Child bereavement-what matters to the families. Part 2: The long term.

The death of a child is a devastating event. Families experience profound grief and loss immediately following the death, and this remains and evolves as time progresses. In this, the second in a series, we discuss the importance of longer term bereavement care and how continuing contact with healthcare can be navigated. As bereaved parents who are also doctors, we again share our experiences. The complex nature of parenting, supporting siblings or managing a pregnancy after loss are explored, and we look at the involvement of bereaved parents in developing bereavement services.

Child bereavement-what matters to the families. Part 1: Immediate and short-term communication and care.

The death of a child is a complex and hugely significant time for a family and community. Sophisticated but sensitive management by clinicians can have both short-term and long-term impacts on how families process the death. There is a paucity of guidance for optimal child bereavement care. A description of the child death review process including key legalities is provided here, and other essential aspects such as memory making, cultural aspects and sibling involvement are explored. Useful agencies and resources are also detailed. We, as both clinicians and bereaved parents, can uniquely provide an overview of the logistics of managing such a challenging event and highlight important subtleties in communication. We attempt, using our own experiences, to provide a framework and best inform future practice.

Transient Clozapine-induced Myocarditis Without Discontinuation of Medication: A Series of 2 Patients.

BACKGROUND: Clozapine, an antipsychotic medication used to treat treatment-refractory schizophrenia, has been associated with various dangerous side effects, including myocarditis. However, there have been few published cases reporting on patients with clozapine-induced myocarditis confirmed by cardiac magnetic resonance imaging or the management, treatment, and follow-up of these patients. METHODS: This report describes 2 cases of patients with treatment-refractory schizophrenia evidencing transient clozapine-induced myocarditis. Detailed information including laboratory values, imaging results, and clinical notes were gathered. FINDINGS: The 2 cases demonstrated differing manifestations of clozapine-induced myocarditis. Both cases showed that such myocarditis can be transient and can be treated clinically with close observation without discontinuation of clozapine. IMPLICATIONS: These cases show that clozapine-induced myocarditis is transient at times and can self-resolve without discontinuation of clozapine. These observations may suggest a change in clinical practice so that, with close observation, we can avoid risking psychiatric decompensation in select patients with a history of treatment-resistant schizophrenia.

The in vivo antioxidant action and the reduction of oxidative stress by boysenberry extract is dependent on base diet constituents in rats.

Dietary antioxidants are often defined by in vitro measures of antioxidant activity. Such measures are valid indicators of the antioxidant potential, but provide little evidence of activity as a dietary antioxidant. This study was undertaken to assess the in vivo antioxidant efficacy of a berry fruit extract by measuring biomarkers of oxidative damage to protein (carbonyls), lipids (malondialdehyde), and DNA (8-oxo-2'-deoxyguanosine urinary excretion) and plasma antioxidant status (antioxidant capacity, vitamin E) in rats when fed basal diets containing fish and soybean oils, which are likely to generate different levels of oxidative stress. Boysenberry (Rubus loganbaccus x baileyanus Britt) extract was used as the dietary antioxidant. The basal diets (chow, synthetic/soybean oil, or synthetic/fish oil) had significant effects on the biomarkers of oxidative damage and antioxidant status, with rats fed the synthetic/fish oil diet having the lowest levels of oxidative damage and the highest antioxidant status. When boysenberry extract was added to the diet, there was little change in 8-oxo-2'-deoxyguanosine excretion in urine, oxidative damage to proteins decreased, and plasma malondialdehyde either increased or decreased depending on the basal diet. This study showed that boysenberry extract functioned as an in vivo antioxidant and raised the antioxidant status of plasma while decreasing some biomarkers of oxidative damage, but the effect was highly modified by basal diet. Our results are further evidence of complex interactions among dietary antioxidants, background nutritional status as determined by diet, and the biochemical nature of the compartments in which antioxidants function.

Cultivar and growing region determine the antioxidant polyphenolic concentration and composition of apples grown in New Zealand.

Evidence suggests that increasing consumption of fruit and vegetables contributes to improved health and well-being by providing protection from diseases including various cancers and cardiovascular disease. Although there is uncertainty about which components generate this effect, an attractive hypothesis is that the antioxidants are at least partly responsible. We measured the polyphenolic concentrations in 10 different apple cultivars grown commercially in New Zealand, each sourced from three different geographic regions. Our results showed that the concentration of polyphenolics varied among the apple cultivars, with Pacific Queen containing 2.7 times the amount of polyphenolics found in Cox's Orange. Furthermore, there were significant differences in polyphenolic concentrations in fruit from different regions for some cultivars but not for others. We also measured the polyphenolic concentrations in apple skin and flesh and found that on average 46% of the polyphenolics in whole apples were in the skin. Essentially all of the flavonols (quercetin derivatives) were present in the skin. To maximize the intake of apple polyphenols, it is necessary to consume apples of cultivars with high polyphenolic concentrations such as Pacific Queen and include the skin. Our results also showed that there is potential for promoting apple fruit from specific geographical regions because they contained elevated concentrations of antioxidant polyphenolic compounds.

Anthocyanin glycosides from berry fruit are absorbed and excreted unmetabolized by both humans and rats.

Anthocyanins, the red/blue pigments found in plants, are polyphenolic compounds consumed by humans and are part of a normal diet. Recent studies have shown that anthocyanins have substantial bioactivity including antioxidant activity and therefore may have beneficial effects on human health. Anthocyanins are a group of over 500 compounds of diverse structures containing different core phenolic aglycons and conjugated with sugars in a variety of glycosylation patterns. In this study, we have investigated the bioabsorption of 15 anthocyanins with structures containing different aglycons and conjugated sugars extracted from blueberry, boysenberry, black raspberry, and blackcurrant in both humans and rats. Intact and unmetabolized anthocyanins were detected in urine of rats and humans following dosing for all molecular structures investigated, thus demonstrating that anthocyanins with diverse molecular structure and from different dietary sources are bioavailable at diet relevant dosage rates. In addition, the relative concentrations of anthocyanins detected in urine following dosing varied, indicating that differences in bioavailability are due to variations in chemical structure. Our results suggest that the nature of the sugar conjugate and the phenolic aglycon are both important determinants of anthocyanin absorption and excretion in rats and humans.

An integrated physical and genetic map of the rice genome.

Rice was chosen as a model organism for genome sequencing because of its economic importance, small genome size, and syntenic relationship with other cereal species. We have constructed a bacterial artificial chromosome fingerprint-based physical map of the rice genome to facilitate the whole-genome sequencing of rice. Most of the rice genome ( approximately 90.6%) was anchored genetically by overgo hybridization, DNA gel blot hybridization, and in silico anchoring. Genome sequencing data also were integrated into the rice physical map. Comparison of the genetic and physical maps reveals that recombination is suppressed severely in centromeric regions as well as on the short arms of chromosomes 4 and 10. This integrated high-resolution physical map of the rice genome will greatly facilitate whole-genome sequencing by helping to identify a minimum tiling path of clones to sequence. Furthermore, the physical map will aid map-based cloning of agronomically important genes and will provide an important tool for the comparative analysis of grass genomes.