a laboratory stress task that included a psychological stressor close to real life work stress scenario and a physical stressor. The capability of stressors to elicit persistent stress response was validated by assessing variations in salivary cortisol levels. EDA was monitored throughout the experiment sessions as a measure of sympathetic activation in subjects. Six classification models were investigated concerning their usability to distinguish physical and psychological stressors based on EDA. A maximum accuracy of 95.1% was achieved using linear discriminat analysis (LDA) based classifier which imply that EDA is indeed a potential discriminate measure to classify physical and psychological stress responses. Furthermore, the best feature combination for maximum classification accuracy was also determined.

Support vector machines for automated snoring detection: proof-of-concept.

BACKGROUND: Snoring has been shown to be associated with adverse physical and mental health, independent of the effects of sleep disordered breathing. Despite increasing evidence for the risks of snoring, few studies on sleep and health include objective measures of snoring. One reason for this methodological limitation is the difficulty of quantifying snoring. Conventional methods may rely on manual scoring of snore events by trained human scorers, but this process is both time- and labor-intensive, making the measurement of objective snoring impractical for large or multi-night studies. METHODS: The current study is a proof-of-concept to validate the use of support vector machines (SVM), a form of machine learning, for the automated scoring of an objective snoring signal. An SVM algorithm was trained and tested on a set of approximately 150,000 snoring and non-snoring data segments, and F-scores for SVM performance compared to visual scoring performance were calculated using the Wilcoxon signed rank test for paired data. RESULTS: The ability of the SVM algorithm to discriminate snore from non-snore segments of data did not differ statistically from visual scorer performance (SVM F-score = 82.46 ± 7.93 versus average visual F-score = 88.35 ± 4.61, p = 0.2786), supporting SVM snore classification ability comparable to visual scorers. CONCLUSION: In this proof-of-concept, we established that the SVM algorithm performs comparably to trained visual scorers, supporting the use of SVM for automated snoring detection in future studies.

Distraction osteogenesis in the treatment of temporomandibular joint ankylosis with mandibular micrognathia.

AIMS: The aims of the study were to evaluate the efficacy of simultaneous interpositional arthroplasty with distraction osteogenesis (DO) as a single procedure and to give the patient acceptable functional rehabilitation with correction of the gross facial asymmetry. MATERIALS AND METHODS: Nine patients of temporomandibular joint (TMJ) ankylosis with micrognathia were treated with interpositional arthroplasty and simultaneous DO and followed for a period of minimum 3 years. Preoperative, immediate postoperative, at the end of distraction, at 6 months and 3 years postdistraction consolidation radiographs were taken along with the clinical examination for mouth opening, deviation, length of the mandible and ramus, midline shift, occlusal cant, and occlusion. RESULTS: The results showed an increase in the mouth opening, length of the mandible and ramus height, correction of deviation, occlusion, and midline shift. Relapse was not seen in any case, rather one patient developed infection at the distractor site and two patients had fracture of the roots of the teeth at the osteotomy site. There was an overall improvement in the facial asymmetry. CONCLUSION: Simultaneous interpositional arthroplasty with DO should be used to correct TMJ ankylosis associated with facial asymmetry/micrognathia, as it reduces the need for second surgery, thereby saving the trauma of a second surgery and difficulty in intubation, increases the length of the mandible, corrects the deformity, thereby resulting in an acceptable facial esthetics and function.

Oncological screening for Bilateral Breast Reduction: a survey of practice variations in UK Breast and Plastics surgeons 2009.

INTRODUCTION: Bilateral Breast Reduction (BBR) is a common procedure performed by Breast and Plastic surgeons in the UK. No consensus exists regarding preoperative screening for malignancy or for selective criteria for such screening. Preoperative BBR screening practices among UK Breast and Plastic surgeons are unknown. AIMS: Ascertain the preoperative and postoperative BBR screening practices of UK Breast and Plastic surgeons. MATERIALS AND METHODS: A questionnaire was posted to all 434 Breast and 335 Plastic surgeons in the UK. All results were analysed with relevant statistical methods. KEY RESULTS: 64% of Breast surgeons and 72% of Plastic surgeons responded. 40% of Breast surgeons and 91% of Plastic surgeons perform BBR. Routine radiological screening: 92% Breast 41% Plastic (p < 0.05). Routine breast examination prior to BBR: 98% Breast 91% Plastic. Routine histology for BBR specimens: 96% Breast 90% Plastic. Selective screening of patients aged 30-40 years old: Breast 38% Plastic 10%. Selective screening of patients aged 40-50: Breast 78%, Plastic 53%. Selective screening of patients with strong family history of breast cancer: Breast 72%, Plastic 91%. Selective screening of patients with previous breast cancer: Breast 77%, Plastic 93%. CONCLUSIONS: There are significant differences in practice between UK Breast surgeons and Plastic surgeons in preoperative oncological screening for BBR. The large discrepancy in preoperative radiological screening, reflects a ubiquitous pro-screening ideology among Breast surgeons not prevalent among Plastic surgeons. These results will provoke debate towards the direction of consensus to ultimately reflect best practice.

Sturge-Weber syndrome and dermatomal facial port-wine stains: incidence, association with glaucoma, and pulsed tunable dye laser treatment effectiveness.

BACKGROUND: Laser therapy is the optimal approach for treating port-wine stains, but whether it is effective for patients with facial dermatomal port-wine stains and Sturge-Weber syndrome is undetermined. This project aimed to verify the incidence of Sturge-Weber syndrome and glaucoma within the population, compare the response in syndromic and nonsyndromic patients with facial dermatomal port-wine stains to laser, and determine the treatment response in relation to dermatome and color. METHODS: The authors retrospectively reviewed 874 patients with facial port-wine stains (203 displayed a dermatomal pattern). Pretreatment and posttreatment photographs were assessed clinically and recorded on a statistically reliable percentage gradient. RESULTS: Sturge-Weber syndrome was diagnosed in 30 patients. Twelve patients had glaucoma, with the port-wine stains involving the ophthalmic (V1) division of the trigeminal nerve. The highest proportion of patients with glaucoma came from those with involvement of the maxillary (V2) and/or mandibular (V3) division of the trigeminal nerve. No patients had Sturge-Weber syndrome with V3 port-wine stains alone. After laser therapy, only 45 percent of syndromal patients and 55 percent of nonsyndromic patients had a satisfactory outcome (>50 percent) in color and size reduction of dermatomal port-wine stains. CONCLUSIONS: The incidence of Sturge-Weber syndrome was 3 percent in patients with a facial port-wine stain. There was an increased risk of Sturge-Weber syndrome with involvement of V1 port-wine stains and no risk with involvement of V3 port-wine stains alone. Laser treatment produced unsatisfactory outcomes in patients with facial dermatomal port-wine stains. V3 port-wine stains responded best and V2 worst to laser.

Is clozapine antisuicidal?

Suicide accounts for approximately 10% of patient deaths in schizophrenia. The atypical antipsychotic clozapine (Clozaril), successful in treatment-resistant patients with schizophrenia, may have an additional antisuicidal effect. Numerous published reports, including the collaborative International Suicide Prevention Trial, have compared mortality rates between clozapine recipients and patients receiving other forms of antipsychotic treatment and observed a significant reduction in patient risk for suicide with clozapine therapy. Preliminary reports indicate improvements in suicidality in schizophrenia patients treated with other modern atypical antipsychotics, for example olanzapine [Zyprexa], risperidone [Risperdal] and sertindole [Serdolect], but further investigation is required to clarify their role as antisuicidal drugs. It has been estimated that 53 suicides in treatment-resistant patients could have been prevented by clozapine, but the number of lives saved may be significantly higher if clozapine therapy was extended to treatment responders at a high risk for suicide.