Self-assessed remission rates after electroconvulsive therapy of depressive disorders.

BACKGROUND: Electroconvulsive therapy (ECT) effectively treats severe depression, but not all patients remit. The aim of the study was to identify clinical factors that associate with ECT-induced remission in a community setting. METHODS: Depressed patients who underwent ECT in 2011-2014 were identified from the Swedish National Quality Register for ECT. Remission was defined as self-rated Montgomery-Åsberg Depression Rating Scale scores of 0-10 after ECT. Other registers provided data on previous antidepressant use, comorbidities, and demographics. RESULTS: Of 1671 patients fulfilling the inclusion criteria, 42.8% achieved remission. Older age, education length over 9 years, psychotic symptoms, shorter duration of preceding antidepressant use, pulse width stimulus≥0.50ms, absence of substance use disorders, anxiety diagnosis, lamotrigine, and benzodiazepines, were associated with remission. CONCLUSIONS: This study shows that psychotic subtype of depression and older age are clinically relevant predictors of a beneficial ECT effect. Additionally, ECT outcomes can be further improved by optimizing the treatment technique and concomitant medication.

Methicillin-resistant Staphylococcus aureus with mecC: a description of 45 human cases in southern Sweden.

In 2011, a novel mecA gene homologue, mecC, was reported in isolates from both humans and dairy cattle. The epidemiology of mecC methicillin-resistant Staphylococcus aureus (MRSA) in humans is not yet well known. In this retrospective study, we present the epidemiology of human clinical cases with mecC MRSA detected in the southern part of Sweden during the period 2005-2014. A total of 45 patients with an isolate positive for mecC MRSA were included in the study. Twenty-six isolates were found before 2012 and were retrospectively tested for mecC. Nineteen isolates were detected in 2012-2014 through routine testing. Culture results, resistance patterns, Panton-Valentine leukocidin (PVL) genes, and spa types were collected from the Clinical Microbiology Laboratory. Epidemiological data were received from the database at the Regional Centre for Communicable Disease Control and the patient's medical files. The majority of the patients with mecC MRSA were of Swedish origin, had underlying diseases, and lived in rural areas. The median age was 60 years. Of the mecC MRSA, 76 % belonged to spa types t373 and t843. The median minimum inhibitory concentration (MIC) value for oxacillin was 16 mg/L (1-64 mg/L) and only one isolate was resistant to other classes of antibiotics. The most common type of infection was skin and soft tissue infections, most often in an existing skin lesion. The patients with mecC MRSA were colonized for a short time and gave rise to few secondary cases. mecC MRSA in our region appears to have a domestic origin and mainly affects patients with underlying diseases or patients with an existing skin lesion. Our data indicate that it could be a poor colonizer.

Reliability testing of oxaliplatin-associated neurotoxicity questionnaire (OANQ), a pilot study.

PURPOSE: The purpose of this study was to test the reliability of the Swedish version of the Oxaliplatin-Associated Neurotoxicity Questionnaire (OANQ) administrated throughout a self-reported mobile phone-based system, a pilot study. METHODS: Twenty-three patients from two university hospitals and two regional hospitals who had been treated with oxaliplatin were included through purposive sampling between autumn 2013 to autumn 2014. A test-retest was performed through a mobile phone-based system, with a recall period of 1 h to determine the reliability of the questionnaire. RESULTS: Internal consistency was strong for the three domains of the scale (α > 0.840). The statistical analyses for the test-retest indicated that the OANQ was stable. Intraclass correlation (ICC) for symptom items and effect on daily activities items showed an overall excellent reproducibility at 69 and 83 %, respectively. The weighted kappa for symptom items and daily activities items showed an overall almost perfect agreement at 59 and 52 %, respectively. A paired samples t test did not reveal any significant differences between the two measures. CONCLUSIONS: The OANQ was tested and considered a reliable assessment for capturing the oxaliplatin-induced peripheral neurotoxicity (OIPN) in patients receiving oxaliplatin. However, further reliability testing of the OANQ is needed.

A novel modeling tool with multi-stressor functionality for organic contaminant transport and fate in the Baltic Sea.

The coupled physical-biogeochemical model BALTSEM, previously used to assess nutrient/carbon cycles and eutrophication in the Baltic Sea, has been expanded to include algorithms for calculations of organic contaminant environmental transport and fate. This novel model version (BALTSEM-POP) is evaluated for polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins/dibenzofurans (PCDD/Fs) and hexachlorobenzene (HCB) in Baltic Sea surface water and sediment. Modeled dissolved concentrations are usually within a factor of 2-4 of observed concentrations, however with larger deviations for furans. Calculated concentrations in particulate organic matter are less accurate (within factors of 1-700), likely due to errors in estimated pelagic biomass, particulate matter-water partitioning, and large natural variability in field data. Concentrations in sediments are usually predicted within a factor of 6. The good performance of the model illustrates its usefulness for exploration of contaminant fate in response to variations in nutrient input and climatic conditions in the Baltic Sea marine environment.

Epidemiology of MRSA in southern Sweden: strong relation to foreign country of origin, health care abroad and foreign travel.

All notified MRSA cases in Skåne County have been followed since 2000. We have investigated the MRSA epidemiology over time, method of acquisition, whether some spa types are more prone to spread, and/or cause more infections, and the connection between spa type and country of acquisition/origin. All cases between 2000 and 2010 were included. Infection or colonization and the presence of PVL genes were noted. The spa types of the index cases were correlated with community or healthcare acquisition, proportion of MRSA-positive household contacts, country of origin of families and country of acquisition of MRSA. The number of cases increased from 31 in 2000 to 315 in 2010. Most cases were community-acquired and the median age was 30 years. Thirty-two per cent of the MRSA cases were found because of a clinical infection. Of the household contacts 35 % were MRSA-positive. Only 24 % of the MRSA cases were both of Swedish origin and had contracted MRSA in Sweden. An association between spa type and certain regions of acquisition/origin was noted. Spa types t044, t002 and t008 were the most predominant strains. PVL-positive spa types t008, t019 and t044 caused more skin infections than the other spa types. Our results support screening for MRSA in patients with health care contacts abroad, culturing of patients with skin infections contracted outside Sweden and performing contact tracing among household members. Knowledge of spa type might give guidance in the process of contact tracing. Eradication treatment of MRSA spa types causing more skin infections may be warranted.

The requirements of a specialist Breast Centre.

INTRODUCTION: In recognition of the advances and evidence based changes in clinical practice that have occurred in recent years and taking into account the knowledge and experience accumulated through the voluntary breast unit certification programme, Eusoma has produced this up-dated and revised guidelines on the requirements of a Specialist Breast Centre (BC). METHODS: The content of these guidelines is based on evidence from the recent relevant peer reviewed literature and the consensus of a multidisciplinary team of European experts. The guidelines define the requirements for each breast service and for the specialists who work in specialist Breast Centres. RESULTS: The guidelines identify the minimum requirements needed to set up a BC, these being an integrated Breast Centre, dealing with a sufficient number of cases to allow effective working and continuing expertise, dedicated specialists working with a multidisciplinary approach, providing all services throughout the patients pathway and data collection and audit. It is essential that the BC also guarantees the continuity of care for patients with advanced (metastatic) disease offering treatments according to multidisciplinary competencies and a high quality palliative care service. The BC must ensure that comprehensive support and expertise may be needed, not only through the core BC team, but also ensure that all other medical and paramedical expertise that may be necessary depending on the individual case are freely available, referring the patient to the specific care provider depending on the problem. CONCLUSIONS: Applying minimum requirements and quality indicators is essential to improve organisation, performance and outcome in breast care. Efficacy and compliance have to be constantly monitored to evaluate the quality of patient care and to allow appropriate corrective actions leading to improvements in patient care.

Rehabilitation between institutional and non-institutional forensic psychiatric care: important influences on the transition process.

All patients cared for in forensic psychiatric care (FPC) have some kind of psychiatric disorder and most of them have committed one or more criminal acts. One part of the patient's rehabilitation is the transition from institutional to non-institutional FPC, but a number of patients do not succeed. The aim of this study was to elucidate different caregivers' experiences of aspects that influence the patients' ability to manage this rehabilitation. A qualitative approach was chosen. Data were collected by interviews in two focus groups, each group comprising of six caregivers representing both institutional and non-institutional FPC. The transcribed interviews were analysed using a qualitative content analysis. Important aspects influencing the patients' transition described were a well-planned care plan, together with a suitable non-institutional dwelling and a tailored occupation. Other important areas were having a well-functioning and trusting social network and a good relationship with a contact person/advocate. A major barrier to a successful transition was whether the patients managed their own finances or not. It was stated that it is important that the patients participate in the care and that different authorities create individual conditions and flexible solutions. All of these factors are important to focus on when caring for patients during their stay in the institutional FPC.

Antibody responses in patients with invasive Staphylococcus aureus infections.

Correlation between antibody response and clinical outcome in Staphylococcus aureus bacteremia has yielded conflicting results. Immunization schedules have failed in clinical trials. Is the humoral response toward S. aureus of protective nature? A prospective study was performed in patients with invasive S. aureus (ISA) infections during the period 2003-2005. The antibody levels were determined at the beginning and at the end of treatment and one month later (n = 96, n = 71, and n = 51, respectively). As controls, 115 healthy individuals were used. A quantitative enzyme-linked immunosorbent assay (ELISA) against eight purified antigens was performed. Bacterial isolates were grouped as to the production of alpha-toxin, agr type, and pulsed-field gel electrophoresis (PFGE) type. Large variations were seen in the antibody levels. The levels in the second sample were the highest. A correlation between agr group, PFGE group, alpha-toxin production, and initial antibody levels was observed. Patients with fatal outcome displayed lower initial antibody levels to all antigens and significantly so in regard to teichoic acid, lipase, enterotoxin A, and scalded skin syndrome toxin. In episodes with complicated bacteremia, initial significantly low levels to teichoic acid and lipase were registered. Low initial antibody levels against several antigens were associated with increased mortality and complicated bacteremia in invasive S. aureus infections. Bacterial properties, strain, and toxin production affected the antibody response.

Outcome for invasive Staphylococcus aureus infections.

We report a survey of invasive Staphylococcus aureus (ISA) infections concerning outcome variables such as mortality, recurrence and residual symptoms. A prospective, population-based study of all cases of ISA was conducted in the catchment area of Skaraborg Hospital (population 255,109) in western Sweden during the period from 1st March 2003 to 28th February 2005. One hundred and fifty-seven patients were included. Recurrences were seen in 13 cases (9.3%). Thirty patients (19.1%) died during the first 28 days. Mortality rates for complicated bacteraemia and severe sepsis were 32% and 54%, respectively. Older patients (>65 years of age), patients with concomitant heart disease and patients with endovascular infections all suffered higher mortality. Line-associated infections had a higher recurrence rate. Residual symptoms were common, with 34% of the living patients reporting incomplete recovery. Accessory gene regulator (agr) type within the bacteria did not affect disease presentation. We conclude that ISA infections are of major medical importance, with high rates of mortality (19.1%), recurrence (9.3%) and residual functional impairment (34%).

Broadband attosecond pulse shaping.

We use semiconductor (Si) and metallic (Al, Zr) transmission filters to shape, in amplitude and phase, high-order harmonics generated from the interaction of an intense titanium sapphire laser field with a pulsed neon gas target. Depending on the properties of the filter, the emitted attosecond pulses can be optimized in bandwidth and/or pulse length. We demonstrate the generation of attosecond pulses centered at energies from 50 to 80 eV, with bandwidths as large as 45 eV and with pulse durations compressed to 130 as.

MRSA in children from foreign countries adopted to Swedish families.

AIM: To determine if children adopted to Swedish families from countries with a high carrier rate of methicillin-resistant Staphylococcus aureus (MRSA) are infected or colonized with MRSA. METHODS: From January 2000 to May 2005, 23 adopted children from 6 countries were examined for MRSA at the University hospital in Lund after their arrival in Sweden. RESULTS: Thirteen of the 23 children (57%) were MRSA positive with a median age of the children at the time MRSA was detected of 6 (range 3-16) months. All MRSA positive children had a history of hospitalization in their native country before arriving in Sweden. The throat was the most frequent and persistent site where MRSA was seen while in sites such as the anterior nares and perineum, MRSA was found more intermittently. The MRSA-positive children were adopted into 13 Swedish families and in 3 families, 6 of 10 family members became MRSA positive. CONCLUSION: Children adopted from foreign countries to Swedish families and with a history of hospitalization in their native country were commonly colonized with MRSA. The throat was the most frequent site colonized and transmission of MRSA from adopted children to other family members occurred.

Attosecond pulse trains generated using two color laser fields.

We investigate the spectral and temporal structure of high harmonic emission from argon exposed to an infrared laser field and its second harmonic. For a wide range of generating conditions, trains of attosecond pulses with only one pulse per infrared cycle are generated. The synchronization necessary for producing such trains ensures that they have a stable pulse-to-pulse carrier envelope phase, unlike trains generated from one color fields, which have two pulses per cycle and a pi phase shift between consecutive pulses. Our experiment extends the generation of phase stabilized few cycle pulses to the extreme ultraviolet regime.

Reconstruction of attosecond pulse trains using an adiabatic phase expansion.

We propose a new method to reconstruct the electric field of attosecond pulse trains. The phase of the high-order harmonic emission electric field is Taylor expanded around the maximum of the laser pulse envelope in the time domain and around the central harmonic in the frequency domain. Experimental measurements allow us to determine the coefficients of this expansion and to characterize the radiation with attosecond accuracy over a femtosecond time scale. The method gives access to pulse-to-pulse variations along the train, including the timing, the chirp, and the attosecond carrier envelope phase.

Early expression of endomucin on endothelium of the mouse embryo and on putative hematopoietic clusters in the dorsal aorta.

Endomucin is a recently identified sialomucin that is specifically expressed on endothelium of the adult mouse. Here, we have analysed the expression of endomucin during development of the vascular system by immunohistochemistry by using three monoclonal antibodies (mAb). We demonstrate that two of the mAb, V.5C7 and V.1A7, recognize epitopes on the nonglycosylated protein, because they recognize the antigen when it is synthesized as a bacterial fusion protein and when it is in vitro translated in a membrane-free reticulocyte lysate. During in vitro differentiation of embryonic stem cells to endothelial cells, endomucin is expressed at day 6 after onset of differentiation, 1 day later than PECAM-1. During differentiation of the mouse embryo, endomucin is first detected at E8.0 in all embryonic blood vessels detectable at this stage but is absent in blood islands of the yolk sac. Analysing the paraaortic-splanchnopleura (P-SP) region and the aorta-gonad-mesonephros (AGM) region as sites of intraembryonic hematopoiesis, we found that endothelium of the dorsal aorta is brightly positive for endomucin at E8.5-9.0 and at E11.5. At later stages and in the adult aorta, endothelial staining is strongly reduced and confined to focal areas. Cell clusters associated with the luminal surface of the endothelium of the dorsal aorta could be stained for endomucin and for CD34. At a later stage (E15.5) single leukocytes in the lumen of large venules were stained for endomucin. We conclude that endomucin is an early endothelial-specific antigen that is also expressed on putative hematopoietic progenitor cells.

Mice lacking desmocollin 1 show epidermal fragility accompanied by barrier defects and abnormal differentiation.

The desmosomal cadherin desmocollin (Dsc)1 is expressed in upper epidermis where strong adhesion is required. To investigate its role in vivo, we have genetically engineered mice with a targeted disruption in the Dsc1 gene. Soon after birth, null mice exhibit flaky skin and a striking punctate epidermal barrier defect. The epidermis is fragile, and acantholysis in the granular layer generates localized lesions, compromising skin barrier function. Neutrophils accumulate in the lesions and further degrade the tissue, causing sloughing (flaking) of lesional epidermis, but rapid wound healing prevents the formation of overt lesions. Null epidermis is hyperproliferative and overexpresses keratins 6 and 16, indicating abnormal differentiation. From 6 wk, null mice develop ulcerating lesions resembling chronic dermatitis. We speculate that ulceration occurs after acantholysis in the fragile epidermis because environmental insults are more stringent and wound healing is less rapid than in neonatal mice. This dermatitis is accompanied by localized hair loss associated with formation of utriculi and dermal cysts, denoting hair follicle degeneration. Possible resemblance of the lesions to human blistering diseases is discussed. These results show that Dsc1 is required for strong adhesion and barrier maintenance in epidermis and contributes to epidermal differentiation.

Functional consequences of integrin gene mutations in mice.

Integrins are cell-surface receptors responsible for cell attachment to extracellular matrices and to other cells. The application of mouse genetics has significantly increased our understanding of integrin function in vivo. In this review, we summarize the phenotypes of mice carrying mutant integrin genes and compare them with phenotypes of mice lacking the integrin ligands.

Neonatal ingestion of IgG-containing milk increases the survival of adoptively transferred B-lineage cells in B cell-deficient mice.

This study shows that neonatal ingestion of immunoglobulin-containing milk increases the survival of adoptively transferred B-lineage cells in non-irradiated B cell-deficient (mu-/-) mice. Neonatal mu-/- mice were either transferred to lactating mu+/+ foster dams, allowing them to suckle IgG-containing milk, or were kept with their mu-) dams, without IgG in the milk. After adoptive transfer of spleen cells as adults, serum-IgG levels, numbers of plasma cells, T and B cells in spleen and bone marrow were determined. The results showed that the mice which had received milk-IgG had significantly higher levels of serum-IgG and splenic B cells, as well as a higher number of Ig-secreting cells in spleen and bone marrow. This indicates that the mice might have been tolerised against IgG as neonates, if allowed to ingest Ig-containing milk. There is, however, a possibility that B cells in the milk may also contribute to the observed tolerising effect. In summary, the results suggest that 'cross-fostering' could be a suitable method to facilitate the long-term reconstitution of B- and plasma cell numbers in non-irradiated B cell-deficient mice.

Identification of proteins from Escherichia coli using two-dimensional semi-preparative electrophoresis and mass spectrometry.

Escherichia coli is a gram-negative bacterium that causes sepsis and infections of the nervous system, and the digestive and urinary tracts. The availability of the complete nucleotide sequence encoding the E. coli K-12 genome has made this organism an excellent model for proteomic studies. Semi-preparative two-dimensional electrophoresis, including liquid phase isoelectric focusing (IEF), one-dimensional sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE) and gel elution, have for the first time been used in combination with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOFMS), electrospray tandem mass spectrometry and database searching for rapid separation of proteins from a uropathogenic strain of E. coli. The identity of 30 proteins, including the membrane protein nmpC, was obtained using this approach.

Distinct roles for dystroglycan, beta1 integrin and perlecan in cell surface laminin organization.

Dystroglycan (DG) is a cell surface receptor for several extracellular matrix (ECM) molecules including laminins, agrin and perlecan. Recent data indicate that DG function is required for the formation of basement membranes in early development and the organization of laminin on the cell surface. Here we show that DG-mediated laminin clustering on mouse embryonic stem (ES) cells is a dynamic process in which clusters are consolidated over time into increasingly more complex structures. Utilizing various null-mutant ES cell lines, we define roles for other molecules in this process. In beta1 integrin-deficient ES cells, laminin-1 binds to the cell surface, but fails to organize into more morphologically complex structures. This result indicates that beta1 integrin function is required after DG function in the cell surface-mediated laminin assembly process. In perlecan-deficient ES cells, the formation of complex laminin-1 structures is defective, implicating perlecan in the laminin matrix assembly process. Moreover, laminin and perlecan reciprocally modulate the organization of the other on the cell surface. Taken together, the data support a model whereby DG serves as a receptor essential for the initial binding of laminin on the cell surface, whereas beta1 integrins and perlecan are required for laminin matrix assembly processes after it binds to the cell.

Tie-1-directed expression of Cre recombinase in endothelial cells of embryoid bodies and transgenic mice.

Tissue-specific gene inactivation using the Cre-loxP system has become an important tool to unravel functions of genes when the conventional null mutation is lethal. We report here the generation of a transgenic mouse line expressing Cre recombinase in endothelial cells. In order to avoid the production and screening of multiple transgenic lines we used embryonic stem cell and embryoid body technology to identify recombinant embryonic stem cell clones with high, endothelial-specific Cre activity. One embryonic stem cell clone that showed high Cre activity in endothelial cells was used to generate germline chimeras. The in vivo efficiency and specificity of the transgenic Cre was analysed by intercrossing the tie-1-Cre line with the ROSA26R reporter mice. At initial stages of vascular formation (E8-9), LacZ staining was detected in almost all cells of the forming vasculature. Between E10 and birth, LacZ activity was detected in most endothelial cells within the embryo and of extra-embryonic tissues such as yolk sac and chorioallantoic placenta. Ectopic expression of Cre was observed in approximately 12-20% of the adult erythroid, myeloid and lymphoid cells and in subregions of the adult brain. These results show that the tie-1-Cre transgenic strain can efficiently direct deletion of floxed genes in endothelial cells in vivo.