Clinical utility of biomarkers of the hand in the diagnosis of schizophrenia.

A number of biomarkers were assessed in photos and prints of the hands of 95 patients with a variety of mental disorders to determine whether patients with schizophrenia could be distinguished from the others. Patients were recruited as consecutive admissions from an outpatient psychiatric day hospital population. Fourteen patients were diagnosed with schizophrenia/schizoaffective disorder and 81 were diagnosed with other mental disorders. A discriminant analysis yielded an overall 80% correct classification, with a sensitivity (schizophrenia patients identified correctly) of 78.6% and a specificity (non-schizophrenia patients identified correctly) of 80.2%. Significant differences were noted in the proximal interphalangeal joint, eponychium of the middle digit and fingernails. To determine biomarker frequency distribution patients with bipolar disorder were then compared to those with schizophrenia/schizoaffective disorder and then to patients with PTSD. The former yielded an overall 78.6% correct classification, with a sensitivity of 71.4% and a specificity of 85.7% and with similar biomarker frequency distribution for bipolar disorder as for the entire non schizophrenia group. The latter comparison yielded an overall 58.6% correct classification, with no significant differences between the features. The application of these biomarkers in clinical practice could constitute an additional tool for the psychiatrist in cases lacking diagnostic clarity.

Do biometric parameters of the hand differentiate schizophrenia from other psychiatric disorders? A comparative evaluation using three mental health modules.

The link between schizophrenia and anomalies in the distal upper limb is well documented. Preliminary studies have identified a number of biometric parameters of the hand by which schizophrenics can be distinguished from matched controls. The current study seeks to determine whether patients with schizophrenia can be singled out from a disparate group of other mental disorders by using the same parameters. We studied three groups, totaling 134 men: 51 diagnosed with schizophrenia, 29 with anxiety and mood disorders, and 54 comprising a control group. Seven parameters were studied: the proximal interphalangeal joint, the eponychia of the middle and ring digits, two dermatoglyphic features, and two constitutional factors. Examiners evaluated the parameters based on photographs and prints. An initial Mann Whitney comparison showed no significant difference between the control group and those identified with anxiety and mood disorders. We therefore accounted for them as a single group. In a discriminant analysis, an overall accuracy of 78.4% was established with a sensitivity of 80.4% (schizophrenics identified correctly) and a specificity of 77.1% (controls identified correctly). These results suggest that the biometric parameters employed may be useful in identifying patients with schizophrenia from a disparate group of other mental disorders.

Biometric parameters of the hand as an index of schizophrenia--a preliminary study.

Since abnormalities in distal upper limb development are among the minor physical anomalies associated with schizophrenia we attempted to determine whether patients with schizophrenia can be identified on the basis of specific morphologic and dermatoglyphic features of the hand. Photographs and prints of the hands of 38 patients with schizophrenia and those of 42 control subjects were evaluated and graded on 13 biometric parameters. Results were statistically evaluated. A combination of three of the parameters was found to have good predicting abilities to distinguish between schizophrenics and controls. Subjects having high values in these three parameters were found to have a higher propensity to be defined as schizophrenics. In order to define a simple rule for classifying subjects we chose a criterion of having a value of 3 (in a scale from 1 to 3) in at least one of these three discriminating variables. This rule yielded an overall accuracy of 81.2%. Among controls, 85.7% of subjects did not fulfill such criteria, while 14.3% were defined as false positives. Among schizophrenics 76.3% achieved this condition while 23.7% were false negatives. The technique's objectivity and ease of application could facilitate the diagnosis of this disease.

[Laparoscopic sleeve gastrectomy (LSG) in adolescents with morbid obesity].

BACKGROUND: Morbid obesity has become a significant health problem for the pediatric population. The medical impact of obesity in youth is determinant. Conservative methods for weight loss are disappointing and therefore, bariatric surgery should be considered. AIMS: To present the experience of laparoscopic sleeve gastrectomy in adolescents with morbid obesity, treated by the pediatric multi-disciplinary obesity clinic. METHODS: All patients (n=7, all female) participated in a weight loss program for at least 6 months without success. At referral, the mean age was 16.2 years (range 13.8 - 18 years), mean body mass index (BMI in kg/m2) was 44.4 (range 38.9-55.2). All suffered from various co-morbidities of obesity: type 2 diabetes, insulin treated (n=1), hypertension (n=5), fatty liver (n=2), obstructive sleep apnea (n=2) and pseudotumor cerebri (n=1). RESULTS: There were no intra- or postoperative complications. After a mean follow-up of 15.1 months (range 5-25 months), all patients but one had reduced BMI (mean BMI of 32.55). In all subjects who lost weight, remission or improvement of the co-morbidities was noted. CONCLUSION: In this study, with a mean follow-up of 15.1 months, LSG was proven to be a safe and effective option of bariatric surgery in adolescents, resulting in a significant weight loss and remission or improvement of co-morbidities. We suggest that LSG might be considered as a single intervention for morbid obesity in adolescents. Long-term studies are needed to evaluate the efficacy of LSG and other bariatric surgeries in adolescents.

Screening criteria for diagnosis of infantile feeding disorders as a cause of poor feeding or food refusal.

OBJECTIVES: Infantile feeding disorders (IFDs) are a common cause of food refusal, failure to thrive, and vomiting, but they may be difficult to diagnose. We have previously identified certain patterns of pathological feeding and behaviors as high-risk characteristics for IFDs and subsequently developed the diagnostic Wolfson criteria. Here, we evaluate these high-risk behaviors and prospectively compare the Wolfson criteria with 2 existing classifications of IFD, the Chatoor and that in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). PATIENTS AND METHODS: Infants and young children referred for food refusal were invited to participate by completing a feeding pattern questionnaire. Following physicians' interview and examination, patients were scored by all 3 criteria and enrolled in a structured treatment program for IFD. Infants whose food refusal was associated with an organic cause served as a comparison group. The ability of the criteria to detect IFD and to predict response to therapy was compared with an intention-to-treat analysis. RESULTS: Eighty-five infants with new-onset IFD and 55 controls were included. The Wolfson criteria, Chatoor, and DSM-IV accurately diagnosed 100%, 77%, and 56% of the patients with IFD, respectively. Anticipatory gagging occurred in 47% of the children with IFD compared to 2% controls (P < 0.001). The response to therapy was similar among the 3 criteria (73-76%), suggesting that the Wolfson criteria did not incorrectly diagnose organic disease as IFD. The 20 infants who were diagnosed as having IFD by Wolfson but not by Chatoor responded equally well (80%) to an IFD treatment program. CONCLUSIONS: Diagnostic criteria of IFD that are based on food refusal, pathological feeding, and anticipatory gagging have a higher detection rate than the present criteria and are simpler to implement.

Diagnostic clues for identification of nonorganic vs organic causes of food refusal and poor feeding.

OBJECTIVES: Food refusal, poor feeding, and somatic symptoms such as vomiting, gagging, irritability and failure to thrive (FTT) are commonly found in both infantile feeding disorders (IFD) and common treatable medical conditions. Present diagnostic classifications for diagnosing IFD are complex and difficult to apply in daily practice, leading to underdiagnosis and delay in diagnosis of IFD. We attempted to identify parental and infantile behaviour patterns or symptoms that could help distinguish between organic or behavioural causes for these symptoms. METHODS: We screened 226 children with poor feeding. After exclusion criteria, we divided the remaining 151 into 2 groups. The nonorganic group (n=83) included patients with onset of symptoms before age 2, persistent food aversion longer than 1 month, and a response to behavioural intervention. The second group consisted of children (n=68) presenting with similar characteristics, who responded to medical or nutritional therapy in which a final diagnosis of gastro-esophageal reflux disease, milk allergy, or idiopathic or nutritional FTT was made. RESULTS: Poor intake, poor weight gain, or vomiting did not discriminate between organic and nonorganic causes. Factors indicating the presence of a behavioural cause included food refusal, food fixation, abnormal parental feeding practices, onset after a specific trigger, and presence of anticipatory gagging (P<0.0001 for all). CONCLUSIONS: Integration of a few structured questions regarding infant behaviour, parental feeding practices, infant symptoms, and triggers for the onset of symptoms may help clinicians distinguish between organic and nonorganic causes for food refusal or low intake FTT.

ACE2 expression and activity are enhanced during pregnancy.

In the current study, we investigated the expression and activity of ACE2 during pregnancy in normotensive and hypertensive rats, focusing on the relative contribution of the uterus and the placentas, the kidney serving as a reference. We used the Sabra rat model of salt-sensitive hypertension. We confirmed a systemic vasodilatory state during the third trimester of pregnancy, as evidenced by a reduction in blood pressure, both in normotensive and hypertensive rats. At the time that blood pressure was reduced, ACE2 was expressed abundantly in the reproductive organs. The relative levels of ACE2 mRNA in the pregnant animal were placenta > kidneys > or = uterus and of ACE2 activity kidney > placenta > uterus. In the uterus and the placenta, ACE2 expression was unaffected by strain, salt-loading, or the level of blood pressure. ACE2 activity in the uterus of the nonpregnant rat was not affected by any of these variables either, but during pregnancy increased in salt-loaded animals. When estimating the total contribution of the uterus to ACE2 mRNA and activity during pregnancy, we found that the amount of ACE2 mRNA increased in both strains irrespective of diet, but that ACE2 activity increased only in salt-loaded animals. We further estimated the relative total contribution of the uterus, placentas, and kidneys to ACE2 expression and activity during pregnancy by adjusting for mass and number of organs and found that the placentas were the major contributors, followed by the kidney and the uterus. We conclude that during pregnancy, the placentas, in particular, but also the uterus, constitute important sources of ACE2, in addition to its normal production in the kidney, leading to an estimated twofold increase in total ACE2 activity. These data are consistent the hypothesis that transient ACE2 overexpression and increased activity during pregnancy may be important in modulating systemic, as well as local hemodynamics in the uteroplacental unit.

Yeast linker histone Hho1p is required for efficient RNA polymerase I processivity and transcriptional silencing at the ribosomal DNA.

Nucleosome core particles in eukaryotes are linked by a stretch of DNA that is usually associated with a linker histone. Here, we show in yeast, that the presence of yeast linker histone Hho1p represses expression of a pol II transcribed gene (MET15) embedded in the rDNA. In vivo deletions of Hho1p sequences showed that the second globular domain is sufficient for that repression, whereas the presence of the N terminus is required for its derepression. In contrast, a run-on assay confirmed by a ChIP experiment showed that Hho1p is required for maximal pol I processivity during rDNA transcription. Psoralen accessibility experiments indicated that Hho1p is necessary for normal rDNA compaction. DNA array expression analysis comparing RNA transcripts in wild-type and hho1 strains before and after a heat-shock showed that Hho1p is necessary to achieve wild-type mRNA levels of transcripts that encode ribosomal components. Taken together, our results suggest that Hho1p is involved in rDNA compaction, and like core histones, is required for efficient rDNA transcription by pol I.