Suicide risk after psychiatric discharge: study protocol of a naturalistic, long-term, prospective observational study.

BACKGROUND: Suicide risk of psychiatric patients has proven to be strongly increased in the months after discharge from a psychiatric hospital. Despite this high risk, there is a lack of systematic research on the causes of this elevated suicide risk as well as a lack of treatment and intervention for patients at high risk after discharge. The main objective of this pilot study is, firstly, to examine the factors contributing to the elevated suicide risk and, secondly, to investigate whether an additional setting of care starting at discharge may reduce suicidality. METHODS: In this multi-centre pilot study, treatment as usual is complemented by an additional 18-month post-discharge setting of care for psychiatric patients at high risk for suicide. Two groups of patients differing in the amount of post-discharge personal contacts will be compared. One group of patients will be offered continuous personal contacts after discharge (months 1-6: monthly contacts; months 6-18: every 2 months) while another group of patients will receive contacts only at months 6, 12, and 18 after discharge. Data on suicidality, as well as associated with other symptoms, treatment, and significant events, will be collected. In the case of health-related severe events, the setting of care allows the patient to have the opportunity to connect with the doctor or therapist treating the patient. DISCUSSION: The results of this study will contribute to identifying critical factors raising suicide risk after discharge and will demonstrate the potential influence on suicide prevention of a setting of care with regular personal contact after discharge. TRIAL REGISTRATION: ZMVI1-2517FSB135 - funded by the German Federal Ministry of Health.

Topo-optical visualization reactions of carbohydrate-containing amyloid deposits in the respiratory tract.

Staining with Congo red according to is the most commonly used method for the demonstration of amyloid, but structures other than amyloid can give false-positive results. To overcome this problem, introduced an aqueous Congo red staining with gum arabic as the mounting medium, which we have used in this and previous publications. Most histochemical studies on amyloid deposits to date have concentrated on conventional methods including staining with thioflavine, sirius red, alcian blue, methyl and crystal violet. In this study, we used topo-optical reactions with thiazine dyes on both the light and polarization microscopic level to establish the structure, distribution and location of carbohydrate components that occur within amyloid deposits, especially in the respiratory tract. Topo-optical staining reactions for the qualitative analysis of carbohydrate components in amyloid deposits included (1) reactions that identify the carbohydrate residues, (2) reactions that detect sialic acids and, (3) methods that visualize glycosaminoglycans. In conclusion, a comparison of consecutive serial sections stained with Congo red, aldehyde bisulfite toluidine blue reaction, sialic acid-specific topo-optical reaction, toluidine blue topo-optical reaction and chemically intensified basophilic reaction showed correlative staining patterns and anisotropic effects, corresponding to a close pathomorphological relationship between amyloid fibrils, periodate reactive carbohydrates, including sialic acids, and glycosaminoglycans.

Case report: amyloid tumors in a case of non-secretory multiple myeloma.

Multiple myeloma (MM) is a neoplastic disorder characterized by proliferation of a single clone of plasma cells derived from B cells, which proliferates in the bone marrow and frequently invades the adjacent bone, producing skeletal destruction that results in bone pain and fractures. Patients with MM can furthermore present with anemia, hypercalcemia and renal failure. Non-secretory multiple myeloma (NSMM) is characterized by the absence of a monoclonal (M) protein in both the serum and urine. The reported incidence is 1-5% of all multiple myeloma cases. Development of amyloid tumors in NSMM has been described in the literature only occasionally. The clinical features of a 49-year-old female patient with NSMM and amyloid tumors in the breast, lung and rib are presented in this report. Conventional histology, Congo red staining with and without potassium permanganate pretreatment, aldehyde bisulfite-toluidine blue (ABT) reaction, sialic acid specific topo-optical reaction, toluidine blue topo-optical reaction as well as immunohistochemistry were performed. An attempt is made to explain the lack of monoclonal immunoglobulins in the serum and urine, although extensive organ amyloidosis of AL type (kappa-light chains) has been found. It is assumed that the plasmocytic plasma cells possess an excretory mechanism, which allows the pathologic immunoglobulins to be secreted either as amyloid proteins polymerizing into amyloid fibrils, or as immunoglobulin fragments that are subject to degradation as soon as they are excreted out of the tumor cell. In this paper, we review the occurrence of amyloid tumors in non-secretory multiple myeloma and, in a single case report, we confirm the existence of carbohydrate residues, including sialic acids and sulfated GAGs, in amyloid deposits.

Topooptical investigations and enzymatic digestions on tissue-isolated amyloid fibrils.

Chemical and biochemical analysis of isolated amyloid fibrils reveals the presence of different classes of proteins which are often related to distinct clinical forms of amyloidosis and are useful to classify the amyloid deposits. In this study, enzymatic digestions using hyaluronidase, chondroitinase AC and B, neuraminidase, and chemical extractions using mild acid hydrolysis with hydrochloric and sulfuric acid, were used to control the specificity of various topooptical reactions. The disappearance of intense staining after these extraction methods indicates that tissue-isolated amyloid fibrils contain sialic acids and glycosaminoglycans (GAGs). We conclude that topooptical reactions are the most sensitive methods to detect conformational changes in the non-fibrillar component of amyloid deposits and tissue-isolated amyloid fibrils.

Histochemical and topo-optical investigations on tissue-isolated and in vitro amyloid fibrils.

An improved microscopic slide preparation for staining of tissue-isolated and in vitro amyloid fibrils is described in detail. Specimens were prepared by slow drying of an amyloid fibril suspension on aminoalkyl-silanised glass slides underneath a coverglass. The purpose of this method is to obtain microscopically visible fibers. Polarization microscopy was performed on unstained fibers in different embedding media, on fibers stained with Congo red, toluidine blue, 1,9-dimethylmethylene blue, anisotropic PAS reaction and Sudan black. Results were identical in 8 tissue-isolated amyloid fibril preparations. The refractive index of amyloid was about 1.5, as expected for protein fibrils. Congo red-stained fibrils showed yellow or blue-green polarization colors, while staining with toluidine blue or 1,9-dimethylmethylene blue induced green or orange polarization colors. The latter dyes stained the fibrils even in buffers with low pH or high ionic strength, pointing to strong acidic groups like sulphates in amyloid. The anisotropic PAS reaction for selective demonstration of periodate reactive carbohydrates in tissue-isolated amyloid fibrils was positive. Thus, linearly ordered acidic groups and carbohydrate residues could be detected for the first time in tissue-isolated amyloid fibrils using an improved technique for microscopic slide preparation on one side and topo-optical reactions on the other.

Nonsecretory multiple myeloma with amyloidosis. A case report and review of the literature.

We report a case concerning a 49-year-old female patient with thoracic pain. X-rays showed a single osteolytic lesion on the right seventh rib. The excision of the rib disclosed a plasmocytic plasmocytoma with extensive amyloidosis. Serum and urine protein electrophoresis were both negative for monoclonal gammopathy. Bone marrow biopsy showed that 80% of the marrow had been replaced by plasma cells. A diagnosis of nonsecretory multiple myeloma was made. Immunohistochemistry revealed amyloid light (AL) amyloidosis of kappa-light chain origin. The relationship between nonsecretory multiple myeloma and amyloidosis is discussed.

The relevance of the aldehyde bisulfite toluidine blue reaction and its variants in the submicroscopic carbohydrate research.

Carbohydrates are chemical compounds that contain only oxygen, hydrogen and carbon. They are classified by their number of sugar units: monosaccharides (such as glucose and fructose), and disaccharides (such as sucrose and lactose) are simple carbohydrates; oligosaccharides and polysaccharides (such as starch, glycogen and cellulose) are complex carbohydrates. Carbohydrates play a crucial role in diverse biological systems [Hricovín M. Structural aspects of carbohydrates and the relation with their biological properties. Curr Med Chem 2004;11:2565-83]. According to Roseman [Sugars of the cell membrane. In: Weissmann G, Clairborn E, editors. Cell membranes. Biochemistry, Cell Biology, Pathology. New York: H. P. Publ. Co; 1975. p. 55-64], two classes of glycoproteins are described. Free glycoproteins are localised in the surface coat of the membranes and form a thick mobile layer, without any association to the membrane itself. Functionally, however, they are located in a close association with the membrane (e.g. in the duodenal mucosa). The other group consists of the membrane glycoproteins, which are integral to the membranes and are located in the outer layer. The oligosaccharide chains are bound to the N-terminal part of proteins, and are situated in the hydrophilic zone. Glycoproteins have diverse functions. They are important in specific receptor functions, in immunological cell destruction and play a significant role in reactions with lectins, antibodies, as well as in cell association and mutual recognition of the cells. This paper focuses on aspects of a summary of polarisation optical investigations and biological functions of the following three groups of carbohydrates: oligosaccharides, glycoproteins and glycosaminoglycans.

Topo-optical reactions for the identification of O-acyl sugars in amyloid deposits.

The aldehyde bisulfite toluidine blue (ABT) reaction with former saponification (KOH-ABT) and periodic acid-borohydride reduction-saponification (PB-KOH-ABT) were applied to sections of human amyloid deposits in the respiratory tract. The saponification-induced increase in ABT-reactivity was confined to the presence of O-acyl sugars associated with the amyloid fibrils. The anisotropic and metachromatic effect in the ABT and KOH-ABT reaction was reduced in the corresponding PB-KOH-ABT reaction, a difference attributed to the removal of staining due to neutral carbohydrate residues. Since the periodic acid-borohydride reduction abolishes all pre-existing ABT-reactivity of neutral sugar vicinal diols, the isolated KOH-effect could be shown using the PB-KOH-ABT reaction. By application of this sequence, the problem identifying small quantities of O-acyl sugars was solved. It is suggested that the KOH-effect depends upon the removal of O-acyl substituents located on the polyhydroxy side chain (C7, C8, C9) of sialic acid residues. An advantage of such topo-optical reactions over biochemical techniques is the exact localization of O-acyl sugars in tissue sites. By means of the KOH-ABT and PB-KOH-ABT reactions we have demonstrated, for the first time, that O-acyl sugars occur within amyloid deposits.

Risk-inducing activities leading to injuries in a child and adolescent population of Germany.

BACKGROUND: Injuries are the most common cause of mortality in children, also accounting considerably for childhood morbidity. However, data on injuries only provide valid information on the actual risk of each injury-causing activity when taken in consideration of the relationship with actual activity exposure data. Therefore, the primary goal of this investigation is to determine the relative risk of normal child and adolescent activities. METHODS: From January 1, 1999 to December 31, 2001, a school questioning in regard to social, pedagogic, and leisure activities was performed among 2,325 students ranging from 6 to 17 years old. A total of 3,645 injuries sustained by children and adolescents treated at the surgical emergency department of the University Hospital Dresden were analyzed. Furthermore, a danger awareness test was performed. RESULTS: Forty-three percent of all injuries happened during leisure time, 41% at school, 8% in traffic, and 8% at home. Bicycle riding was pointed out as the most frequent leisure activity, regardless of gender and age. Horse riding had a 9-fold increased risk and moped driving had a 23.75-fold increased risk for injury compared with adolescent bike riding. Horse riding and snowboarding showed an increased risk for injury in children (5.6- and 4.2-fold, relative to biking). The level of danger awareness was significantly lower in children with a history of frequent injuries. CONCLUSIONS: The riskier activities were horse-riding, moped driving, and snowboarding. The level of danger awareness did affect the frequency of injuries. The authors recommend a danger awareness test for all children to identify those who would benefit from injury prevention training.