Effects of country of origin and wave of immigration on prevalence of schizophrenia among first and second-generation immigrants: A 30-year retrospective study.

OBJECTIVES: To compare the rates of schizophrenia among 1st and 2nd generation immigrants from two distinct backgrounds and across sequential periods of immigration. METHODS: A 30-years retrospective cohort study (187,184 individuals) of 1st and 2nd generation East-African immigrants (EAIs) and former Soviet-Union immigrants (FSUIs) who migrated to Israel between 1980 and 2012. EAIs were further divided according to waves of immigration. Period prevalence was calculated between the years 2002-2012. Multivariate logistic regression models were used to examine the association between immigration-related factors and prevalence of schizophrenia (Native-Born Israelis serving as reference group). RESULTS: The prevalence of schizophrenia in 1st generation EAIs and FSUIs was 1.8% and 1.2%, respectively, compared to 1.0% among NBIs (p<0.001). The prevalence of schizophrenia among 2nd generation EAIs and FSUIs was 1.3% and 0.8%, respectively, compared to 0.6% among NBIs (p<0.001). Adjusted odds ratios for developing schizophrenia compared to NBIs were 1.6 (95%CI:1.4-1.8) and 2.1 (95%CI:1.6-2.7), among 1st and 2nd generation EAIs and 1.1 (95%CI:0.9-1.2) and 1.3 (95%CI:1.0-1.8) among 1st and 2nd generation FSUIs respectively. Among EAIs, we observed the highest rate of schizophrenia in the pioneer wave of immigrants with gradual decline across subsequent waves: 2.4%, 1.9% and 1.0% for the 1st, 2nd and 3rd waves of immigration, respectively (p<0.001). CONCLUSIONS: The increased risk for developing schizophrenia among 2nd generation immigrants and among pioneer groups of immigrants emphasizes the importance of persistent investment in acculturation. Further studies elucidating the impact of country of origin and ethnic density on the risk for developing schizophrenia are warranted.

Staphylococcus aureus colonization in the nasopharynx of nasogastric tube-fed patients in a long-term care facility.

The purpose of this paper is to investigate whether the presence of a nasogastric tube (NGT) for feeding has an impact on the nasal colonization by Staphylococcus aureus. Three groups of frail elderly were examined: 76 patients fed by NGTs and 52 orally fed patients in skilled nursing wards, and 33 orally fed patients in regular nursing wards. Samples from the nasal and oral cavities were cultured for S. aureus and susceptibility testing for oxacillin was performed. The prevalence of S. aureus (either oxacillin-susceptible or oxacillin-resistant) in the NGT-fed group was not significantly different to that in the two orally fed groups nor the nostril in which the NGT was placed. A significant correlation in colonization was found between the two nares and between the nares and oral cavity in the same patient (r > 0.45, P < 0.005) for both oxacillin-susceptible and oxacillin-resistant S. aureus. The presence of NGTs for feeding in elderly frail patients is not associated with higher rates of S. aureus colonization in the nares or oral cavity.

Eotaxin-3 is involved in Churg-Strauss syndrome--a serum marker closely correlating with disease activity.

OBJECTIVE: Churg-Strauss Syndrome (CSS) is characterized by excessive eosinophil accumulation in peripheral blood and affected tissues with development of granulomatous vasculitic organ damage. The contribution of eosinophil-chemotactic cytokines (eotaxin family) to eosinophilia and disease activity in CSS is unknown. Thus, we compared serum levels of the eotaxin family members in CSS patients with healthy and disease controls. METHODS: Forty patients with CSS diagnosed according to ACR 1990 criteria, 30 healthy controls (HC) and 57 disease controls (28 asthma, 20 small vessel vasculitis, 9 hypereosinophilic syndrome) were studied. Clinical data were collected and serum levels of eotaxin-1, -2 and -3 were determined by ELISA. Further, immunohistochemistry was applied to identify eotaxin-3 expression in tissue biopsies from patients with CSS. RESULTS: In contrast to eotaxin-1 and -2, eotaxin-3 was highly elevated in serum samples of active CSS patients and correlated highly significantly with eosinophil counts, total immunoglobulin E (IgE) levels and acute-phase parameters. Moreover, eotaxin-3 was not elevated in other eosinophilic and vasculitic diseases. Immunohistochemical analysis revealed strong expression of eotaxin-3 in endothelial and inflammatory cells in affected tissues of active CSS patients. CONCLUSIONS: This study reveals the specific association of elevated eotaxin-3 expression with high disease activity and eosinophilia in CSS patients. Eotaxin-3 might thus be a pathogenic player, biomarker and potential therapeutic target in CSS.

Continuous immunotherapy for hymenoptera venom allergy using six month intervals.

BACKGROUND: Specific immunotherapy for hymenoptera venom allergy (venom immunotherapy [VIT]) is safe and effective. The duration of treatment is still open for discussion because there is no reliable routine test to determine the real risk of serious anaphylactic reactions. This prospective study, which spans more than 25 years, was conducted to ensure unlimited protection through continuous VIT. To reduce workload and cost, the maintenance interval was increased to 6 months without increasing the rate of adverse events. Only patients with continuous follow-up by our service were included in this study. PATIENTS AND METHODS: VIT was conducted in 176 patients (125 allergic to wasp venom, 20 to bee venom, 31 to both) over a mean of 7.14 years (1.16-25.49). Total and specific IgE were determined on a regular basis. RESULTS: A total of 162 re-stings were reported. Of these, 154 produced a strictly local reaction, seven produced non-serious reactions and one produced a systemic reaction similar to that produced by the initial sting before VIT. Total and specific IgE diminished during VIT. Substantial adverse effects were rare and never life-threatening. The effects occurred during observation in the ward and were controlled according to the treatment protocol recommended by a German expert consensus meeting on the treatment of anaphylactoid reactions. VIT was terminated in only one patient due to recurrent adverse effects. CONCLUSION: Continuous VIT at 6-monthly maintenance intervals conferred permanent protection in patients allergic to bee and wasp venoms and was found to be a safe and effective alternative to current standard protocols.

Continuous immunotherapy for hymenoptera venom allergy using six month intervals

Background: Specific immunotherapy for hymenoptera venom allergy (venom immunotherapy [VIT]) is safe and effective. The duration of treatment is still open for discussion because there is no reliable routine test to determine the real risk of serious anaphylactic reactions. This prospective study, which spans more than 25 years, was conducted to ensure unlimited protection through continuous VIT. To reduce workload and cost, the maintenance interval was increased to 6 months without increasing the rate of adverse events. Only patients with continuous follow-up by our service were included in this study. Patients and methods: VIT was conducted in 176 patients (125 allergic to wasp venom, 20 to bee venom, 31 to both) over a mean of 7.14 years (1.16-25.49). Total and specific IgE were determined on a regular basis. Results: A total of 162 re-stings were reported. Of these, 154 produced a strictly local reaction, seven produced non-serious reactions and one produced a systemic reaction similar to that produced by the initial sting before VIT. Total and specific IgE diminished during VIT. Substantial adverse effects were rare and never life-threatening. The effects occurred during observation in the ward and were controlled according to the treatment protocol recommended by a German expert consensus meeting on the treatment of anaphylactoid reactions. VIT was terminated in only one patient due to recurrent adverse effects. Conclusion: Continuous VIT at 6-monthly maintenance intervals conferred permanent protection in patients allergic to bee and wasp venoms and was found to be a safe and effective alternative to current standard protocols

Antecedentes: La inmunoterapia al veneno de hymenopteros (ITVH) se considera segura y eficaz. La discusión sobre la duración del tratamiento está todavía abierta dado que no existe un método fiable para determinar el riesgo real de reacción anafiláctica grave. Este estudio prospectivo que abarca un periodo de 25 años, se llevó a cabo para asegurar la protección ilimitada de la ITVH con el intervalo entre dosis ampliado a 6 meses, que disminuía costes y esfuerzos y sin incremento del índice de reacciones adversas. Únicamente se incluyeron en el estudio a pacientes de nuestro servicio en fase de seguimiento. Pacientes y métodos: La inmunoterapia frente a venenos se llevó a cabo en 176 pacientes (125 alérgicos al veneno de avispa, 20 al veneno de abeja y 31 a ambos) durante una media de 7,14 años (1,16-25,49). La IgE, total y específica, se determinó de forma habitual. Resultados: Se comunicaron un total de 162 re-pi-caduras, 154 de ellas con reacciones estrictamente locales, 7 con reacciones menos que intensas y sólo 1 con una reacción comparable a la primera picadura antes de la ITVH. Tanto la IgE total como específica disminuyeron durante la ITVH. Lo importante sobre los efectos secundarios es que fueron poco habituales y nunca amenazaron la vida de los pacientes. Las reacciones se presentaron durante el periodo de observación en el servicio y se trataron según el protocolo recomendado por un grupo de expertos de Alemania tras una reunión de consenso sobre reacciones anafilácticas. Sólo 1 paciente abandonó el tratamiento con ITVH por repetidos efectos adversos. Conclusión: Se demostró una protección permanente en pacientes alérgicos al veneno de abeja y/o avispa con una inmunoterapia de continuación frente a venenos, administrada a intervalos de 6 meses que se consideró una alternativa segura y eficaz a los actuales protocolos utilizados de forma estándar

[Manifestation of neuro-Behçet disease in cyclosporin A therapy]. / Manifestation eines Neuro-Behçet unter Cyclosporin A-Therapie.

Behçet's disease is a chronic inflammatory disorder characterized by the triad of oral and genital ulcers and ocular lesions. One of the most life-threatening manifestations results from involvement of the central nervous system, presenting as necrotising meningo-encephalitis, most typically affecting the brain stem, internal capsula and basal brain ganglia. We report on a young Caucasian mate with Behçet's disease (HLA B 51+) and recurrent uveitis, who presented with acute neurologic involvement under CyA therapy 5 years after first diagnosis. At the time of admission MRI showed two high intensity lesions in the brain stem on T1 weighted images enhanced with Gd-DTPA, reflecting active inflammation. Shortly after admission the CyA treatment was stopped and a therapy with high dose steroids and chlorambucil, starting with a dose of 2 mg daily was initiated. This led to improvement of neurologic symptoms, also documented by brain stem evoked potentials and investigations of cerebrospinal fluid, as well as of ophtalmologic symptoms within few days of treatment. Steroids were reduced to a maintenance dose of 12 mg Prednyliden daily. The brain MRI taken 8 weeks after onset of chlorambucil treatment showed the same lesions in the brain stem, with low intensity in the T1 weighted images an no longer enhanced Gd-DTPA uptake. Chlorambucil dose was reduced to 2 mg every second day after 8 months. There was no exacerbation in the follow-up of 12 months. We conclude that a 6-week Chlorambucil therapy consisting of 2 mg/p.o./d led to remission of neurologic involvement firstly evolving under CyA-medication which suggests superiority of chlorambucil as a treatment modality in neurologic as well as ophtalmologic features of the disease.

Urinary excretion of proteolyzed alpha1-antitrypsin: specificity, quantitation, and relation to therapy response in patients with acute myeloid leukemia.

During remission induction chemotherapy, a 41-kDa cleavage product of alpha1-antitrypsin (alpha1-AT41) can be found in the urine of patients with acute myeloid leukemia. By using immunoblotting with antibodies against this protein, 27 patients with acute myeloid leukemia were screened for the excretion of this fragment and the amount of alpha1-AT41 compared with treatment response assessed by therapy-induced cytoreduction in the bone marrow and time to reach remission. Patients with acute lymphoblastic leukemia, malignant lymphomas, and solid tumors receiving chemotherapy, patients with nonmalignant diseases like sepsis and kidney dysfunction, and healthy subjects were probed to evaluate the specificity of this phenomenon. In 74% of the acute myeloid leukemia patients, the truncated inhibitor was detected. Mean concentration of peak excretion was found to be 6.7 microgram/mg creatinine (range, 1.1-41 microgram/mg). Among the patients treated with induction chemotherapy, those who responded completely (<5% residual marrow blast cells) exhibited significantly higher alpha1-AT41 concentrations than the nonresponders (P < 0.03). Patients who showed a partial response (6-25% residual blasts) excreted intermediate values of the protein. The probability of median time to reach remission was 40 days in patients excreting the truncated inhibitor in measurable amounts compared to 100 days in patients negative for alpha1-AT41 (P < 0.02). The 41-kDa fragment was also found in one of 10 patients with acute lymphoblastic leukemia and in 3 of 18 lymphoma patients but not in those with solid tumors, infections, or kidney disease or in healthy individuals.

[Arthroosteitis pustulosa, spondarthritis hyperostotica pustulo-psoriatica, SAPHO syndrome: clinical experiences and review of the literature]. / Arthroosteitis pustulosa, Spondarthritis hyperostotica pustulo-psoriatica, SAPHO-Syndrom: Klinische Erfahrungen und Literaturübersicht.

Pustulotic arthroosteitis is characterized by the association of inflammatory and hyperostotic skeletal changes, primarily of the anterior chest wall, and chronic recurrent skin lesions of the palms and soles known as pustulosis palmaris et plantaris. Since its first description by Sonozaki in 1981 in Japan, it has also been reported by several European authors and become widely accepted as a separate entity within the spectrum of the seronegative spondylarthropathies. In this report, we describe 11 cases seen in our clinic in the years 1985 to 1992. Course and severity of the disease varied greatly among individual patients. In four of them a difference of up to 6 years between the onset of skin and skeletal symptoms were noted. Besides chronic recurrent nonspecific osteomyelitis in two cases, neither an association to other rheumatic or dermatologic diseases nor to HLA-B27 could be found. Corticosteroids, non-steroidal anti-inflammatory drugs, immunosuppressive agents, and antibiotics were all used with uncertain therapeutic success. Based on these data, we suppose that pustulotic arthroosteitis is more common in Germany than previously thought, and has to be considered as an important differential diagnosis of sternoclavicular arthritis. In a review of the available literature, the current opinions on nomenclature, etiology, pathogenesis, and treatment are discussed.

CD45 mAb induces cell adhesion in peripheral blood mononuclear cells via lymphocyte function-associated antigen-1 (LFA-1) and intercellular cell adhesion molecule 1 (ICAM-1).

A novel cell aggregation-inducing characteristic of the leukocyte common antigen, CD45, is described and its underlying molecular mechanisms investigated. Formation of strong cell clusters was consistently observed in human PBMCs after crosslinking CD45 molecules with antibodies, directed to epitopes common for all CD45 isoforms (e.g., mAb ROS220 or NIH45-2) or the CD45RA (e.g., mAb Alb11) or the CD45RO isoform (e.g., mAb UCHL1). This phenomenon was not seen after PBMC treatment with CD45RA mAb HB11 or CD2 mAb 39C1.5. Identical to phorbol 12-myristate 13-acetate (PMA)-induced clustering, CD45-mediated aggregation was also suppressed by EDTA, by cytochalasin B, and by incubation at 4 degrees C, all characteristics of adhesion mediated by integrins. The involvement of LFA-1 and ICAM-1 in CD45-mediated adhesion was supported by the observation that CD11a (LFA-1 alpha) mAb R7.1, CD18 (LFA-1 beta) mAb R3.3, and CD54 (ICAM-1) mAb R6.1 or RR/l all strongly inhibited CD45- and PMA-induced aggregation. Interestingly, highly pure T lymphocytes did not aggregate in response to CD45 mAb, but did after PMA treatment. These results indicate that triggering human PBMCs via CD45 can cause strong cell aggregation, largely through LFA-1/ICAM-1 interactions. Our findings support an important role of the CD45 antigen in signal transduction and intercellular interaction in human PBMCs.

Proteolytic inactivation of alpha 1-proteinase inhibitor in vivo: detection, characterization and quantitation of the main fragment excreted in the urine of leukemia patients.

During the search for a therapy response parameter in patients with acute myeloid leukemia, we observed the appearance of a 41 kDa glycoprotein band in the urines of these patients under therapy. To investigate the nature of this molecule and to develop a specific detection system, the protein was isolated and antibodies were raised. Urines and sera of patients and healthy subjects were screened for crossreacting proteins by immunoblotting. Only the leukemia patients showed the urinary 41 kDa protein plus a 53 kDa band. In all sera, including those from healthy donors, a 53 kDa protein was intensely stained. Isolation of the plasma protein and sequence analysis of the urinary protein revealed that alpha 1-proteinase inhibitor is the crossreacting plasma protein and that the 41 kDa molecule is proteolytically modified alpha 1-PI, which has lost its antitryptic activity. Cleavage occurred in the N-terminal part as well as in the reactive site loop of the inhibitor. The 41 kDa truncated inhibitor was also found in the leukemic blast cells. A densitometric method is described for the quantitation of the molecule in the nanomolar range.

Monoclonal antibodies EBU-141 (CDw75) and EBU-65 allow reliable distinction between mature and pre-B-cell tumors in suspension and on tissue sections.

Two new monoclonal antibodies, EBU-65 and EBU-141, were raised by immunization with plasma cell line U-266. Both antibodies strongly react with B lymphocytes in immunofluorescent staining as well as on paraffin-embedded sections. More than 200 leukemias and lymphomas were tested, and for both antibodies reactivity was found only with "mature" B-cell tumors but not with precursor B-cell leukemias. None of the non-B-lineage hematolymphatic tumors tested was stained by EBU-141 or EBU-65. A subpopulation of T lymphocytes particularly present in nonmalignant pleural effusions was detected by EBU-65 additionally. Although EBU-141 was clustered as CDw75 and EBU-65 as "unique," a close relationship of the staining pattern was found and both antibodies react with a sialyltransferase. In particular, CDw75 antibody EBU-141 was demonstrated to be very useful for immunophenotyping of B-cell neoplasias, while EBU-65 reacted with most multiple myelomas and a subgroup of "activated"-appearing T cells.

Thigh muscle activity and anterior cruciate ligament insufficiency.

The purpose of this study was to examine the dynamic relationship between the quadriceps femoris and hamstrings in anterior cruciate ligament (ACL) insufficiency. Thirty-five young active patients with an untreated complete tear of the ACL took part in the study. Using a KINCOM isokinetic dynamometer, the dynamic capacity of each muscle group at 30° in concentric and eccentric exertion in both the deficient and sound knee was measured. Findings demonstrated a significant reduction (P<0.05) in the torque produced by the deficient-side quadriceps compared to the sound side but no significant variations in the hamstring torque. Discussion of the findings considers a possible involvement of neurophysiological inhibition of the quadriceps as a cause for the observed weakness.

Severe peripheral arteriospasm following oxytocin administration.

A parturient patient with imminent gangrene of the extremity caused by oxytocin-induced arteriospasm is described. The appliance of conventional measures such as anticoagulation and vasodilatation produced an immediate and sustained reversal of the arteriospasm together with dramatic relief of symptoms and signs.

Socioeconomic factors in family planning.

PIP: In a developing country with an average life expectancy of 50 years or higher (an age already reached by several less developed nations) unl imited procreation is no longer necessary to insure the survival of 1 or 2 sons. Data from Pakistan computed from the Population Growth Estimation Experiment of 1962-1965 shows that the male mortality ratio for infants under 1 year was 232/1000 but for 1-4 years it was 25/1000 and for 5-14 years, 3/1000. Further study showed that women had an average of about 5 living children and some of these children already had children of their own as a result of early marriage. If a 27-year-old father has a 2-year-old son there is a 77.2% chance the child will survive him. If replacement is permitted in case of death, a campaign of "at least 2 sons" would result in Pakistan of an average family size of 3.6 children, far fewer than is now the case. This strategy should be more acceptable to parents than the present recommendation to restrict the number of children to 2 or 3. There also needs to be economic incentives for small families. Under present conditions the cost per child is small to the average rural family and the reward in prestige is great. The People's Republic of China has used negative incentives effectively. Positive incentives should be just as effective but they must be high enough to offset the current rewards of childbearing. There is also need to find out why so many couples do not practice family planning even though they approve of it and how administrative structure influences the success of a program. It has already been shown in Pakistan that repeat visits bring in far more acceptors than just 1 visit and repeated personal contacts should be maintained with the target population.^ieng

Pleurotus Ostreatus - breeding potential of a new cultivated mushroom.

Two isolates of Pleurotus ostreatus from North America and one from Germany are interbreedable. Under identical conditions at low temperatures, their fruiting bodies are hard to distinguish. However, shape and colour and several other characters vary with culture conditions. The American stocks fruit well at temperatures from 4 to 24 °C, the German ones only below 15 °C. Four types of hybrids between German and American Pleupotus were obtained: i) The whole fruiting process is temperature sensitive as in German Pleurotus. ii) It proceeds at 4-24 °C as in American stocks, iii) Fruiting initiation is insensitive but sporophore development is sensitive to elevated temperatures, iv) Primordia formation and initial sporophore development depend on temperatures below 15 °C, but pileus expansion and spore discharge continue above 20 °. The involvement of separate genes for the single developmental steps and the use of temperature sensitivity for commercial varieties are discussed. One sporeless strain, "F42x11", with considerable fruiting bodies has been obtained. In intrastock di-mon-matings this character was dominant.

[Investigations on the stimulation of fruit body formation in aPleurotis from Florida]. / Untersuchungen zur Stimulation der Fruchtkörperbildung bei einemPleurotus aus Florida.

Extracts from fruit bodies ofPleurolus orAgaricus promoted fructification ofPleurotus mycelium. This was visible in regular primordia formation 7-10 days after application of extract to the mycelium and in higher sporophore weights.After fractionating the extracts by ultra- and gel-filtration a marked stimulation of sporophore weights was detectable only in fractions of lower molecular weight. The number of primordia, however, was also increased by compounds of high molecular weight, but not by protein alone.With increasing dilution of the extracts the weight of fruit bodies decreased more rapidly than the number of primordia.40 mg of L-asparagine or equimolar amounts of urea showed an effect similar to that of the extract from 1 g fruit body. Suggars gave no reaction.Sporophore initiation and fruit body growth are supposed to be two different processes inPleurotus as well as inAgaricus bisporus.Methods for detecting a hypothetical sporophore inducer and an inhibitor are discussed.