The long-term clinical benefit and effectiveness of switching to once-daily quetiapine extended release in patients with schizophrenia.

OBJECTIVE: To evaluate the long-term clinical benefit and effectiveness of switching to once-daily quetiapine extended release (XR) from an oral antipsychotic in patients with schizophrenia. Reasons for switching included insufficient efficacy, tolerability, and/or non-acceptability. The primary endpoint was the percentage of patients achieving an improvement in Clinical Global Impression - Clinical Benefit (CGI-CB) scale scores. RESEARCH DESIGN AND METHODS: A 24-week, international, multicentre, open-label, prospective study ( www.clinicaltrials.gov : NCT00640601). After a 7-14 day enrolment period (depending whether prior antipsychotic mono- or combination therapy), all patients received quetiapine XR 300 mg once daily (day 1), 600 mg/day (day 2), 600-800 mg/day (day 3) and 400-800 mg/day thereafter, with down-titration and discontinuation of prior antipsychotic by day 4. RESULTS: A total of 62% of patients completed the study and 56.9% (LOCF, ITT) achieved a significant improvement in CGI-CB (95% CI [0.51, 0.63]; p = 0.02). Switches due to insufficient efficacy showed a significant improvement (60%, 95% CI [0.51, 0.68]; p = 0.02), compared to 54.4% ([0.44, 0.64]; p = 0.38) and 52.4% ([0.36, 0.68]; p = 0.76) of switches due to insufficient tolerability and non-acceptability respectively (both p = ns). Patients previously on olanzapine and quetiapine IR showed a significant improvement in CGI-CB (62.6% [p = 0.02] and 61.2% [p = 0.04], respectively). Somnolence (18.0%) and dizziness (14.6%) were the main adverse events. Anticholinergic use decreased from 7.1 to 2.7%. Overall mean weight gain was 0.4 kg; 12.9% of patients experienced a weight gain of ≥7% and 15% experienced a clinically relevant shift in triglycerides from baseline. CONCLUSIONS: A majority of patients switched from other antipsychotics to quetiapine XR experienced clinical benefit. This was supported by all other efficacy outcomes regardless of the reason for switching. Safety data confirmed quetiapine XR was safe and well tolerated. The open-label design and lack of a placebo group represent limitations.

Scission of polysaccharides by peroxidase-generated hydroxyl radicals.

Cell-wall polysaccharides can be broken down non-enzymatically in vitro by scission of backbone bonds in a Fenton reaction system producing hydroxyl radicals (OH*) (Fry, S.C. (1998). Biochemical Journal, 332, 507-515). OH* can also be generated enzymatically from O2 by horseradish peroxidase (HRP) in a complex reaction cycle involving NADH or dihydroxyfumarate (DHF) as reducing substrate (Chen, S.-X., & Schopfer, P. (1999). European Journal of Biochemistry, 260, 726-735). Based on these recent findings the possibility that HRP can be used to degrade cell-wall polysaccharides in vitro was investigated. The production of OH* from O2 by HRP in the presence of NADH or DHF was confirmed by EPR spectroscopy using 5,5-dimethyl-1-pyrroline-N-oxide as a spin trap. Chemical scission of polysaccharides (dextran, pectin, xyloglucan) by HRP-generated OH* was demonstrated using a viscometric assay. The reaction could be inhibited by an array of OH* scavengers, confirming the involvement OH* as the causative agent for macromolecule cleavage. The significance of these findings for the biochemical function of peroxidase in cell-wall loosening processes underlying cell expansion and related physiological processes is discussed.

[Skateboards: a dangerous toy? (author's transl)]. / Rollbrett--gefährliches Spielzeug?

Eighteen persons (average age 12.4 years) with injuries from skateboard accidents were admitted between 1 March to 5 June, 1977--4.4% of all accidents and 7.5% of all sports accidents treated during this interval. These kinds of accidents are now in fourth place as to frequency, after accidents during play (81), bicycling (45), football (35) and motorcycling (28). To avoid skateboard accidents attention must be paid to technically high-grade equipment, reasonable skill and training, and restriction of skateboarding to enclosed areas, as well as protective clothing.

Medullary nailing according to Swiss study group principles.

Internal fixation of long tubular bone fractures by intramedullary nailing has become established worldwide as an efficient and successful procedure, besides the methods of interfragmentary compression, buttress and adaptation, intramedullary splinting and stabilization constitute the basic principles of osteosynthesis. Improvements in knowledge of equipment, indications, technique, aftercare and possible complications have increased the success of intramedullary nailing. The results of 1,905 intramedullary nailings of femur and tibia demonstrate that with other methods of osteosynthesis poor results usually are attributable to an inappropriate indication and/or a faulty surgical technique. Occasionally a failure may stem from the surgeon's technical incompetence or inexperience.

[Osteosynthesis and simultaneous anchorage of a plastic hip cup in an unstable acetabulum (author' transl)]. / Zur Osteosynthese und gleichzeitigen Verankerung einer Hüftprothesenpfanne bei instabilem Acetabulum.

Attempts at total hip replacement in the presence of unstable acetabula--which may be caused by a recent fracture or pseudarthrosis--are doomed to failure if conventional implantation technics are used. Such attempts lead inevitably to a rapid loosening of the cup. This article describes a newly developed implant which simultaneously re-establishes acetabular stability while solidly anchoring the cup. Use of this implant contributes to early patient mobilization and undisturbed healing of fractures and pseudarthroses.

[Spontaneous fractures and tumors (author's transl)]. / 40. Spontanfrakturen und tumoren

During childhood, pathologic fractures are found in systemic diseases of the skeleton (e.g. osteogenesis imperfecta or rachitis), but especially when bone tumors or tumorlike changes are present. Conservative measures such as continuous traction and application of a plaster cast lead to healing of the fracture only in a limited number of cases. Treatment of benign and potentially malignant and tumors and of tumorlike growths by excochleation and by resection and subsequent filling of the defect with autologous spongiosa and in some cases metallic fixation respectively has proved useful. The surgical treatment of malignant tumors depends on the king of tumor and its localization.