Cylindrical single-wall and double-wall structures with or without internal water subjected to underwater shock loading.

A series of experimental studies were conducted for cylindrical structures subjected to underwater shock loading to understand their dynamic responses and failure characteristics. All tests were performed inside an anechoic water tank. The submerged test cylinders were freely suspended, and an underwater shock loading was generated by the Compressed Air Shock Pipe Underwater Release (CASPUR) system. Cylinders were made of two different materials. The first group of cylinders was fabricated from carbon fiber and resin using the filament winding technique. The winding angles were ± 45° resulting in the same properties along axial and hoop directions. The second group of cylinders was constructed using a 3-D printer with polylactic acid (PLA) material. The 3-D printed cylinders had an orthotropic material property with different values in the axial and hoop directions. Both single-wall and double-wall cylindrical structures were tested. The latter consisted of two concentric cylinders of different diameters with uniform spacing between them. In addition, within the single-wall cylinders and the annuli of double-wall cylinders, the water fill was varied at 0%, 50%, or 100%. Pressure and strain gages were used to measure the shock pressure and deformation of the cylinders. The number of cylinders such as single-wall or double-wall and the internal water resulted in significant effects on the measured dynamic response (i.e., strain gage response) as well as the failure loading and failure characteristics including major failure locations. Internal water reduced the strain on the cylinders and made them withstand greater shock loading for both single-wall and double-wall cylinders.

Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation.

OBJECTIVE: To review the current status of psychiatry in selected countries of Central and Eastern Europe: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Russia, Slovakia, and Slovenia. METHOD: A group of psychiatrists from the region evaluated the status of psychiatry at the end of 2004 based on data from their countries and information available on WHO homepages. RESULTS: There is a shift from traditional in-patient facilities towards out-patient and community services as evidenced by a decreasing number of hospital beds. Economic pressures affect the financing of psychiatric services, and reimbursement for novel psychotropics. Political changes were followed by updated legislation. Psychiatric training, pre-, postgraduate and continuous medical education, are gradually being transformed. Scientific output as measured by publications in peer-reviewed journals has been significantly lower than in the West. CONCLUSION: The major changes in the period of transition documented in the review pose new challenges for psychiatry.

Healthcare resource utilization during 1-year treatment with long-acting, injectable risperidone.

BACKGROUND: Schizophrenia is associated with disproportionately high costs, mainly due to hospitalization rates. This study assessed healthcare resource use in patients with schizophrenia and schizoaffective disorder during treatment with long-acting risperidone. METHODS: Patients (n = 397 [inpatients, 24%; outpatients, 76%]) receiving stable doses of an antipsychotic for >or=4 weeks were eligible to enter this 1-year, open-label study. Following a 2-week run-in period (oral risperidone 1-6 mg/day), patients received intramuscular long-acting risperidone (25 or 50 mg modal dose) every 2 weeks. Healthcare resource use in the previous 12 weeks was assessed at baseline and 12-weekly intervals. RESULTS: Patients needing hospitalization decreased significantly and continuously from 38% during the 12 weeks before study entry to 12% during the last 12 weeks. Mean hospitalization length during the study was 30.5 days (outpatients, 4.9 days; inpatients, 110 days). This included 28 patients (7%) who remained in hospital throughout the study. During treatment, 71% of those hospitalized at baseline were discharged. Partial hospitalization decreased significantly from 7% of patients during the 12 weeks before treatment to 3% during the last 12 weeks. Outpatient consultations also decreased significantly from 70% of patients to 30% in the first 12 weeks of treatment and remained stable thereafter. Only 9% of patients required an emergency room visit; mostly for non-psychiatric conditions. CONCLUSION: Healthcare resource use is significantly reduced in patients with stable schizophrenia or schizoaffective disorder receiving long-acting risperidone. It is highly likely that these reductions will decrease healthcare costs in patients receiving long-acting risperidone.

[Subjective and objective evaluation of treating schizophrenia with classic or atypical drugs]. / Subiektywna i obiektywna ocena leczenia schizofrenii lekami klasycznymi i atypowymi.

Subjective and objective evaluation of pharmacological treatment was made in 105 schizophrenic in-patients. PANSS and Calgary scale as well as Van Putten scale were used. Fifty-four percent of subjects received classic neuroleptics and 46%--new atypical drugs for an average period of 8 weeks. The severity of schizophrenic symptoms during treatment as well as subjective evaluation of first effects of the drug did not differ among subjects treated with classic or atypical drugs. Depressive symptoms decreased significantly during treatment with atypicals but not with classic drugs. Also a significant decrease of depression was found under olanzapine treatment. The severity of neuroleptic-induced side-effects did not differ in both groups. Neurological side effects were more prominent in subjects after 4 weeks of therapy with risperidone, in comparison to patients receiving olanzapine. Forty-seven per-cent of patients showed a dysphoric reaction to the first dose of medication. After treatment with atypical drugs, better subjective evaluation of pharmacotherapy correlated with less severe general and depressive schizophrenia symptoms. Patients' better evaluation of olanzapine treatment correlated with less severe schizophrenic general symptomatology. The subjective evaluation of treatment was better in patients with less severe neurological side-effects of atypical drugs (including olanzapine but not risperidone) and less severe autonomic side-effects of classic drugs. The evaluation of pharmacotherapy made by patients' family members did not correlate with subjects' opinions after distribution of the first dose of the drugs, but correlated significantly with patients' opinion after 8-weeks of treatment. The treatment received by the patients was judged better by the family members if less severe neurological side-effects were present.

NMR spectroscopy in beta cell engineering and islet transplantation.

Islet transplantation is a promising method for restoring normoglycemia and alleviating the long term complications of diabetes. Widespread application of islet transplantation is hindered by the limited supply of human islets and requires a large increase in the availability of suitable insulin secreting tissue as well as robust quality assessment methodologies that can ensure safety and in vivo efficacy. We explore the application of nuclear magnetic resonance (NMR) spectroscopy in two areas relevant to beta cell engineering and islet transplantation: (1) the effect of genetic alterations on glucose metabolism, and (2) quality assessment of islet preparations prior to transplantation. Results obtained utilizing a variety of NMR techniques demonstrate the following: (1) Transfection of Rat1 cells with the c-myc oncogene (which may be involved in cell proliferation and cell cycle regulation) and overexpression of Bcl-2 (which may protect cells from stresses such as hypoxia and exposure to cytokines) introduce a wide array of alterations in cellular biochemistry, including changes in anaerobic and oxidative glucose metabolism, as assessed by 13C and 31P NMR spectroscopy. (2) Overnight incubation of islets and beta cells in the bottom of centrifuge tubes filled with medium at room temperature, as is sometimes done in islet transportation, exposes them to severe oxygen limitations that may cause cell damage. Such exposure, leading to reversible or irreversible damage, can be observed with NMR-detectable markers using conventional 13C and 31P NMR spectroscopy of extracts. In addition, markers of irreversible damage (as well as markers of hypoxia) can be detected and quantified without cell extraction using high-resolution magic angle spinning 1H NMR spectroscopy. Finally, acute ischemia in a bed of perfused beta cells leads to completely reversible changes that can be followed in real time with 31P NMR spectroscopy.

[Quality of life in schizophrenic patients treated with classic and "old" atypical neuroleptics]. / Badanie jakosci zycia a efekty farmakoterapii schizofrenii lekami klasycznymi i "starymi" atypowymi.

Subjective health-related quality of life was evaluated in 100 patients from day-hospital, treated for schizophrenia with classical (perazine, perphenazine, zuclopenthixol) or "old" atypical (klozapine, sulpiride) neuroleptics. No correlation was found between the clinical improvement (PANSS scale) and the quality of life (SF-36). After the treatment the improvement of the quality of life was significantly better in female than in male patients. In women more correlations were found between clinical improvement after treatment and the of quality of life domains. The general subjective health-related quality of life after treatment with classical and "old" atypical drugs did not differ. After the treatment those patients who received classical neuroleptics reported more physical complains but better improvement in the domain "role-emotional" than the subjects treated with "old" atypical drugs. Significant clinical improvement was found in patients treated with perazine, perphenazine and zuclopenthixol but not with clozapine or sulpiride. The presence and intensity of neuroleptic side-effects did not correlate with the quality of life. In patients who had more pronounced neuroleptic side-effects less favorable improvement was found in regard to those quality of life domains which included physical status as well as the evaluation of patients' mental health.

[Practical aspects of drug resistance in schizophrenia]. / Praktyczne aspekty problemu lekoopornosci w schizofrenii.

About 30-60% of patients with schizophrenia show resistance to neuroleptic treatment. In about 5-20% of them the resistance to antipsychotic treatment appears during the first therapy (primary resistance), however in the rest of patients, treatment resistance develops during 5 to 10 years of the illness (secondary resistance). In addition, another group of 5 to 20% of schizophrenics shows intolerance of therapeutic dosages of neuroleptic drugs. Before the diagnose of treatment resistance has been made, there is the need to reconfirm the diagnosis of schizophrenia, exclusion of other psychiatric disorders, assessment of patients' compliance, drug dosing, as well as pharmacokinetic and pharmacodynamic factors which have an impact on the therapeutic effect of antipsychotic treatment. Clozapine seems to be a "gold standard" for treatment of drug-resistant schizophrenic patients, however new atypical antipsychotics should be considered as a new therapeutic strategy, even before clozapine. The use of adjunctive treatment with carbamazepine, lithium, valproic acid, benzodiazepines and others, is a reasonable strategy, however dangerous drug interaction has to be taken into account.

[The risk of neuroleptic discontinuation in schizophrenia]. / Ryzyko zaprzestania przyjmowania neuroleptyku w schizofrenii.

The most effective method to maintain clinical improvement in the course of schizophrenia is the continuation of neuroleptic therapy. Sometimes we face the dilemma whether neuroleptic administration could be discontinued. There are some unconditional indications for treatment cessation (signs of intolerance, complications, general medical conditions); all other situations can be considered as relative indications. The risk and benefit of treatment discontinuation should be carefully evaluated. Neuroleptic withdrawal seems to be safer among older patients, with single episode of the psychosis of mild severity, with no family history of schizophrenia. It is necessary to achieve a stable clinical improvement before neuroleptic withdrawal. Worsening of the clinical status creates the most important risk of treatment discontinuation. Other risk factors include unacceptable threatening behavior, increase of family burden. The appearance of withdrawal symptoms such as nausea, vomiting, dyskinesia, insomnia, anxiety, etc. are to be considered. These symptoms are rare, and the risk of relapse is smaller when patients were treated with depot neuroleptics before treatment discontinuation than in the case of treatment with oral neuroleptics. Neuroleptic discontinuation and introduction of placebo cause more risk of relapse than continuation of active treatment.

[Treatment of catatonic syndrome with fluoxetine. Case report]. / Leczenie zespolu katatonicznego fluoksetyna. Opis przypadku.

The case of catatonic syndrome in 34-years old male patient is described. The patient's initial complaints regarded somatic distress. Previously, because of persistence of somatic complaints and depressed mood, the patient was treated with classic antidepressants with no clinical effect. Consequently, before admission to our clinic, the patient received neuroleptic treatment without any improvement. To our clinic he was referred as drug-resistant schizoaffective psychosis. He was completely inactive, had hipochondriac delusions and blunted affect. Further on, severe psychomotor inhibition and negativism prevailed. Initial treatment with fluphenazine did not bring any clinical effect. Because of presence of depressed mood and lack of activity, fluoxetine was administered concomitantly with fluphenazine. After 8 weeks administration of fluoxetine 20 mg daily showed substantial clinical improvement, especially in regard to the patient's mood and activity. The dose of fluoxetine was increased to 40 mg daily, and the patient was discharged from the clinic. The follow-up revealed that the patient reassumed his professional career. He was still on fluoxetine 20 mg daily and showed substantial clinical improvement. His overall tolerance of fluoxetine 20-40 mg daily was very good.

Glucose-stimulated insulin secretion is not obligatorily linked to an increase in O2 consumption in betaHC9 cells.

We investigated the effects of glucose on the rates of oxygen consumption (OCR) and insulin secretion (ISR) by betaHC9 cells derived from mouse pancreatic islets with beta-cell hyperplasia. Our results demonstrate that the OCR by betaHC9 cells incubated in nutrient-rich DMEM is unaffected by glucose (0-25 mM), is dissociated from the ISR (which increases with the addition of glucose), and is always higher than that measured in PBS. Glucose (25 mM) increases both the OCR and ISR when added to nutrient-free PBS. On the basis of results presented here, we suggest that, contrary to the current consensus, the observed increases in the OCR by beta-cells upon addition of glucose to nutrient-free buffers may be unrelated to the process of glucose-stimulated insulin secretion (GSIS) and, instead, related to nutrient starvation. We believe that a reevaluation of the implication of changes in OCR upon glucose stimulation in the process of GSIS is warranted and that OCR and ISR measurements should be performed in more physiological media to avoid nutrient starvation artifacts.

[Family burden of schizophrenic patients with various forms of psychiatric care]. / Brzemie rodziny pacjentów ze schizofrenia objetych róznymi formami opieki psychiatrycznej.

Caregiver burden was evaluated among family members of 90 schizophrenic patients from hospital psychiatric ward, day hospital or from community psychiatry unit. Psychopathology was evaluated with the use of PANSS while family burden with the use of Tessler's scale which allowed to differentiate between objective and subjective burden regarding assistance to the subject and patient's supervision. Schizophrenic symptoms were more severe in hospitalized patients than among patients from day hospital or patients treated in the community. Family burden, both subjective and objective was more severe among family members of hospitalized patients. There was no difference in the severity of family burden among family members of patients from day-hospital or from community psychiatry unit. The severity of positive and general schizophrenic symptoms (PANSS) correlated positively with the lack of patient's acceptance by a family member as well as with the global subjective family burden and with the necessity of taking control over patient. There was a positive correlation between the severity of schizophrenic negative symptoms and subjective family burden (dimension: assistance to the patient) and the sum of objective family burden.

[Evaluation of depressive syndromes in the course of schizophrenia with the use of Calgary scale in patients from the inpatient hospital care]. / Ocena za pomoca skali Calgary zespolów depresyjnych w przebiegu schizofrenii leczonej na subrejonowym oddziale dziennym.

Among 98 schizophrenic patients consecutively admitted to day hospital during the period of one year, the presence of depressive syndrome diagnosed with the use of Calgary Depression Scale was established in 39% of patients. The intensity of depression was higher in the patients' than in the investigators' evaluation. After therapy at day hospital, which lasted 3.7 months on average, the repeated clinical evaluation showed significant decrease of all depressive symptoms as well as schizophrenia psychopathology. In 29% of patients there were no symptoms of depression at discharge from the day hospital. In 66%, the depressive symptoms which were most severe at admission, i.e. depressive mood, hopelessness and guilty ideas of reference, showed most distinct diminution after treatment.

[Evaluation of health-related quality of life in hospitalized schizophrenics]. / Badanie jakosci zycia zaleznej od stanu zdrowia chorych leczonych z powodu schizofrenii na oddziale dziennym.

Health related quality of life was evaluated in 40 schizophrenics from day hospital at admission, during the treatment and after 8 weeks. In contrast to the psychopathology which significantly decreased after 4 weeks already, the improvement of quality of life was found to be significant only at the discharge from day hospital. The quality of life did not correlate with the severity of schizophrenic symptoms. The older and more frequently hospitalized patients were, the less favorably they evaluated the quality of life. Patients professionally disabled were also less pleased with their quality of life. All quality of life domains improved after treatment with the exception of physical functioning and reported health transition. Physical functioning, role-physical, general health and mental health correlated inversely with severity of schizophrenia after treatment. There was no correlation between clinical improvement after treatment and quality of life domains. The higher was the patients' educational level the better they evaluated their vitality, social functioning and reported health transition.

[Selected parameters of magnetic resonance imaging of the brain, clinical picture and recovery after treatment in schizophrenia. Preliminary report]. / Wybrane parametry w badaniu rezonansu magnetycznego mózgu a stan kliniczny i poprawa po leczeniu w schizofrenii. Doniesienie wstepne.

In forty schizophrenic (or schizophreniform disorder) patients diagnosed according to DSM-IV, the magnetic resonance imaging was performed. The T2 relaxation time was measured in selected brain regions from the dorsolateral prefrontal cortex as well as in amygdala. These results were compared with clinical parameters regarding severity of psychopathology and improvement after neuroleptic treatment. The mean T2 values of grey matter of right inferior frontal gyrus were significantly higher in patients with schizophreniform disorders (those patients were clinically diagnosed as suffering from cycloid psychoses) than in other types of schizophrenia. The T2 values of this region correlated inversely with the severity of negative symptoms before treatment. The T2 values of gray matter of left inferior frontal gyrus correlated positively with the severity of schizophrenic symptoms before treatment. Mean T2 values of left amygdala were significantly higher in patients showing less favorable improvement after neuroleptic treatment in comparison to those who improved better. No correlation was found between the presence of brain atrophy and T2 values in brain regions studied. The results allow to suggest that the measurement of T2 relaxation time might reveal interesting relations between clinical picture and neuroradiologic findings in schizophrenia, however clinical significance of such parameters still requires further elaboration.

[Improvement criteria after neuroleptic treatment and clinical and neuroradiological factors in schizophrenic psychoses. Preliminary studies]. / Kryteria poprawy po leczeniu neuroleptykami a niektóre parametry kliniczne i neuroradiologiczne w psychozach schizofrenicznych. Badania wstepne.

In 40 schizophrenic patients, various criteria of clinical improvement after neuroleptic treatment were compared in order to establish correlations between improvement after treatment and some clinical and MRI parameters. Three ways of evaluation of clinical improvement (CGI scale, PANSS index, percentage of improvement) correlated strongly with one another. Only the distribution of numbers of patients with different clinical improvement evaluated by the use of PANSS index was not statistically significant. Clinical improvement, evaluated with all three methods, significantly correlated with basal PANSS score as well as with the severity of positive symptoms and affective blunting, but not with the severity of schizophrenia negative symptoms. Only clinical improvement with the use of CGI demonstrated significantly better improvement in patients who had good previous response to neuroleptics. This particular method of clinical improvement evaluation, in contrast to other two methods, failed to reveal better response to neuroleptics among patients with no cortical atrophy found in MRI. Among patients with different improvement after treatment, evaluated with the use of all three methods, selected MRI parameters did not show significant differences with the exception of CGI improvement which correlated positively with the intensity of signal in T2-weighted image of gray matter in left medial frontal gyrus.

[Therapeutic effect of zuclopenthixol acetate on positive and negative symptoms in schizophrenia]. / Ocena wplywu terapeutycznego octanu zuklopentyksolu na objawy pozytywne i negatywne w schizofrenii.

Fifty schizophrenic in-patients (DSM-IV) were treated in an open study with zuclopenthixol acetate. Mental status, improvement and side-effects were measured before administration of the drug as well as after the 1st, 2nd and 3rd injection. Positive and negative symptoms were evaluated with the use of PANSS. 60% of patients received three injections. Usually the intervals between injections lasted 48 hours. The improvement after the 3rd injection of zuclopenthixol acetate was found in 80% of patients. All positive symptoms improved after the treatment (p < 0.001), among them excitement (54% reduction vs. baseline), hostility (49%) suspiciousness/persecution (45%). The study revealed that parallel to the decrease of positive symptoms, the severity of negative symptoms also decreased, in particular: difficulty in abstract thinking (28%) and stereotyped thinking (27%) (p < 0.001). Passive/apathetic social withdrawal and lack of spontaneity as well as flow of conversation only slightly improved (p < 0.05). 50% of patients experienced side-effects--usually extrapyramidal reactions.

[The evaluation of well-being of schizophrenic or depressed patients with Bradley's questionnaire: a pilot study]. / Badanie dobrego samopoczucia pacjentów z rozpoznaniem schizofrenii lub depresji za pomoca skali Bradley--doniesienie wstepne.

Well-being of 65 in-patients with the diagnosis of schizophrenia or major depression was evaluated with the use of Bradley's well-being questionnaire. The severity of psychopathology as well as clinical improvement after pharmacotherapy were evaluated by doctors using CGI scale. Patients with the diagnosis of depression estimated their well-being lower in comparison to schizophrenics. The groups did not differ in the subscales of depression and energy. Female patients revealed more anxiety than male ones, regardless diagnosis. Physicians' evaluation of disease severity did not correlate with patients' well-being judgement using Bradley's questionnaire. After pharmacotherapy correlation between clinical improvement and several questions from Bradley's questionnaire was found.

[Cortical atrophy in MRI, mental status and neuroleptic treatment effect in schizophrenia]. / Zaniki korowe stwierdzane w badaniu MR a obraz kliniczny i efekt leczenia neuroleptykami w schizofrenii.

MR imaging of the head was performed in forty schizophrenics (DSM-IV). Mental status was evaluated before and during 8-weeks of neuroleptic treatment. Cortical atrophy in frontal and temporal regions was found in 40% of subjects. They were older, had longer history of schizophrenia, were less active professionally and were more frequently hospitalized. Patients with and without cortical atrophy in MRI did not differ in the severity of schizophrenic psychopathology at baseline. During neuroleptic treatment negative schizophrenia symptoms were significantly better diminished in patients without cortical atrophy than in subjects with cortical atrophy in MRI; this regarded specially the severity of emotional blunting. Clinical improvement after 8-weeks of neuroleptic administration was less favorable in patients with cortical atrophy.

[Comparison of quality of life of schizophrenic patients in different forms of psychiatric care]. / Porównanie oceny jakosci zycia chorych na schizofrenie objetych róznymi formami opieki psychiatrycznej.

Health related quality of life and severity of psychopathological symptoms were evaluated in 90 patients with schizophrenia, hospitalized in a psychiatric ward in a day hospital or followed by the therapist in a community care center. No statistical differences were found in the quality of life evaluation between patients from all three settings. The quality of life did not correlate with the severity of schizophrenic symptoms. Older patients and those more frequently hospitalized were more pessimistic in evaluation of their quality of life. Health status transition, as compared to the situation one year before, correlated inversely with patients' age. Male patients as well as patients from schizophrenic families evaluated their quality of life as worse.

[A test for using meta-analysis to evaluate antidepressive effects of fluoxetine]. / Próba zastosowania metaanalizy do oceny skutecznosci przeciwdepresyjnej fluoksetyny.

The review of clinical antidepressive efficacy of fluoxetine was made on the basis of various authors' reports. The results showed that clinical efficacy of fluoxetine and of classical antidepressive drugs in the treatment of depression was comparable. The meta-analysis revealed effect-size of fluoxetine to be similar to tricyclics. Also the clinical effects of fluoxetine in the treatment of depressive disorders of different severity (mild, moderate, severe) were similar to the effects of classic tricyclic agents. The tolerability of therapeutic doses of fluoxetine in the daily range 20 to 40 mg is comparable while the dosage augmentation to 60 mg per day causes increase in the percentage of patients demonstrating side effects. In comparison with placebo fluoxetine showed significantly better clinical efficacy in the treatment of depression.