Images of interest. Gastrointestinal: esophagitis caused by alendronate.
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Alendronate↗
Biomedical subjects
R Y Chen
Publications and source records attributed to R Y Chen.
Endoscopic ultrasound for investigations of gastrointestinal conditions.
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Attitude of Health Personnel↗
Stroke audit.
Medical audit is vital to ensure continuous quality assurance and quality improvements. We did a retrospective study to ascertain the adequacy of clinical documentation and the factors hindering early discharge after an acute stroke in a restructured hospital. The medical records of all patients with acute stroke who died or were discharged from a restructured hospital in Singapore in January and February 1999 were reviewed retrospectively. Demographic data and the presence or absence of clinical documentation were noted. Factors hindering the discharge of patients at Day 5, Day 10 of stroke and at final discharge were noted and classified into: stroke-related, complications of stroke, medical-related and social factors. There were 101 patients in the study cohort, 55 males (54.5%) and 46 females (45.5%). The mean age was 67.9 years (SD 12.3). Documentation in Barthel scores (0%), presence of depression (0%), mental scores (1.0%), visual problems (10.0%), bladder continence (39.6%), admission functional status (37.6%) and dysphagia (52.5%) were deficient. The mean length of stay (LOS) was 13.0 (SD 14.2) days. The main factor hindering discharge at Day 5 (90.4%), Day 10 (95.2%) and at final discharge (82.1%) was stroke-related problems. Poor function (60.3%) and dysphagia (15.8%) were the 2 most common stroke-related problems hindering final discharge. Complications of stroke, medical-related problems and social reasons hindered final discharge in 10.8%, 17.8% and 2.9% of patients respectively. This audit revealed inadequacy in clinical documentation in patients with acute stroke. The main hindrance to final discharge of patients was stroke-related problems. The 2 most important stroke-related problems were poor function and dysphagia.
Aged↗
No association between T102C polymorphism of serotonin-2A receptor gene and clinical phenotypes of Chinese schizophrenic patients.
Serotonin dysfunction has been implicated in the pathogenesis of schizophrenia. Previous studies have shown an association between the T102C polymorphism of the 5HT2a receptor gene and schizophrenia. However, negative findings have also been reported. One possible explanation for such discrepancy is disease heterogeneity due to the current limitations in the diagnosis of schizophrenia. We conducted a case-control study of the T102C polymorphism with detailed characterisation of the clinical phenotypes to investigate the possible association with schizophrenia not only at the diagnostic level, but also with reference to other clinical phenotypes potentially related to serotonin dysfunction. Four hundred and seventy-one biologically unrelated schizophrenic patients and 523 unrelated healthy controls of Han Chinese descent in Hong Kong were compared for genotypes and allele frequencies of the T102C polymorphism by PCR amplification and restriction analysis. No evidence of association was detected at the diagnostic level and various clinical phenotypes. However, we found a trend association with small effect size between genotype 102T/102C and patients with better verbal fluency and less motor co-ordination soft neurological signs. There is a need for future large-scale studies on the possible associations between genetic polymorphisms and neurocognitive function impairments in schizophrenia.
Adolescent↗
Stroop interference and facilitation effects in first-episode schizophrenic patients.
In the Stroop test, interference occurs in naming the print color of a word when the word is itself the name of another color. Facilitation occurs when the word is the same as the print color. Previous studies on selective attention in schizophrenia using the Stroop interference effects have yielded contradicting results. Constraints included limited sample size and the recruitment of medicated chronic patients. We studied the Stroop interference and facilitation effects in a relatively large sample of first-episode schizophrenic patients (n=56), a substantial proportion of whom were medication-naïve (n=30) at the time of initial testing. We have also carried out longitudinal follow-up assessments when patients reached a clinically stable state, as well as 4months after recovery from the episode. We found that the Stroop interference effect was not increased in first-episode schizophrenic patients, whether medication-naïve or not. This effect did not change over the follow-up period. In addition, we detected an increase in Stroop facilitation effect in medicated schizophrenic patients, but only in the initial assessment soon after they had received medication. After sustained treatment, the increase in facilitation was normalized. These observations supported previous findings of a normal Stroop interference effect amongst schizophrenic patients. The increased facilitation effect for patients in their early phase of treatment (but not later) may represent an acute effect of anti-psychotic medication. Its nature and significance require further investigation.
Adult↗
Neurological signs and sustained attention impairment in schizophrenia.
Both neurological signs and attention impairments are often found in schizophrenia. This study addresses the extent to which neurological signs are related to sustained attention impairment. We assessed subgroups of neurological signs using the standardised Cambridge Neurological Inventory (CNI). Sustained attention was measured using a monotone counting paradigm. After taking into consideration potential confounds such as age, education level and duration of illness, we explored the correlation between sustained attention and groups of neurological signs, as well as with individual signs. We found that "motor coordination" and "disinhibition" signs were significantly related to sustained attention. The correlation with "sensory integration" just failed to reach significance after correction for multiple comparison. "Dyskinesia", "catatonia", "pyramidal" and "extrapyramidal" subgroups were unrelated to sustained attention. The results support the notion of heterogeneity and diversity in neurological signs (even among soft neurological signs) and argue against the use of a single global measure to embrace all soft neurological signs in schizophrenia.
Attention↗
Five new diprenylated flavonols from the leaves of Broussonetia kazinoki.
Five new diprenylated flavonols, broussonol A (1), broussonol B (2), broussonol C (3), broussonol D (4), and broussonol E (5), along with two known compounds, were isolated from an ethanolic extract of the leaves of Broussonetia kazinoki. Their structures were elucidated by chemical and spectral methods. Cytotoxic activities were evaluated against several different cell lines.
Dose-Response Relationship, Drug↗
Use of an overtube for enteroscopy--does it increase depth of insertion? A prospective study of enteroscopy with and without an overtube.
BACKGROUND AND STUDY AIMS: Although a stiffening overtube is commonly used with push enteroscopy, in the belief that this will allow increased insertion into the small intestine, there is no prospective data to support this view. The aim of this study is to prospectively study the depth of insertion into the small intestine at enteroscopy with and without an overtube. PATIENTS AND METHODS: A total of 38 patients referred for enteroscopy were prospectively studied. Alternate enteroscopies were performed with or without an overtube; therefore 19 patients had enteroscopy with and 19 without an overtube. The groups were well matched for age, sex, indication, use of fluoroscopy, and dedicated anesthetic assistance. Depth of insertion was assessed by advancing the enteroscope as far as possible, then straightening the enteroscope until the tip began withdrawing. The difference between the straightened insertion depth and the distance from the incisors to the pylorus was recorded as the insertion depth beyond the pylorus. This was considered the major end point. Statistical analysis was performed using the Mann-Whitney test for nonparametric data. RESULTS: The median straightened total insertion depth from the incisors was greater when enteroscopy was performed with an overtube compared with enteroscopy without an overtube (125 cm vs. 110 cm, P=0.05). The median straightened insertion depth beyond the pylorus was significantly greater with overtube use (70 cm vs. 50 cm, P = 0.01). No significant difference between the groups was observed in terms of the likelihood of significant findings at enteroscopy. CONCLUSIONS: Use of an overtube for push enteroscopy results in significantly deeper insertion into the small intestine. Although a larger study would be needed to demonstrate an increase in diagnostic yield and to confirm the safety of overtube use, this study does provide the first objective evidence of an advantage in terms of insertion depth.
Adult↗
Two new bislabdane-type diterpenoids and three new diterpenoids from the roots of Cunninghamia lanceolata.
Two new bislabdane-type diterpenoids lanceolatin (1), lancelatol (2) and three new diterpenoids 15-nor-14-oxo-8(17),12-labdanien-14,18-dionic acid (3), 8(17),12,14-labdantrien-18-oic acid (4) and 8(17),12,14-labdantrien-18-ol (5), together with 7 known diterpenoids were isolated from the roots of Cunninghamia lanceolata. Their structures were determined by spectroscopic and chemical methods. All of these compounds were isolated from the species for the first time. One of the isolated compounds showed a significant inhibition effect on mouse hind-paw edema induced by carrageenan.
Animals↗
Structures of two new benzofuran derivatives from the bark of mulberry tree (Morus macroura Miq.).
Two new benzofuran derivatives, macrourins A (1) and B (2), together with two known stilbene derivatives, were isolated from the barks of Morus macroura Miq. Their structures were elucidated by means of spectroscopic evidence.
Benzofurans↗
Chemical constituents from the leaves of Magnolia denudata.
20 compounds were isolated from the leaves of Magnolia denudata including 16 lignans, which belong to 6 structural types. Except for (7R, 8S, 1'S)-delta8' -1', 4'- dihydro-5'-methoxy-3,4-methylenedioxy-4'-oxo-7.0.2', 8.1'-neolignan (6), magliflonenone (9), 2, 5'-diene-2', 8'-epoxy-5'-methoxy-8-methyl-4'-oxo-3,4- methylenedioxy-spiro (5, 5)-undecane (10), veraguensin (16) and beta-sitosterol (20), the other 15 compounds were obtained from this species for the first time. The absolute configurations of 3 compounds (1, 4, 10) were determined by CD spectroscopy for the first time. The anti-inflammatory activities of compounds 1, 2 and 16 were assessed and 2 was shown to have significant inhibition effect on mice hind-paw edema induced by carrageenan.
Animals↗
Insight changes in acute psychotic episodes: a prospective study of Hong Kong Chinese patients.
Insight impairment occurs commonly in psychotic disorders (including mood episodes with psychotic symptoms). The aim of the present study is to measure changes of insight over the course of a psychotic episode and to investigate its relationships with symptoms and neurocognitive functions, as well as psychosocial factors. Insight was assessed at weekly intervals in 80 consecutive inpatients presenting with a psychotic episode by using a Chinese translation of the Scale to Assess Unawareness of Mental Disorder (SUMD). The relationships between insight change and other variables were explored. Modest but significant changes in insight were found in both directions with clinical resolution of psychotic symptoms. In particular, insight "declined" as symptoms improved in a number of patients. In addition, changes in insight score correlated with changes in Wisconsin Card Sorting Test (WCST) performance. More changes in insight (in either direction) tended to occur in younger patients. These results indicated that adequate control of psychotic symptoms and improvement in neuropsychological functioning might be associated with better insight recovery.
Acute Disease↗
Clostridial gas gangrene. I. Cellular and molecular mechanisms of microvascular dysfunction induced by exotoxins of Clostridium perfringens.
Mechanisms responsible for the rapid tissue destruction in gas gangrene are not well understood. To examine the early effects of Clostridium perfringens exotoxins on tissue perfusion, a rat model of muscle blood flow was developed. Intramuscular injection of a clostridial toxin preparation containing both phospholipase C (PLC) and theta-toxin caused a rapid (1-2 min) and irreversible decrease in blood flow that paralleled formation of activated platelet aggregates in venules and arterioles. Later (20-40 min), aggregates contained fibrin and leukocytes, and neutrophils accumulated along vascular walls. Flow cytometry confirmed that these clostridial toxins or recombinant PLC induced formation of P-selectin-positive platelet aggregates. Neutralization of PLC activity in the clostridial toxin preparation completely abrogated human platelet responses and reduced perfusion deficits. It is concluded that tissue destruction in gas gangrene is related to profound attenuation of blood flow initiated by activation of platelet responses by PLC.
Animals↗
Clostridial gas gangrene. II. Phospholipase C-induced activation of platelet gpIIbIIIa mediates vascular occlusion and myonecrosis in Clostridium perfringens gas gangrene.
Clostridium perfringens gas gangrene is a fulminant infection, and radical amputation remains the single best treatment. It has been hypothesized that rapid tissue destruction is related to tissue hypoxia secondary to toxin-induced vascular obstruction, and previous studies demonstrated that phospholipase C (PLC) caused a rapid and irreversible decrease in skeletal muscle blood flow that paralleled the formation of intravascular aggregates of activated platelets, fibrin, and leukocytes. In this study, flow cytometry demonstrated that PLC stimulated platelet/neutrophil aggregation in a gpIIbIIIa-dependent fashion. Pretreatment of animals with heparin or depletion of leukocytes reduced blood-flow deficits, and aggregate formation caused by PLC. It is concluded that fulminant tissue destruction in gas gangrene results from profound attenuation of blood flow caused by PLC-induced, gpIIbIIIa-mediated formation of heterotypic platelet/polymorphonuclear leukocyte aggregates. Therapeutic strategies that target gpIIbIIIa may prevent vascular occlusion, maintain tissue viability, and provide an alternative to radical amputation for patients with this infection.
Animals↗
A five-year longitudinal study of the regional cerebral metabolic changes of a schizophrenic patient from the first episode using Tc-99m HMPAO SPECT.
This is a naturalistic study of the relationship between cerebral metabolic activity, clinical symptoms and treatment response in a schizophrenic patient for 5 years from the onset of her illness. Serial technetium-99m-HMPAO brain SPECT was used to measure regional cerebral metabolism. The Cambridge Neurological Inventory and neuropsychological tests (WAIS-R verbal subscales, Wisconsin Card Sorting Test, semantic verbal fluency, logical memory in Weschler Memory Scale) were used for neurocognitive assessment. Under-activity of the left temporal area was observed in the course of patient illness despite remission of the psychotic symptoms. Bilateral prefrontal metabolic under-activity was noted at the emergence of negative symptoms, executive neurocognitive dysfunction and the treatment-resistant state. After response to clozapine, the right prefrontal activity returned to a normal level. Our findings suggested that persistent left temporal underactivity detected by SPECT despite clinical remission may indicate a vulnerability for further relapses and development of a treatment-resistant state. Treatment-resistant state, negative symptoms and executive neurocognitive deficit may involve abnormal prefrontal metabolic activity and can be alleviated in clozapine-responsive patients.
Adult↗
New annonaceous acetogenins from the roots of Uvaria calamistrata.
Five new annonaceous acetogenins, calamistrins C-G (1-5), were isolated from an ethanolic extract of the roots of Uvaria calamistrata. Compounds 1-3 were mono-THF ring acetogenins; compounds 4 and 5 were bis-THF acetogenins, with the THF rings from C-18 to C-25. The absolute configurations of 3, 4, and 5 as well as the partial absolute configurations of 1 and 2 were determined by (13)C NMR spectroscopy and advanced Mosher methodology.
Drug Screening Assays, Antitumor↗
Progressive deterioration of soft neurological signs in chronic schizophrenic patients.
OBJECTIVE: Neurological signs are found to be increased in schizophrenia in cross-sectional studies. Whether they progress with time is an important issue in addressing the course of the illness. METHOD: The current study investigated different groups of neurological signs in 43 stable chronic schizophrenic patients over a 3-year period using an operationalized instrument. RESULTS: While symptoms and medication have remained largely unchanged in the 3-year period, significant increase in soft neurological signs (SNS) ('motor coordination', 'sensory integration' and 'disinhibition') has been observed. This contrasted with the stability of 'pyramidal', 'extrapyramidal', 'dyskinesia' and 'catatonia' signs. The increase in SNS appears not to be related to age, illness duration, symptoms or medication. CONCLUSION: This finding suggests that SNS represent a marker sensitive to a possible late deterioration process in the course of a schizophrenic illness.
Adult↗
Verbal fluency in schizophrenia: reduction in semantic store.
OBJECTIVE: This is a study of the word production of patients with schizophrenia using a semantic verbal fluency task to address the unresolved issue of retrieval or storage impairment. METHOD: Twenty-one patients with schizophrenia and 11 matched healthy subjects performed a semantic verbal fluency task on 'food', 'animal' and 'transport' categories in Cantonese for 3 minutes each on five separate trials. RESULTS: Patients generated significantly fewer numbers of words compared with control on each trial. The estimated lexicon size of the patients was significantly smaller than that of the equivalent group. The amount of shared words and variable words generated in all five trials were reduced in the patient group. CONCLUSIONS: Our results suggest that poor verbal fluency in patients with schizophrenia may partly be attributable to reduction in semantic store. The importance of temporal lobe involvement on verbal fluency deficits needs to be emphasised as an integral part of the neurobiological basis of schizophrenia research.
Adult↗