Humanistic burden in schizophrenia: a literature review.

OBJECTIVES OF THE STUDY AND BACKGROUND: Schizophrenia is a complex disease that affects 1% of the population. This disease has a considerable impact not only on patients' health and well-being but also on their surrounding environment. The costs of the disease's management remain large for individuals and society. While literature on the economic impact of schizophrenia is abundant, few studies have focused on its humanistic burden. This does not only concern patients, but also caregivers, relatives, neighbours and others in a patient's daily life. This burden appears through several dimensions, including treatment side effects and the impact on caregivers and features of the patient's environment. The aim of this review is to consider, compile and describe the humanistic burden of schizophrenia as documented in the literature. MATERIALS AND METHODS: We conducted a literature review assessing the worldwide disease burden of schizophrenia, taking into account all humanistic burden topics. The search considered several databases, including Embase, Medline, Cochrane Library, The German Institute of Medical Documentation and Information (DIMDI) and the ISPOR conference websites. RESULTS: The search identified 200 literature reviews, covering several dimensions of humanistic burden and documenting many issues. Main findings included the high death rates that may be explained by long-lasting negative health habits, disease- and treatment-related metabolic disorders, and consequent increased frequencies of cardiovascular diseases. Co-existing depression was found to have adverse consequence on the course of schizophrenia progression, morbidity and mortality. Cognitive impairment also adds to the burden of schizophrenia. Social impairment is worsened by underestimated stigmatisation and lack of corresponding awareness within the professional and social spheres. Finally, caregiver burden was found to be considerable. DISCUSSION: Humanistic burden among patients with schizophrenia is substantial potentially impacted by co-morbid depressive symptoms, caregiver burden and cognitive impairment. Effects of treatment on humanistic burden in addition to economic burden need to be explored in future trials.

R-phycoerythrin-cyanine 5 tandem discerns CD72 polymorphism.

By fluorescence analysis, we demonstrated that a fluorochrome tandem composed of R-phycoerythrin and cyanine 5 specifically recognized B cells from SJL, AKR, MRL/Mp, and NOD mouse strains, whereas B cells from C57BL/6, DBA/2, SWR, 129/Sv, and BALB/c were not stained. A strict correlation was observed between the fixation of the fluorochrome and the pattern of expression of the pan-B cell marker CD72, i.e., early expression in B-cell lineage development and downregulation on the terminally differentiated activated B cells. Three allelic forms, CD72a, CD72b and CD72c have been well characterized, and show a high number of amino acid substitutions concentrated in the membrane-distal extracellular domain. Using a PCR approach, we determined that all mouse strains positive for fluorochrome staining display the CD72c allelic form. Moreover, a genetic analysis showed that the fixation of the fluorochrome on the B cell is exclusively dependent on the presence of the CD72c allele. Together, these results strongly suggest that the tandem binds a molecular complex comprising the CD72c molecule or recognizes directly the CD72c molecule itself.

Paraneoplastic limbic encephalitis, a complication of the testicular cancer.

We report a case of paraneoplastic limbic encephalitis related to a testicular neoplasm. The syndrome is characterized by progressive amnesia and psychiatric disturbances resulting from an inflammatory reaction probably related to an immune response to the neuronal proteins expressed by tumors. It is usually associated with small cell lung cancer. In other cases, testicular cancer occurs more frequently than expected. Cranial magnetic resonance imaging may show increased signal intensity in the limbic cortex. Genitourinary examinations are sometimes inadequate. Testicular ultrasonography is recommended if no tumor is detected on the chest and abdominal computed tomography scan. The outcome of the treatment of the testicular cancer on the paraneoplastic syndrome is variable.

Listeria monocytogenes as a short-lived delivery system for the induction of type 1 cell-mediated immunity against the p36/LACK antigen of Leishmania major.

Listeria monocytogenes has been used as an experimental live vector for the induction of CD8-mediated immune responses in various viral and tumoral experimental models. Susceptibility of BALB/c mice to Leishmania major infection has been correlated to the preferential development of Th2 CD4 T cells through an early production of interleukin 4 (IL-4) by a restricted population of CD4 T cells which react to a single parasite antigen, LACK (stands for Leishmania homologue of receptors for activated C kinase). Experimental vaccination with LACK can redirect the differentiation of CD4(+) T cells towards the Th1 pathway if LACK is coadministrated with IL-12. As IL-12 is known to be induced by L. monocytogenes, we have tested the ability of a recombinant attenuated actA mutant L. monocytogenes strain expressing LACK to induce the development of LACK-specific Th1 cells in both B10.D2 and BALB/c mice, which are resistant and susceptible to L. major, respectively. After a single injection of LACK-expressing L. monocytogenes, IL-12/p40 transcripts showed a rapid burst, and peaks of gamma interferon (IFN-gamma)-secreting LACK-specific Th1 cells were detected around day 5 in the spleens and livers of mice of both strains. These primed IFN-gamma-secreting LACK-reactive T cells were not detected ex vivo after day 7 of immunization but could be recruited and detected 15 days later in the draining lymph node after an L. major footpad challenge. Although immunization of BALB/c mice with LACK-expressing L. monocytogenes did not change the course of the infection with L. major, immunized B10.D2 mice exhibited significantly smaller lesions than nonimmunized controls. Thus, our results demonstrate that, in addition of its recognized use for the induction of effector CD8 T cells, L. monocytogenes can also be used as a live recombinant vector to favor the development of potentially protective IFN-gamma-secreting Th1 CD4 T lymphocytes.

Longitudinal study of tissue- and subunit-specific obesity-induced regulation of the pyruvate dehydrogenase complex.

The tissue-specific expression of the mitochondrial pyruvate dehydrogenase complex (PDHc) has been studied in an animal model of obesity with hyperinsulinemia, the obese (fa/fa) Zucker rat. Liver and heart were obtained from 4 and 8 week-old obese rats and age-matched lean animals, and in each tissue the following parameters were analyzed: (1) total activity of the mitochondrial PDHc; (2) abundance of the mitochondrial PDHc subunits on Western blots; and (3) abundance of the E1alpha and E1beta subunit mRNAs on Northern blots and semi-quantitative RT-PCR. Regardless of age, obese rats showed an increase in liver total PDHc activity and a coordinate increase in liver E1alpha and E1beta PDHc subunit abundance. At 4 weeks, obese rats also showed an increase in liver PDH E1alpha mRNA level, but regardless of age E1beta mRNA level was unchanged. In contrast, neither total PDHc activity nor the concentration of its protein subunits were increased in heart of obese rats. Thus, obese Zucker rats display a liver-specific early increase in PDHc which results from a selective up-regulation of the E1alpha gene expression.

The biology of macrophages.

The main properties of the mononuclear phagocytic system (MPS) are summarized, focusing on their relevance within the framework of the steady-state and the inducible functions of the mammalian immune system, more specifically the immune system of the laboratory mouse, a reference vertebrate which remains the best studied. A peculiar attention is given to the rationale underlying the generation of so-called specific tools and reagents whose use is promoted to characterize this lineage, whatever the level under study, i.e. tissular, cellular, or subcellular levels. As one lineage among other lineages of the hemopoietic system, the MPS is characterizable by constitutive and inducible phenotypic and functional markers whose combination is unique for a given tissular micro-environment. Considering our present understanding of the innate and adaptive immune system functions, some of the properties of the MPS are discussed in relation with properties of another recently recognized hemopoietic lineage, namely the dendritic leukocyte system.

[Initial clinical experiences with the Storz Modulith SL 20 lithotripter: the results 3 months after a single session]. / Première expérience clinique du lithotripteur Storz Modulith SL 20: résultats à trois mois après une séance unique.

The objective of this study was to evaluate the performances of the Storz Modulith SL20 lithotriptor. Fifty patients with a total of 52 renal (31) or ureteric (21) stones were treated, in a single session, between June and October 1993. The mean stone diameter was 7.9 mm. All patients were reviewed after 3 months. The complete success rate, with radiological cure, was 65% at 3 months. The partial success rate, defined as fragmentation of the stone with persistence of residual fragments less than 3 mm in diameter, not requiring further treatment, was 12% at 3 months. The failure rate at 3 months was 23%. The commonest complication was renal colic in 12 patients (24%). Two patients developed an extrarenal haematoma. The Modulith SL20 possesses a good detection system: firing is well tolerated under minimal analgesia. Our success rates are slightly lower than those obtained by other teams using the same apparatus.

[Distribution of hydrocarbon residues in the sediment from Bizerte lagoon (Northern Tunisia)]. / Répartition des résidus d'hydrocarbures dans les sédiments de la lagune de Bizerte (Tunisie septentrionale).

The study of hydrocarbon residue by infrared spectrophotometry in the deposits of the Bizerta Lagoon allows us to recognize a polluted zone sector of the Menzel Bourguiba Arsenal. The Eastern part of the lagoon, a zone of "oyster parks" is not affected by pollution. Its average contents of hydrocarbon residues are clearly below the maximum content determined by international regulations. The distribution of hydrocarbon residues in the superficial sediments following three well differentiated zones, reflects the weak hydrodynamism in the lagoon. The vertical variations of this pollution agent contents show the preferential accumulation of the terrigenous material, from lake Ichkeul , in the western part and the weak rate of sedimentation in the eastern zone.