Olfactory identification in patients with schizophrenia - the influence of ß-endorphin and calcitonin gene-related peptide concentrations.

BACKGROUND: The relationship between the olfactory system and emotional processing is an area of growing interest in schizophrenia research. Both the orbitofrontal cortex and amygdala are involved in the processing of olfactory information, and olfactory deficits may be also influenced by endogenous opioids and calcitonin gene-related peptide (CGRP), which is probably involved in dopaminergic transmission. However, the relationship between endorphins and dopaminergic transmission has not been fully explored. METHODS: Odor identification performance and valence interaction was evaluated among 50 schizophrenic patients and 50 controls. Schizophrenia symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). All study participants were subjected to the University of Pennsylvania Smell Identification Test (UPSIT), blood ß-endorphin (BE) and CGRP measurement. RESULTS: Insignificantly higher BE concentrations were observed in the patient group, while significantly higher UPSIT scores were seen in controls (mean UPSIT 32.48 vs 26.82). The patients demonstrated significantly more identification errors for pleasant (P=0.000) and neutral (P=0.055) odors than for unpleasant odors. Patients with higher BE concentrations made more identification errors concerning pleasant (Rs=-0.292; P=0.04) and neutral odors (Rs=-0.331; P=0.019). Although the concentration of CGRP was significantly higher in the patient sample (P<0.001), no relationship was observed between concentration and UPSIT performance. A strong negative correlation was observed between PANSS N score and UPSIT total score (Rs=-0.646; P=0.000), between PANSS N score and identification by valence for pleasant and neutral odors (UPSIT n/16: Rs=-0.450, P=0.001; UPSIT n/15: Rs=-0.586, P=0.000), and a weak negative correlation between PANSS N score and identification of unpleasant odors (UPSIT n/9: Rs=-0.325, P=0.021). CONCLUSIONS: Schizophrenic patients present a unique pattern of smell identification characterized by aberrant hedonic ratings for pleasant odors but not unpleasant ones. Individuals with predominant negative symptoms and higher BE concentrations are most able to identify negative odors.

Morphology and a proposed model of innervation of the human deltoid muscle: a pilot study.

BACKGROUND: The deltoid muscle (DM) plays an essential role in retaining the stability and correct function of the upper limb. The aims of the study were to perform a detailed morphological analysis of the DM including its innervation, structure, attachments and relationship with adjacent structures. MATERIALS AND METHODS: The study was carried out on 17 formalin-fixed cadavericupper limbs. After dissection of the shoulders, the DM was visualised and analysed.The following measurements of the muscle were performed for all cases: width of attachments (acromial, clavicular, spinal), entire width of origin, length of the component parts (acromial, clavicular, and spinal) and length of the arm. RESULTS: In all specimens, a characteristic 'segmented' innervation scheme of the DM was observed. The axillary nerve (AN) was always divided into an anterior branch (abAN) and a posterior branch (pbAN). Two variations of the DM innervation were distinguished: variation I, where the clavicular and the acromial parts were innervated by the abAN, while the spinal part was supplied both by abAN (anterior fibres) and by pbAN (posterior fibres), and variation II, in which the spinal part did not have double innervation - the abAN innervation area covered only the acromial and clavicular parts, and the entire spinal part was supplied by pbAN. Both variations had a segmented arrangement of sub-branches reaching individual parts of the DM, which was particularly distinct in the clavicular and acromial parts. Correlations were found between the entire width of the DM originand the length of the arm (p = 0.001), between the length of the acromial part of the DM and the length of the arm (p = 0.003), between the width of the spinal attachment and the length of the spinal part (p = 0.002), and between the width of the spinal attachment and the length of the arm (p = 0.0008). CONCLUSIONS: The study confirmed the existence of a characteristic segmented innervation scheme of the DM which corresponds with the segmented morphology of its individual parts. An analysis of the internal structure of the muscle specific architectonics based on the tendon system was also presented.

Advanced anal squamous cell carcinoma -- radiotherapy or surgery?

BACKGROUND: Anal and rectal cancers occupy the third position of death causes in Poland. Adenocarcinoma is the most frequent among the tumours in this group. Squamous cell carcinoma can be relatively less common. This kind of carcinoma may rather affect the anus than the rectum. Although the lesion is perceived as not very malignant and as such responsive to radiant energy therapy, some cases may require surgical treatment. METHODS: Within 1999-2008 (the observation period of 10 years) there were 18 patients treated for anal squamous cell carcinoma at the Department of Thoracic Surgery, General and Oncological Surgery of the Medical University of Lodz, at the Surgical Department of the Ministry of Interior and Administration Hospital in Lodz and at the Teleradiotherapy Department of Mikolaj Kopernik Voivodship Specialist Hospital in Lodz. Each patient underwent radiochemotherapy with Mitomycin and 5-Fluorouracil and Lucovorin. The applied radiation doses ranged between 45-54 Gy in eighteen 2.0 Gy fractions. The abdomino-perineal resection of the rectum (APR) was performed in 3 patients (16.5%) who did not show full regression of the carcinoma. In all three cases the histopathological diagnosis preceded the surgical procedure. RESULTS: For the total number of 18 patients with anal squamous cell carcinoma the mean observation period was 5.5 years, in the group of the operated patients the mean survival rate was 48 months (the median of 14-74 months) while for the group of the patients treated conservatively the mean survival rate amounted to 55 months (the median of 17-82 months, p=0.23). The mean 5-year disease-free survival rate was rather similar to the same rate of the general group, whereas the post-operative complications occurred in 66% of surgical procedures and 27% of teleradiotherapeutic procedures. CONCLUSIONS: Combined radiotherapy and chemotherapy can be the method of choice in treating anal squamous cell carcinoma. Surgery should be used in advanced cases, when complete regression on radiochemotherapy cannot be observed. The abdomino-perineal resection of the rectum is the kind of a procedure that may be accompanied with a vast number of complications. Nevertheless, it still remains a necessary therapeutic method in the described cases.

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer.

INTRODUCTION: The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. MATERIAL AND METHODS: The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished--29 patients and those with malnutrition--31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. RESULTS: Patients qualified for particular groups differed significantly in age, p<0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05±0.27 g/l, 1.764±0.27 g/l, 68.90±6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32±2.92 g/l (p<0.005). The average percentage weight loss in both groups differed significantly 0.111±0.044 vs. 0.031±0.028 at p<0.0005. In the group of malnourished patients the right hand average strength was 26.52±8.06 kg and the left one amounted to 25.35±6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93±11.27 kg, 32,37±11.72 kg, p<0.001. The tapping test average time of the right hand was 19.24±4.04 vs. 16.72±3.06 and of the left one 19.69±3.59 kg vs. 17.48±2.79 kg and were significantly longer in patients suffering from malnutrition (p<0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50±0.08 s vs. 0.45±0.087 s, (p<0.05) and for auditory one 0.43±0.08 vs. 0.39±0.08 s (non significant). CONCLUSIONS: Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement.

Biochemical and functional indices of malnutrition in patients with operable, non-microcelullar lung cancer / Índices bioquímicos y funcionales de malnutrición en pacientes con cáncer no microcítico de pulmón operable

Introduction: The aim of this study was to assess non-microcellular lung cancer patients´ nutritional status impact on psychomotor performance, muscle strength and functional activity. Material and methods: The study involved 60 consecutive patients admitted to the clinic for surgical treatment due to histologically verified non-microcellular lung cancer. The patients were divided, depending on the stage of weight loss, into two groups: relatively well-nourished - 29 patients and those with malnutrition- 31 patients. History, physical examination, anthropometric data, biochemical parameters as well as functional tests were carefully noted. Results: Patients qualified for particular groups differed significantly in age, p < 0.002. Mean values of albumin, transferrin and total protein for the well nourished patients ranged within proper values. In the malnourished patients they were respectively: 34.05 ± 0.27 g/l, 1.764 ± 0.27 g/l, 68.90 ± 6.39 g/l and the differences were statistically significant. Total loss of urea nitrogen was significantly higher in malnourished patients 13.32 ± 2.92 g/l (p < 0.005). The average percentage weight loss in both groups differed significantly 0.111 ± 0.044 vs. 0.031 ± 0.028 at p < 0.0005. In the group of malnourished patients the right hand average strength was 26.52 ± 8.06 kg and the left one amounted to 25.35 ± 6.04 kg, The values were significantly lower than the results recorded in well nourished patients: 34.93 ± 11.27 kg, 32,37 ± 11.72 kg, p < 0.001. The tapping test average time of the right hand was 19.24 ± 4.04 vs. 16.72 ± 3.06 and of the left one 19.69 ± 3.59 kg vs. 17.48 ± 2.79 kg and were significantly longer in patients suffering from malnutrition (p < 0.01). Simple reaction times for dominating hand were longer in the group of patients with malnutrition, for the visual stimulus 0.50 ± 0.08 s vs. 0.45 ± 0.087 s, (p < 0,05) and for auditory one 0.43 ± 0.08 vs. 0.39 ± 0.08 s (non significant). Conclusions: Malnutrition in the course of non-microcellular lung cancer significantly reduces psychomotor function assessed by reaction time to visual and acoustic stimuli as well as efficiency of the functional tests evaluated by tapping test and muscle strength measurement (AU)

Introducción: El propósito de este estudio fue evaluar el impacto del estado nutricional de pacientes con cáncer no microcítico de pulmón sobre el rendimiento psicomotor, la fortaleza muscular y la actividad funcional. Material y métodos: el estudio incluyó 60 pacientes consecutivos ingresados en la clínica para tratamiento quirúrgico por histología comprobada de cáncer de pulmón no microcítico. Se dividió a los pacientes, dependiendo del estado de pérdida de peso, en dos grupos: pacientes relativamente bien nutridos -29 pacientes, y aquellos con malnutrición- 31 pacientes. Se anotaron cuidadosamente la historia, la exploración física, los datos antropométricos, los parámetros bioquímicos y las pruebas funcionales. Resultados: los pacientes que se clasificaban en grupos concretos diferían significativamente con respecto a la edad, p < 0,002. Los valores promedio de albúmina, transferrina y proteínas totales de los pacientes bien nutridos estaban dentro de los rangos adecuados. En los pacientes malnutridos, estos valores fueron, respectivamente: 34,05 ± 0,27 g/l, 1,764 ± 0,27 g/l, 68,90 ± 6,39 g/l, siendo las diferencias estadísticamente significativas. La pérdida total de nitrógeno ureico fue significativamente mayor en los pacientes malnutridos, 13,32 ± 2,92 g/l (p < 0,005). El porcentaje promedio de pérdida de peso en ambos grupos difería significativamente: 0,111 ± 0,044 vs 0,031 ± 0,028, p < 0,0005. En el grupo de pacientes malnutridos, la fuerza media de la mano derecha fue de 26,52 ± 8,06 kg y de la izquierda 25,35 ± 6,04 kg; estos valores fueron significativamente menores que los resultados registrados en los pacientes bien nutridos: 34,93 ± 11,27 kg, 32,37 ± 11,72 kg, p < 0,001. El promedio de tiempo en la prueba de golpear fue de 19,24 ± 4,04 vs 16,72 ± 3,06 para la mano derecha y de 19,69 ± 3,59 kg vs 17,48 ± 2,79 kg para la mano izquierda, siendo significativamente más prolongado en los pacientes con malnutrición (p < 0,01). Los tiempos de reacción simple para la mano dominante fueron más prolongados en el grupo de pacientes con malnutrición, para el estímulo visual 0,50 ± 0,08 s vs 0,45 ± 0,087 s, (p < 0,05) y para el estímulo auditivo 0,43 ± 0,08 vs 0,39 ± 0,08 s (no significativo). 
Conclusiones: la malnutrición en el curso del cáncer de pulmón no microcítico reduce significativamente la función psicomotriz evaluada mediante el tiempo de reacción a estímulos visuales y acústicos así como la eficiencia de las pruebas funcionales mediante la medición de la prueba de golpear y la fuerza muscular (AU)

Evaluation of urinary 6-hydroxymelatonin sulphate excretion in women at different age with irritable bowel syndrome.

Melatonin (MT) exerts a beneficial action in the treatment of many diseases, among them also in irritable bowel syndrome (IBS). Its secretion decreases with age, particularly, in the postmenopausal period in women. It has not been determined whether these changes can have an impact on the clinical picture of IBS. The study aimed at evaluating the urinary excretion of the main MT metabolite - 6-hydroxymelatonin sulphate (6-HMS) in women at different age with IBS. The investigations were carried out in five groups of 30 women each. Group Ia (the controls) - premenopausal healthy women (20-39 years), group Ib (the controls) - postmenopausal healthy women (46-66 years), group II - women with constipation predominant IBS (IBS-C; 19-42 years), group III - women with diarrhoea predominant IBS (IBS-D; 20-39 years), group IV - women with IBS-C (49-68 years), group V - women with IBS-D (48-69 years). The diagnosis of IBS was based on the Rome III Criteria after excluding other diseases. On the day of the study the patients remained on the same liquid diet (Nutridrink - 3x400 ml) and 1500 ml of still mineral water. 6-HMS concentration in urine was measured by ELISA method applying IBL antibodies (RE-54031, Immunological Laboratories). The results showed that 24-hour urinary 6-HMS excretion in the studied premenopausal women were as follows: group Ia - 15.13+/-5.83 microg/24 h, group II - 28.85+/-12.59 microg/24 h (p<0,01), group III - 26.10+/-11.76 microg/24 h (p<0,01) and in the postmenopausal subjects they were: group Ib - 10.66+/-3.23 microg/24 h, group IV - 13.73+/-5.09 microg/24 h ((p=0,02), group V - 21.39+/-10.88 microg/24 h (p<0,01). In women with IBS-C the obtained results of 24-hour 6-HMS urinary excretion were independent on the intensity of clinical symptoms. On the other hand, in women with IBS-D, both in the group III and V, higher intensity of ailments was accompanied by significantly increased 6-HMS urinary excretion. The results of the study allowed drawing the following conclusions: (1). 24-hour 6-HMS urinary excretion in women with the constipation-predominant (IBS-C) as well as the diarrhoea-predominant IBS (IBS-D) is higher than in healthy persons both in the premenopausal and postmenopausal period. (2). Relatively high 6-HMS urinary excretion in postmenopausal women with IBS-D indicates an adaptive increase in MT secretion from EC in the gut.

Degradation of collagen by metalloproteinase 2 in patients with abdominal hernias.

BACKGROUND: The groin hernia is a significant social and economic problem of our times. The pathogenesis of the disease is not clear. The metalloproteinases (MMP) are the group of proteolytic enzymes responsible for the degradation of extracellular matrix proteins and the basic membrane of blood vessels. THE AIMS OF OUR STUDY WERE: (1) to estimate the MMP-2 levels in the blood and tissues of patients with a groin hernia; (2) to answer the question of whether changes in MMP-2 activity correlate with the occurrence of inguinal hernias. METHOD: The study was performed on a group of 90 male patients suffering from inguinal hernias, aged 28-70 years (mean: 49 years). The control group was made up of 10 healthy (free from hernia) males, aged 30-68 years (mean: 46 years). RESULTS: We noticed increased levels of MMP-2 in patients with all types of hernia and across all age groups. The MMP-2 mean serum levels were statistically higher in patients with a groin hernia when compared to the control group. The highest blood levels of MMP-2 were observed in young men with a direct hernia. CONCLUSIONS: This study confirmed the important role of MMP-2 in the pathogenesis of inguinal hernia. The increased activity may lead to dysfunctions in collagen fiber, which is responsible for forming fascial structures, and as a result weaken their durability.

Outcome evaluation and prediction in a comprehensive-integrated post-acute outpatient brain injury rehabilitation programme.

Outcomes for 29 individuals with brain injuries (BI) were examined following a comprehensive-integrated rehabilitation programme. From programme admission to completion, proportion living with no supervision increased from 59% to 93%; proportion in transitional or competitive work placements increased from 7% to 59%; unemployment decreased from 76% to 31%. Significant changes in behaviour and functional abilities and achievement of individual goals were also documented with the Portland Adaptability Inventory (PAI) and Goal Attainment Scaling. One year follow-up of 21 graduates indicated general maintenance of gains in independent living and work. At follow-up 86% were living without supervision; 48% were in competitive work; one in transitional work; and 29% unemployed. Although individuals entering treatment less than 1 year after injury showed greater gains than those injured more than 1 year prior to admission, both early and late intervention groups showed significant changes on outcome measures. More extensive disabilities as measured by the PAI had a negative impact on programme outcome. Except for reading ability, neuropsychological measures obtained prior to admission did not significantly predict outcome. Programme costs are reported. Results indicate that the group-oriented comprehensive-integrated approach to post-acute brain injury rehabilitation is effective and cost-effective, and recommend early intervention for optimal outcomes.

Mayo Medical Center Brain Injury Outpatient Program: treatment procedures and early outcome data.

The rehabilitation of persons with brain injuries has proved challenging; community reintegration is often unsuccessful. Herein we describe our intensive group-oriented outpatient treatment program for persons with brain injury and report outcome data for the graduates of the program thus far. This interdisciplinary program emphasizes the development of cognitive skills, compensation techniques, social skills, emotional adjustment, leisure skills, physical fitness, and health maintenance. Although goals are individually determined, independent living and employment are goals for most participants in the program. Before initial participation, all candidates undergo an extensive 2-day assessment. Typically, a patient remains in the program for approximately 6 months. The specific group treatment approaches used in the program are discussed. Outcome data are assessed with use of the Portland Adaptability Inventory and goal attainment scaling, as well as comparisons of preprogram and postprogram employment status and level of independent living. Our initial results support the conclusion that this comprehensive and integrated treatment program is efficacious in rehabilitating persons with mild to moderate sequelae of brain injury.

The treatable dementia of Sjögren's syndrome.

Progressive dementia developed during a 15-month period in a 56-year-old woman with serologically and clinically documented primary Sjögren's syndrome. Findings from magnetic resonance imaging and angiography were normal, but a brain biopsy disclosed perivascular lymphocytic inflammation in leptomeningeal and parenchymal vessels. Treatment with high-dose corticosteroids produced rapid and nearly complete resolution of the dementia.

Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation.

Relationships among two-month and final goal attainment scaling (GAS) scores, preadmission and final Portland Adaptability Inventory (PAI) scores, and work outcome for 16 graduates of a comprehensive, postacute brain injury rehabilitation program were examined. Final GAS scores were higher for program graduates who obtained the most desirable work outcomes, and preadmission and final PAI scores were lower for the successful program graduates. Final GAS scores were significantly correlated with other outcome measures. Preadmission PAI scores predicted work outcome, and two-month GAS scores predicted final GAS scores. Initial PAI scores distinguished between program successes and failures, but not between program successes and dropouts. A brief look at one case illustrates the modified application of GAS in postacute brain injury rehabilitation. Results of this study and case analyses support GAS as a quantifiable, individualized measure that is useful for (1) monitoring patient progress, (2) structuring team conferences, (3) ongoing rehabilitation planning and decision-making, (4) concise, relevant communication to family, referral sources, and funding sources, and (5) overall program evaluation when used in the context of other objective outcome measures. Although our results support the clinical utility of GAS, further study is recommended to assess the psychometric characteristics of GAS in this application.

[Nutritional status of workers in selected departments of the Belchatow Industrial Region]. / Badania nad stanem odzywienia pracowników wybranych inwestycji Belchatowskiego Okregu Przemyslowego.

The measurements of the height, body weight, and thickness of 10 skin-fat folds of 753 healthy men, workers of the Belchatów Industrial Region, were made. The nutrition level of the investigated people was determined basing on the relative body weight, Quetelet's index and the total amount of fat in the body. The results proved that over 80% of the men were properly nourished, 8-11% (depending upon the division)--had deficient body weight, whereas 2-7%--displayed obesity.