Comparing medication attitudes and reasons for medication nonadherence among three disparate groups of individuals with serious mental illness.

This analysis compared medication attitudes and reasons for nonadherence in three distinct groups of patients with serious mental illness (SMI). Cohort 1 had 43 patients with bipolar disorder (BD) treated in a community mental health setting, cohort 2 had 43 patients with BD taking an atypical antipsychotic and treated in an academic medical center, and cohort 3 had 30 patients with schizophrenia or schizoaffective disorder who had been homeless in the last year. Standardized attitudinal scales found generally negative attitudes toward medication and limited illness insight. Although the three cohorts differed with regard to severity of symptoms, age of onset, education, baseline adherence, and race, the groups had similar medication attitudes before and after treatment. Despite group differences in demographic and clinical variables, our analyses found more similarities than differences in medication attitudes among these three discrete groups of poorly adherent, symptomatic patients with SMI. The common attitudinal characteristics have implications for delivery of health care services that can enhance treatment adherence in high-risk SMI patients.

Biomechanical wall properties of human intracranial aneurysms resected following surgical clipping (IRRAs Project).

BACKGROUND AND PURPOSE: Individual rupture risk assessment of intracranial aneurysms is a major issue in the clinical management of asymptomatic aneurysms. Aneurysm rupture occurs when wall tension exceeds the strength limit of the wall tissue. At present, aneurysmal wall mechanics are poorly understood and thus, risk assessment involving mechanical properties is inexistent. Aneurysm computational hemodynamics studies make the assumption of rigid walls, an arguable simplification. We therefore aim to assess mechanical properties of ruptured and unruptured intracranial aneurysms in order to provide the foundation for future patient-specific aneurysmal risk assessment. This work also challenges some of the currently held hypotheses in computational flow hemodynamics research. METHODS: A specific conservation protocol was applied to aneurysmal tissues following clipping and resection in order to preserve their mechanical properties. Sixteen intracranial aneurysms (11 female, 5 male) underwent mechanical uniaxial stress tests under physiological conditions, temperature, and saline isotonic solution. These represented 11 unruptured and 5 ruptured aneurysms. Stress/strain curves were then obtained for each sample, and a fitting algorithm was applied following a 3-parameter (C(10), C(01), C(11)) Mooney-Rivlin hyperelastic model. Each aneurysm was classified according to its biomechanical properties and (un)rupture status. RESULTS: Tissue testing demonstrated three main tissue classes: Soft, Rigid, and Intermediate. All unruptured aneurysms presented a more Rigid tissue than ruptured or pre-ruptured aneurysms within each gender subgroup. Wall thickness was not correlated to aneurysmal status (ruptured/unruptured). An Intermediate subgroup of unruptured aneurysms with softer tissue characteristic was identified and correlated with multiple documented risk factors of rupture. CONCLUSION: There is a significant modification in biomechanical properties between ruptured aneurysm, presenting a soft tissue and unruptured aneurysms, presenting a rigid material. This finding strongly supports the idea that a biomechanical risk factor based assessment should be utilized in the to improve the therapeutic decision making.

Effects of the anthelmintic drug PF1022A on mammalian tissue and cells.

Nematode infections cause human morbidity and enormous economic loss in livestock. Since resistance against currently available anthelmintics is a worldwide problem, there is a continuous need for new compounds. The cyclooctadepsipeptide PF1022A is a novel anthelmintic that binds to the latrophilin-like transmembrane receptor important for pharyngeal pumping in nematodes. Furthermore, PF1022A binds to GABA receptors, which might contribute to the anthelmintic effect. Like other cyclodepsipeptides, PF1022A acts as an ionophore. However, no correlation between ionophoric activity and anthelmintic properties was found. This is the first study describing the effect of PF1022A on mammalian cells and tissues. While channel-forming activity was observed already at very low concentrations, changes in intracellular ion concentrations and reduction of contractility in isolated guinea pig ileum occurred at multiples of anthelmintically active concentrations. PF1022A did not induce necrotic cell death indicated by complete lack of cellular lactate dehydrogenase release. In contrast, apoptosis induction via the mitochondrial pathway was suggested for long-term drug treatment at high concentrations due to numerous apoptotic morphological changes as well as mitochondrial membrane depolarisation. Short time effects were based on cell cycle blockade in G(0)/G(1) phase. Additionally, the cell cycle and apoptosis regulating proteins p53, p21 and bax, but not Bcl-2 were shown to impact on PF1022A-induced cytotoxicity. However, since PF1022A-induced cytotoxicity was found at drug concentrations higher than those used in anthelmintic treatment, it can be suggested that PF1022A intake might not impair human or animal health. Thus, PF1022A seems to be a safe alternative to other anthelmintic drugs.

Effects of moniliformin in presence of cyclohexadepsipeptides on isolated mammalian tissue and cells.

Secondary metabolites produced by Fusarium spp. including beauvericin, enniatin and moniliformin are mycotoxins identified in cereal samples. The two cyclohexadepsipeptide mycotoxins beauvericin and enniatin have cytotoxic, antibiotic, insecticidal and ionophoric properties, while moniliformin primarily acts as a cardiotoxic mycotoxin. In this study, we examined the electromechanical and electrophysiological effects of moniliformin and moniliformin with ionophoric mycotoxins on cells (ventricular myocytes, Caco-2 cells) and in multicellular preparations (papillary muscles and terminal ilea of the guinea pig). Additionally, we investigated the influence of moniliformin on cell homeostasis in absence and presence of the cyclodepsipeptide mycotoxins (ventricular myocytes, Caco-2 cells). Experiments were performed using isometric measurements of contractility, intracellular microelectrode and patch-clamp techniques, and fluorescence imaging. While ionophoric cyclohexadepsipeptides affect action potential parameters and cell homeostasis, moniliformin did not change spontaneous rates of activity or cardiac action potentials. Furthermore, moniliformin had no effect on intracellular concentrations of ions and ATP, and did not affect pH. Moniliformin reduced contractility in papillary muscle, terminal ileum, the aorta and the pulmonary artery. However, moniliformin did not alter beauvericin and enniatin induced effects. From our studies, we conclude that moniliformin is not solely a cardiotoxic secondary metabolite, but also exerts its effects on smooth muscle. Moreover, there is no synergistic relationship between moniliformin and the concurrently produced cyclohexadepsipeptide mycotoxins beauvericin and enniatin.

Beauvericin-induced channels in ventricular myocytes and liposomes.

The antibiotic Beauvericin (BEA) was previously shown to express ionophoric properties under simple experimental systems. Its channel-forming activity was examined in inside-out patches of ventricular myocytes and synthetic membranes with the patch clamp and fluorescence imaging techniques. Current transitions to several open state levels were evident after wash-in. The BEA channel is cation-selective. Conductance and kinetics are presented for K(+) and Na(+) substates and main states. The pore was blocked by La(3+). In myocytes, the [K(+)](i) was reduced, while [Na(+)](i) and [Ca(2+)](i) increased, leading to cytolysis. These results indicate that BEA forms cation-selective channels in lipid membranes, which can affect the ionic homeostasis.

Use of creatine and other supplements by members of civilian and military health clubs: a cross-sectional survey.

A survey was used to collect anonymous cross-sectional data on demographics, exercise habits, and use of creatine and other supplements by exercisers in civilian (C) and military (M) health clubs. M (n = 133) reported more aerobic training and less use of creatine and protein supplements than C (n = 96, p <.05). Supplement users (SU, n = 194) and nonusers (SNU, n = 35) engaged in similar frequency and duration of aerobic exercise, as well as number of resistance exercise repetitions, but SU completed more sets for each resistance exercise (x- +/- SE, 5 +/- 1) than SNU (3 +/- 1, p < or =.05). Significant (p < or =.05) associations were observed between SU and resistance training goal of strength (as opposed to endurance), as well as greater frequency of resistance training. Male gender, resistance training goal of strength, lower frequency and duration of aerobic training, and use of protein, b-hydroxy-b-methyl butyrate, and androstenedione/dehydroepiandrosterone supplements were all associated with creatine use (p <.05). For creatine users, the dose and length of creatine supplementation was 12.2 +/- 2.7 g.day-1 for 40 +/- 5 weeks. Popular magazines were the primary source of information on creatine (69%) compared to physicians (14%) or dietitians (10%, p < or =.0001). This study underscores two potential public health concerns: (a) reliance on popular media rather than allied-health professionals for information on creatine, and (b) use of creatine, a popular supplement with unknown long-term effects, in combination with other anabolic supplements of questionable efficacy and/or safety.

Association of Helicobacter pylori genotype with gastroesophageal reflux disease and other upper gastrointestinal diseases.

OBJECTIVE: Helicobacter pylori (H. pylori) is a recognized pathogen, but it may also have a protective effect for gastroesophageal reflux disease (GERD). We compared the prevalence of potential virulence factors (cagA, cagE, vacA genotypes) in GERD to other upper gastrointestinal diseases and controls. METHODS: A total of 405 patients underwent gastroscopy with H. pylori isolation and serum testing. Patient diagnostic subgroups were prospectively defined. Genotypes were determined by amplification using polymerase chain reaction. CagA antibodies were determined by western blot, enzyme-linked immunosorbent, and flow microsphere immunofluorescent assays. RESULTS: Patients were grouped as follows: nonulcer dyspepsia (26%), GERD (20%), gastric ulcer (17%), duodenal ulcer (12%), gastric cancer (6%), or controls (19%). The cagA gene was present in 94-97% of subjects in all categories, but the cagA antibody was less prevalent in nonulcer dyspepsia (69%, 95% CI: 48-86%, p = 0.02) and GERD (69%, CI: 39-91%, p < 0.05) than in those with gastroduodenal pathology including gastric ulcer, duodenal ulcer, and gastric cancer (92%, CI: 81-98%). The cagE gene and vacA S1 genotype were more frequent in patients with gastroduodenal pathology (p < 0.01). GERD was associated with a significantly lower rate of vacA S1 genotype than controls (29% (CI: 10-56%) versus 80% (CI: 59-93%), p < 0.01). The vacA S1 genotype was associated with the presence of cagA antibodies. CONCLUSIONS: The cagE and vacA S1 genotypes are more prevalent in patients with peptic ulcer or gastric cancer, suggesting a potential function in virulence for these genes. However, the vacA S1 genotype was also more prevalent in controls than GERD, suggesting a potential protective effect against GERD.

The effect of the Fusarium metabolite beauvericin on electromechanical and -physiological properties in isolated smooth and heart muscle preparations of guinea pigs.

The electromechanical and -physiological effects of beauvericin were studied in isolated smooth and heart muscle preparations of the guinea pig. Beauvericin concentration-dependently decreased the force of contraction in precontracted (60 mM KCl) terminal ilea with an IC50 of 0.86 microM, and in electrically stimulated (1 Hz) papillary muscles with an IC50 of 18 microM. This negative inotropic effect in papillary muscles was antagonised in a non-competitive way by increased extracellular calcium concentrations. Spontaneous activity in right atria was affected at concentrations > 10 microM beauvericin. The negative chronotropic effect was less pronounced than the negative inotropic effect. In action potentials of electrically driven (1 Hz) papillary muscles, 10 microM beauvericin significantly decreased membrane resting potential until unexcitability of the preparation occurred. Despite depolarisation of the membrane the maximum rate of rise of the action potential was not changed. The action potential duration was shortened, but the decrease was only significant at times to 20% and 50% repolarisation. These data, derived from the electrophysiological experiments, not only imply an effect on the calcium current as suggested by the effects on contractility, but also an interaction with the sodium inward and potassium outward currents.

[A case of renal hemangiopericytoma].

The patient is a 33-year-old female. On precontrast CT, the tumor shows a high density area with a low density area. On postcontrast CT, the tumor demonstrates a well-marginated low density area. Angiographically, the tumor shows a hypervascular mass with tumor vessels like a weeping willow and unhomogeneous stain. This is only the fourth such case ever reported before in Japan.

Axillary artery rupture complicating anterior dislocation of the shoulder. Case report.

Vascular injury is a rare complication of anterior dislocation of the shoulder joint. Two cases, both in elderly persons (65 and 74 years) were treated in our Department during a 5-year period. Atherosclerotic changes of the axillary artery and previous shoulder dislocation are predisposing factors for such injury.