Demographic and clinical features as predictors of clozapine response in patients with schizophrenia spectrum disorders: A systematic review and meta-analysis.

OBJECTIVES: Clozapine (CLZ) is prescribed to (relatively) treatment-resistant patients with schizophrenia spectrum disorders. Currently, it is unknown what factors predict response to CLZ. Therefore, we performed meta-analyses to identify predictors of CLZ response, hence aiming to facilitate timely and efficient prescribing of CLZ. METHODS: A systematic search was performed in 'Pubmed' and 'Embase' until 1 January 2019. Articles were eligible if they provided data on predictors of CLZ response measured demographic and clinical factors at baseline or biochemical factors at follow-up in schizophrenia spectrum disorder patients. RESULTS: A total of 34 articles, total number of participants = 9386; N unique = 2094, were eligible. Factors significantly associated with better CLZ response were: lower age, lower PANSS negative score and paranoid schizophrenia subtype. CONCLUSION: The results of our meta-analyses suggest that three baseline demographic and clinical features are associated with better clozapine response, i.e. relatively young age, few negative symptoms and paranoid schizophrenia subtype. These variables may be taken into account by clinicians who consider treating a specific patient with CLZ.

Three-body nature of N(*) and Δ(*) resonances from sequential decay chains.

The Nπ^{0}π^{0} decays of positive-parity N^{*} and Δ^{*} resonances at about 2 GeV are studied at ELSA by photoproduction of two neutral pions off protons. The data reveal clear evidence for several intermediate resonances: Δ(1232), N(1520)3/2^{-}, and N(1680)5/2^{+}, with spin parities J^{P}=3/2^{+}, 3/2^{-}, and 5/2^{+}. The partial wave analysis (within the Bonn-Gatchina approach) identifies N(1440)1/2^{+} and the N(ππ)_{S wave} (abbreviated as Nσ here) as further isobars and assigns the final states to the formation of nucleon and Δ resonances and to nonresonant contributions. We observe the known Δ(1232)π decays of Δ(1910)1/2^{+}, Δ(1920)3/2^{+}, Δ(1905)5/2^{+}, Δ(1950)7/2^{+}, and of the corresponding spin-parity series in the nucleon sector, N(1880)1/2^{+}, N(1900)3/2^{+}, N(2000)5/2^{+}, and N(1990)7/2^{+}. For the nucleon resonances, these decay modes are reported here for the first time. Further new decay modes proceed via N(1440)1/2^{+}π, N(1520)3/2^{-}π, N(1680)5/2^{+}π, and Nσ. The latter decay modes are observed in the decay of N^{*} resonances and at most weakly in Δ^{*} decays. It is argued that these decay modes provide evidence for a 3-quark nature of N^{*} resonances rather than a quark-diquark structure.

[The impact of sleep endoscopy for obstructive sleep-disordered breathing in children and adolescents]. / Bedeutung der Schlafendoskopie bei obstruktiv-schlafbezogener Atmungsstörung im Kindes- und Jugendalter.

OBJECTIVE: Studies on the surgical treatment of OSAS in adults have shown an improved outcome after targeted therapy by drug-induced sleep endoscopy (DISE). So far, only a few studies have focused on this method in children. The aim of this study is to evaluate the impact of DISE for children with obstructive sleep-disordered breathing and to determine the influence of DISE on treatment recommendations. SUBJECTS AND METHODS: The medical records of children (n=25) who underwent polysomnography and DISE between 05/2012 and 12/2013 were retrospectively reviewed. The subjects were divided into an UARS (upper airway resistance syndrome)/mild OSAS group (AHI<5; n=10) and a moderate/severe OSAS group (AHI≥5; n=15). RESULTS: The oropharynx was the most common site of obstruction. Prevalence of complete obstruction at the oropharynx was significantly higher in moderate or severe OSAS (p=0.02). The obstruction pattern of the velopharynx was significantly associated with the size of the adenoids (p=0.02), but tonsil and adenoid size were not related to the severity of OSAS. 71% of children with grade IV tonsils showed complete obstruction of the oropharynx. After DISE, the initial management plan changed in 5 patients (20%). CONCLUSION: DISE is a promising technique to identify sites of obstruction in children with OSAS and to guide treatment decisions. Further studies are needed to predict persistent OSAS based on this tool.

[Social integration and its relevance for quality of life after laryngectomy]. / Soziale Integration und deren Bedeutung für die Lebensqualität nach Laryngektomie.

BACKGROUND: Social networks and social participation generally have positive effects on health. Yet, little is known about how patients after total laryngectomy (TLE) are integrated into the society. Aim of this study was to investigate how patients are socially integrated after a TLE and if social integration is associated with certain areas of quality of life. PATIENTS AND METHODS: In a longitudinal multi-centred study 161 laryngectomees were interviewed 1 year after the total laryngectomy. Social integration was measured on the basis of an index formed by the questionnaire "Psychosocial Adjustment after Laryngectomy" and questions about social support. To assess quality of life, we used the questionnaire from the European Organisation for Research and Treatment of Cancer EORTC QLQ-C30. RESULTS: 58% of all patients are well integrated 1 year after surgery. Well integrated persons have less problems in different components of quality of life. They report higher levels of social (OR 4.07; CI: 1.96-8.47) and role functioning (OR 3.59; CI: 1.61-8.02). Successful social integration is also associated with higher emotional well-being (OR 8.57; CI: 3.59-20.46). CONCLUSIONS: There is evidence that 1 year after TLE only about half of the patients feel socially integrated. Because of the negative association of poor social integration with social, emotional and role functioning, patients should be supported in their attempts to take actively part in social life.

Self-diffusion of lithium in LiAlSi2O6 glasses studied using mass spectrometry.

In order to improve our understanding of the transport mechanisms of lithium in glasses, we have performed diffusion and ionic conductivity studies on spodumene composition (LiAlSi(2)O(6)) glasses. In diffusion couple experiments pairs of chemically identical glasses with different lithium isotopy (natural Li vs pure (7)Li) were processed at temperatures between 482 and 732 K. Profiles of lithium isotopes were measured after the diffusion runs innovatively applying femtosecond UV laser ablation combined with inductively coupled plasma mass spectrometry (LA ICP-MS). Self-diffusion coefficients of lithium in the glasses were determined by fitting the isotope profiles. During some of the diffusion experiments the electrical conductivity of the samples was intermittently measured by impedance spectrometry. Combining ionic conductivity and self-diffusivity yields a temperature-independent correlation factor of ~0.50, indicating that motions of Li ions are strongly correlated in this type of glasses. Lithium self-diffusivity in LiAlSi(2)O(6) glass was found to be very similar to that in lithium silicate glasses although Raman spectroscopy demonstrates structural differences between these glasses; that is, the aluminosilicate is completely polymerized while the lithium silicate glasses contain large fractions of nonbridging oxygen.

The prevalence of endocrinopathic laminitis among horses presented for laminitis at a first-opinion/referral equine hospital.

Endocrinopathic causes of laminitis may be a common underlying causative pathogenesis in first-opinion or field cases presenting with laminitis, as opposed to laminitis produced in inflammatory research models. This study aimed to determine whether evidence of an underlying endocrinopathy was present in horses presented for laminitis to a first-opinion/referral veterinary teaching hospital. A second aim was to compare the signalment of horses and ponies with laminitis with the equine hospital population during the same period. All horses presenting for laminitis at Helsinki University Equine Teaching Hospital, Finland, over a 16-month period were examined for an underlying endocrinopathy. Horses presenting for laminitis were compared with the hospitalized population over the same period. There were 36 horses presented for laminitis, and evidence of endocrinopathy was present in 89%. Of the horses showing an underlying endocrinopathy, one-third had a diagnosis of pituitary pars intermedia dysfunction, and two-thirds showed basal hyperinsulinemia indicative of insulin resistance, without evidence of hirsutism. Phenotypic indicators of obesity were present in 95% of horses with basal hyperinsulinemia without hirsutism. Compared with the hospital population during the same period, horses with laminitis associated with an underlying endocrinopathy were significantly older and more likely to be pony breeds. Our data support that endocrine testing should be performed on all cases of laminitis that do not have a clear inflammatory or gastrointestinal origin.

[Laryngeal MALT lymphoma with known Sjögren syndrome]. / MALT-Lymphom des Larynx bei bekanntem Sjögren-Syndrom.

Hematopoietic neoplasms represent about 1% of all laryngeal neoplasms. MALT lymphoma arises from mucosa-associated lymphoid tissue and is associated with chronic inflammatory disease. Patients with Sjögren syndrome have a higher risk for development of non-Hodgkin lymphoma (MALT lymphoma). To date, only cases of MALT lymphoma of the salivary glands, thymus and stomach associated with Sjögren syndrome have been published. We present the case of a MALT lymphoma of the larynx associated with Sjögren syndrome. Radiation and chemotherapy are the first line of therapy as published in the literature.

Evidence for a parity doublet Delta(1920)P33 and Delta(1940)D33 from gammap-->ppi;{0}eta.

Evidence is reported for the existence of a parity doublet of Delta resonances with total angular momentum J=3/2 from photoproduction of the ppi;{0}eta final state. The two parity partners Delta(1920)P33 and Delta(1940)D33 make significant contributions to the reaction. Cascades of resonances into Delta(1232)eta, N(1535)pi, and Na0(980) are clearly observed.

Quasifree photoproduction of eta mesons off the neutron.

Quasifree photoproduction of eta mesons off nucleons bound in the deuteron has been measured with the CBELSA/TAPS detector for incident photon energies up to 2.5 GeV at the Bonn ELSA accelerator. The eta mesons have been detected in coincidence with recoil protons and recoil neutrons, which allows a detailed comparison of the quasifree n(gamma,eta)n and p(gamma,eta)p reactions. The excitation function for eta production off the neutron shows a pronounced bumplike structure at W=1.68 GeV (E{gamma} approximately 1 GeV), which is absent for the proton.

Modification of the omega-meson lifetime in nuclear matter.

Information on hadron properties in the nuclear medium has been derived from the photoproduction of omega mesons on the nuclei C, Ca, Nb, and Pb using the Crystal Barrel/TAPS detector at the ELSA tagged photon facility in Bonn. The dependence of the omega-meson cross section on the nuclear mass number has been compared with three different types of models: a Glauber analysis, a Boltzmann-Uehling-Uhlenbeck analysis of the Giessen theory group, and a calculation by the Valencia theory group. In all three cases, the inelastic omega width is found to be 130-150 MeV/c(2) at normal nuclear matter density for an average 3-momentum of 1.1 GeV/c. In the rest frame of the omega meson, this inelastic omega width corresponds to a reduction of the omega lifetime by a factor approximately 30. For the first time, the momentum dependent omegaN cross section has been extracted from the experiment and is in the range of 70 mb.

Observation of in-medium modifications of the omega meson.

The photoproduction of omega mesons on nuclei has been investigated using the Crystal Barrel/TAPS experiment at the ELSA tagged photon facility in Bonn. The aim is to study possible in-medium modifications of the omega meson via the reaction gamma + A --> omega + X --> pi(0)gamma + X('). Results obtained for Nb are compared to a reference measurement on a LH2 target. While for recoiling, long-lived mesons (pi(0), eta, and eta;(')), which decay outside of the nucleus, a difference in the line shape for the two data samples is not observed, we find a significant enhancement towards lower masses for omega mesons produced on the Nb target. For momenta less than 500 MeV/c an in-medium omega meson mass of M(medium) = [722(+4)(-4)(stat)+35-5(syst)] MeV/c(2) has been deduced at an estimated average nuclear density of 0.6rho(0).

Neutral-pion photoproduction off protons in the energy range 0.3 GeV

Single pi(0) photoproduction has been studied with the CB-ELSA experiment at Bonn using tagged photon energies between 0.3 and 3.0 GeV. The experimental setup covers a very large solid angle of approximately 98% of 4pi. Differential cross sections dsigma/dOmega have been measured. Complicated structures in the angular distributions indicate a variety of different resonances being produced in the s channel intermediate state gammap-->N(*)(Delta(*))-->ppi(0). A combined analysis including the data presented in this letter along with other data sets reveals contributions from known resonances and evidence for a new resonance N(2070)D15.

Photoproduction of eta mesons off protons for 0.75 GeV

Total and differential cross sections for the reaction p(gamma,eta)p have been measured for photon energies in the range from 750 MeV to 3 GeV. The low-energy data are dominated by the S11 wave which has two poles in the energy region below 2 GeV. Eleven nucleon resonances are observed in their decay into peta. At medium energies we find evidence for a new resonance N(2070)D15 with (M,Gamma)=(2068+/-22, 295+/-40) MeV. At gamma energies above 1.5 GeV, a strong peak in the forward direction develops, signaling the exchange of vector mesons in the t channel.

Abilities and attainment in Smith-Magenis syndrome.

This study reports on cognitive abilities and attainment in 29 children and 21 adults with Smith-Magenis syndrome. There were 13 boys and 16 girls aged 6 to 16 years, and nine men and 12 women aged 16 to 52 years. All had mild to severe learning disabilities* with no differences overall between verbal and performance skills, but with a particular profile of cognitive strengths and weaknesses. Levels of attainment and of adaptive behaviour were strikingly low, and the group of adults emerged as much more dependent on carers than might have been expected from their general level of intellectual functioning. Reasons for this discrepancy are explored in terms of the severe behavioural difficulties characteristic of the syndrome.

Supernova Sources and the 92Nb-92Zr p-Process Chronometer.

We report new Zr isotope evidence for live (92)Nb (mean life: tau&d1;92Nb=52 Myr) within the early solar system resulting in &parl0;92Nb&solm0;93Nb&parr0;initial approximately 10-3. The meteoritic minerals rutile and zircon have, respectively, very high and very low Nb/Zr ratios and are ideal for exploring the (92)Nb-(92)Zr chronometer. Rutiles exhibit high positive straightepsilon92Zr ( approximately 14-36) while a zircon has a negative straightepsilon92Zr ( approximately -4), as would be expected if (92)Nb was live in the early solar system. The meteoritic rutiles appear to be young, with apparent times of formation of approximately 80-220 Myr subsequent to the origin of the solar system. The initial (92)Nb/(92)Mo for the solar system is broadly compatible with a model of uniform production if the (92)Nb/(92)Mo production ratio for Type II supernova (SNII) sources with neutrino-driven winds is used. Data for all the now extinct p-process nuclides ((92)Nb, (97)Tc, and (146)Sm) are consistent with these isotopes being derived by uniform production from SNII sources and a free decay interval of approximately 10 Myr. Consideration of a range of models indicates that the average p-process production ratio of (92)Nb/(92)Mo needs to be at least in the range of 0.06-0.25.