Connectivity of the anterior insula differentiates participants with first-episode schizophrenia spectrum disorders from controls: a machine-learning study.

BACKGROUND: Early diagnosis of schizophrenia could improve the outcomes and limit the negative effects of untreated illness. Although participants with schizophrenia show aberrant functional connectivity in brain networks, these between-group differences have a limited diagnostic utility. Novel methods of magnetic resonance imaging (MRI) analyses, such as machine learning (ML), may help bring neuroimaging from the bench to the bedside. Here, we used ML to differentiate participants with a first episode of schizophrenia-spectrum disorder (FES) from healthy controls based on resting-state functional connectivity (rsFC). METHOD: We acquired resting-state functional MRI data from 63 patients with FES who were individually matched by age and sex to 63 healthy controls. We applied linear kernel support vector machines (SVM) to rsFC within the default mode network, the salience network and the central executive network. RESULTS: The SVM applied to the rsFC within the salience network distinguished the FES from the control participants with an accuracy of 73.0% (p = 0.001), specificity of 71.4% and sensitivity of 74.6%. The classification accuracy was not significantly affected by medication dose, or by the presence of psychotic symptoms. The functional connectivity within the default mode or the central executive networks did not yield classification accuracies above chance level. CONCLUSIONS: Seed-based functional connectivity maps can be utilized for diagnostic classification, even early in the course of schizophrenia. The classification was probably based on trait rather than state markers, as symptoms or medications were not significantly associated with classification accuracy. Our results support the role of the anterior insula/salience network in the pathophysiology of FES.

[Retroperitoneal lymphangioleiomyomatosis - a case reports]. / Retroperitoneálna lymfangioleiomyomatóza - kazuistiky.

Lymphangioleiomyomatosis (LAM) is a rare progressive disease affecting women of childbearing age. The disease is characterised by an abnormal proliferation of immature smooth muscle cells predominantly in the lung. It gradually leads to respiratory failure, and it frequently result in death. Extrapulmonary LAM typically presents with abdominal mass, abdominal pain and chylous ascites. In the case reports we describe two cases of premenopausal females with extrapulmonary LAM. In both cases they occur in pelvic location in the obturator fossa and around the external iliac artery. After surgical procedures patients were primary treated with progesterone. Sirolimus was second-line drugs.

Smoking influences salivary histamine levels in periodontal disease.

OBJECTIVES: Histamine, a potent vasoactive amine, is increased in saliva of periodontitis patients. The present study aimed to further investigate the diagnostic potential of histamine for periodontal disease and assessed smoking, a major risk factor of periodontitis, as a possible influencing factor. METHODS: Salivary and serum samples of 106 participants (60 periodontitis patients, 46 controls) were collected. Salivary histamine was determined by a commercially available ELISA kit, and serum C-reactive protein was measured by a routine laboratory test. Cigarettes per day and packyears were assessed as smoking exposure parameters. RESULTS: Statistically significantly increased levels of salivary histamine and serum C-reactive protein were detected between the patient and control group (P = 0.022 and P = 0.001). Salivary histamine levels were significantly higher in smoking compared with non-smoking patients (P < 0.001), and salivary histamine as well as serum C-reactive protein correlated significantly positively with smoking exposure parameters (P < 0.05). CONCLUSIONS: Smoking, an established and common risk factor of periodontitis, was assessed as a possible influencing factor for salivary histamine. Most interestingly, salivary histamine differed highly significantly between smoking and non-smoking periodontitis patients. Our results suggest a possible involvement of histamine in tobacco-exacerbated periodontal disease, but do not suggest salivary histamine as a reliable diagnostic marker for periodontitis.

Follow-up after primary therapy of malignant epithelial ovarian tumors.

Follow-up after finishing the primary therapy has become a routine aimed to an early detection of relapse, decreasing the mortality and improving the quality of patient's life. Main aim of the follow-up is to prolong the life of the patient. No prospective randomized study confirming the scientific character of such aims has been published, so far. Opinions on benefit from the follow-up are conflicting. It is supposed, that early relapse detection can contribute to prolonged survival and on the other hand, there are opinions, that regular medical examinations can postpone relapse detection in symptomatic patients. Patients after treatment of an early stage should be followed up in regular intervals according to the presented scheme. Patients in advanced stages of the disease should be treated in a principally different way, based on free access to post primary treatment care. Quality of life has to be emphasized. The main purpose of the follow-up is to detect relapse during the time, when it is curable. When this condition has been fulfilled, the follow- up can have medical and economic relevance. Optimal screening is based on results from prospective randomized studies which objectively compare different models of the follow-up. Routine intensive follow-up might not be cost-effective and might substantially raise patient's anxiety at the same time. Patient education regarding early symptoms of relapse and free access could represent a cost-effective model. In order to decide between minimal and intensive follow-up, needs of all three participating members: patients, doctors and healthcare system have to be taken into account (Tab. 1, Ref. 105).

Beam shaping and probe characterization in the scanning electron microscope.

Here we demonstrate the use of nanofabricated grating holograms to diffract and shape electrons in a scanning electron microscope. The diffraction grating is placed in an aperture in the column. The entire diffraction pattern can be passed through the objective lens and projected onto the specimen, or an intermediate aperture can be used to select particular diffracted beams. We discuss several techniques for characterizing the diffraction pattern. The grating designs can incorporate features that can influence the phase and intensity of the diffracted SEM probe. We demonstrate this by producing electron vortex beams.

[Education of gynecologic surgeons]. / Výchova gynekologických operatérov.

OBJECTIVE: To point out the latest trends in the surgical training that need to be implemented in Slovak and Czech Republic, not only in gynecology and obstetrics but also in all surgical specialties. SUBJECT: Review article. SETTING: Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra. METHODS: Analysis of the database Medline 1979-2010 with the searching words education, competency, surgeon. CONCLUSION: The development of high-technologies, mainly minimally invasive surgery, working-hours shortage and public medical awareness are the factors that have major influence on the education of surgeons. Subspecialization, shortage of learning curve and higher safety of surgical procedures are the key elements of the surgical training.

[Assessment of routine surveillance of patients after primary treatment for cervical cancer in stage I. and II.: retrospective analysis]. / Zhodnotenie rutinného sledovania pacientok po primárnej liecbe pre karcinóm krcka maternice v I. a II. stádiu: retrospektívna analýza.

OBJECTIVE: Evaluate the monitoring and diagnosis of recurrence after primary treatment for cervical cancer. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology Faculty Hospital and Constantine the Philosopher University Nitra. METHODS: We retrospectively analyzed 199 patients who have undergone surgical treatment for cervical cancer between 2000 and 2008 at the Faculty Hospital Nitra and they received chemoradioterapy after evaluation of risk factors. Monitoring after primary treatment consisted of general physical examination, gynecological examination, vaginal and abdominal ultrasonography, chest X-ray and determining the level of SCCA. The examinations were performed by gynecologist and clinical oncologist. We compared the survival of patients with symptomatic and asymptomatic recurrences. RESULTS: The recurrence after 6 months post primary therapy were identified in 17 cases. At the time recurrence diagnosis 3 patients were asymptomatic and 14 were symptomatic. Recurrences all 3 asymptomatic patients were detected during regular examinations. Asymptomatic and symptomatic patients had similar survival. CONCLUSION: Regular monitoring of patients after primary treatment of cervical cancer in the rigid intervals and diagnosis of recurrence in the asymptomatic stage does not improve survival compared with symptomatic patients. It is necessary to re-evaluate the algorithm of follow-up not only in terms of survival but also in terms of economic consequences.

[Peripartum hysterectomy--an audit in Slovakia in 2007]. / Peripartálne hysterektómie--audit na Slovensku v roku 2007.

OBJECTIVE: An audit was performed to assess the number, indications and complications of peripartum hysterectomy at the departments of obstetrics/gynecology in Slovakia in 2007. DESIGN: Observational descriptive study. SETTING: Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra. METHOD: An official questionnaire of Slovak Society of Obstetrics and Gynecology was sent to all 63 departments of obstetrics/gynecology to find the number of peripartum hysterectomy performed in the year 2007. Differences between intrapartum and postpartum cases were compared. RESULTS: 44 from 63 institutions responded to the survey (response rate 69.8%). There were 38,485 deliveries and 24 cases of peripartum hysterectomies. The incidence of peripartum hysterectomy was 0.62/1000 deliveries, 1 case occurred in 1604 deliveries. 16 (66.7%) patients had a total abdominal hysterectomy with the remaining 8 (33.3%) having a sub-total hysterectomy. All operations were emergent. 18 procedures were performed during delivery and 6 in the postpartum period. Hypogastric artery ligation before hysterectomy were performed on 2 patients in the postpartum group. 20 of 24 (83.3%) patients delivered by cesarean section, three (12.5%) by spontaneous vaginal delivery and one (4.2%) with vaccumextraction. The indications for emergency peripartum hysterectomy were: placenta praevia 6 cases (25%), placental abruption with disseminated intravascular coagulation 6 (25%), placenta accreta 3 (12.5%), uterine atony 3 (12.5%), uterine rupture 3 (12.5%) and retroperitoneal haematoma 3 (12.5%). The youngest patient was 15 year-old, the oldest one was 39. After hysterectomy 10 (41.7%) women were admitted to the intensive care unit. There was no maternal mortality, but five newborns died due to perinatal asphyxia. There were more blood transfusions in the group of postpartum hysterectomies in comparison with intrapartum cases (4.0 +/- 1.3 transfusion units vs 9.1 +/- 3.5, p < 0.05), as well as the longer hospital stay (10.3 +/- s4.2 days vs. 19.1 +/- 5.3, p < 0.05). CONCLUSIONS: Peripartal hysterectomy is a dramatic but a life saving procedure. It is usually associated with significant maternal and fetal morbidity and mortality. Every obstetric service should have access to a surgical team capable of performing emergency peripartal hysterectomy.

Characteristic features of trabecular bone in edentulous mandibles.

BACKGROUND: The density and architecture of the alveolar trabecular bone are crucial to the stability of an endosseous implant. A significantly higher implant failure rate can be expected when implants are placed in alveolar bone with reduced density and stability. Therefore, the present study aimed to describe the trabecular bone structure of edentulous mandibles. METHOD: Two hundred and seventy-eight bone sections, including the lateral incisor, first premolar, and first molar regions, were obtained from 128 edentulous lower jaws (68 females and 60 males; mean age: 77.58 years). Ground sections were prepared for each region using the 'sawing and grinding' technique. The following standard structural histomorphometric parameters were determined using a semiautomatic image analysis: trabecular bone volume, trabecular thickness, trabecular number, trabecular separation, and the trabecular bone pattern factor, which describes the connectedness of cancellous bone structures. Also, the maximum height of the jaw section was determined, to detect any possible correlations between vertical height and histomorphometric parameters. RESULTS: All the histomorphometric parameters examined showed an unexpectedly huge range of variation. The mean trabecular bone volume ranged between 20.9% and 36.9%. The mean trabecular thickness showed values between 165.9 and 224.7 microm. The mean trabecular number ranged between 1.22 and 1.77/ mm, and the mean trabecular separation ranged between 436.7 and 720.0 microm. The mean trabecular bone pattern factor showed values between -0.05 and -3.01/ mm. The maximum height of the jaw sections showed values between 16.05 and 23.42 mm. The trabecular bone volume, thickness, number and connectivity were significantly lower in the molar region than in the incisal and premolar regions. Significant sex-specific differences were found in all the regions, female mandibles showing a smaller amount and lower connectivity of cancellous bone than male mandibles. No correlation could be found between the maximum height of the jaw and the histomorphometric parameters of the cancellous bone. CONCLUSION: A possible explanation for the difference in the density between the incisal and the molar region may be that molars are generally lost at an earlier age than anterior and premolar teeth. As a result, atrophy-related resorptive and remodeling processes commence earlier and progress further in this region than in the anterior and premolar regions. Sex-specific differences are probably due to an increased postmenopausal bone loss of the females.

Prognostic factors in women 45 years of age or younger with endometrial cancer.

The purpose of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed in women aged younger than 45 years to better identify the prognostic factors for this subgroup of women. We retrospectively evaluated the clinical history, treatment, and follow-up of patients with histologically confirmed endometrial cancer treated in Faculty Hospital Nitra, Slovakia from 1993 to 2003. Data were abstracted regarding tumor histology, grade, age, parity, stage, diabetes, use of oral contraceptives, body mass index (BMI), and survival. One hundred seventy-three patients with endometrioid histology were divided into two groups: younger group (age 45, n = 153). Patients with high-risk histology (clear cell or serous papillary) were excluded from the study. Twenty patients less than or equal to 45 years of age received treatment for endometrial cancer: stage I, 16 (80%); stage II, 2 (10%); stage III, 1 (5%); and stage IV, 1 (5%). Tumors were well differentiated in 12 (60%), moderately differentiated in 6 (30%), and poorly differentiated in 2 (10%). Age ranged from 28 to 45 years (mean 37), with mean BMI 35.8 +/- 9.4. At the end of study period, 17 (85%) were alive with no evidence of disease and 3 (15%) had died of recurrent disease. We conclude that patients less than or equal to 45 years of age have better survival compared to older patients. Deeper myometrial invasion was significantly associated with age greater than 45 years. Majority of young patients with endometrial cancer were obese and nulliparous.

Effects of a mandibular repositioning appliance on sleep structure, morning behavior and clinical symptomatology in patients with snoring and sleep-disordered breathing.

BACKGROUND: Mandibular repositioning appliances (MRAs) have become an established treatment for snoring and sleep-disordered breathing - though most studies only focused on the evaluation of respiratory variables. METHODS: This single-blind, placebo-controlled case-series study investigated the effects of an individually adjustable MRA on psychopathology, macro-/microstructure of sleep, periodic leg movements, morning performance, mood/affect and psychophysiology. Fifty patients (37 males) aged 59.7 +/- 10.3 years, suffering from primary snoring (7), mild (22), moderate (15) and severe apnea (6), spent 4 nights in the sleep laboratory (adaptation, placebo, drug and MRA night). The drug night is not subject of the present paper. RESULTS: Confirmatory statistics showed an improvement of the snoring index by 72%. Descriptively, the apnea index and the apnea-hypopnea index normalized. A clinical improvement was seen in the Pittsburgh Sleep Quality Index, the Zung Anxiety/Depression Scales and the Epworth Sleepiness Scale. The restless legs syndrome also improved. Polysomnographically, sleep stages REM and 4 as well as REM latency increased, stage 3, movement time, stage shifts and periodic leg movements decreased, as did all arousal measures. Subjectively, morning well-being, drive, affectivity and wakefulness improved. Objectively, attention, motor and reaction time performance, critical flicker frequency as well as muscular strength increased, diastolic blood pressure and the pulse rate decreased. CONCLUSION: Apart from its good therapeutic effects on snoring and respiratory variables (snoring showed complete or partial response in 68%, the apnea-hypopnea index in 67% of the apnea patients), the MRA also improved psychopathology, objective and subjective sleep and awakening quality.

Psychiatrist's adherence: a new factor in relapse prevention of schizophrenia. A randomized controlled study on relapse control through telemedicine system.

ACCESSIBLE SUMMARY: Exposure to psychotic states has detrimental effects on the long-term outcome of schizophrenia and brain integrity. Therefore, improving relapse prevention is a key component of long-term management of schizophrenia. Previous studies using continuous monitoring of an individual's early signs of relapse and adopting preventative pharmacological interventions, when early signs are detected, showed promising clinical results in terms of relapse risk reduction. This 18-month multi-centre parallel randomized controlled, open label, trial with telemedicine relapse prevention programme ITAREPS failed to show superiority of maintenance plus prodrome-based targeted medication strategy over treatment as usual. The study, marked by low investigator's adherence, confirmed that absence of pharmacological intervention at early stage of prodrome, critically influenced the risk of relapse. This and previous randomized controlled trials with telemedicine programme ITAREPS suggested that substantial improvement in relapse prevention in schizophrenia is likely to be unattainable under current clinical settings. Future preventive strategies in schizophrenia would require rapid pharmacological intervention upon occurrence of subclinical prodromal symptoms that are undetectable under conventional outpatient practice. Studies with ITAREPS suggested that integration of telemedicine relapse prevention systems and visiting nurse service might together represent practical solution capable to address those requirements. ABSTRACT: The Information Technology Aided Relapse Prevention Programme in Schizophrenia (ITAREPS) presents a telemedicine solution for weekly monitoring and management of schizophrenia. This study aims to evaluate the effectiveness of the programme in reducing the number of hospitalizations during the 18-month multi-centre parallel randomized controlled, open label, trial. Outpatients with schizophrenia or schizoaffective disorder were randomized to the active (n = 74) or control group (n = 72). In the active arm, investigators increased the antipsychotic dose upon occurrence of prodrome announced by the system. Intention-to-treat analysis showed no between-group difference in the hospitalization-free survival rate [Kaplan-Meier method; hazard ratio (HR) = 1.21, 95% confidence interval (CI): 0.56-2.61, P = 0.6). In a post hoc multivariate Cox proportional hazards model, out of 13 potential predictors, only ITAREPS-related variables (number of alerts without pharmacological intervention/HR = 1.38, P = 0.042/ and patient non-adherence with ITAREPS /HR = 1.08, P = 0.009/) increased the risk of hospitalization. In this trial ITAREPS was not effective. The results in context with previous ITAREPS studies suggest non-adherence of both psychiatrists and patients as the main reasons for the failure of this preventive strategy. Tertiary prevention in schizophrenia have to be regarded a major challenge, warranting the need for implementation of strategies with more active participation of both patient and treating psychiatrist.

The optimal processing of plasma samples for the determination of bicyclo-PGE in patients with malignant maxillofacial tumors.

Prostaglandins (PGs) have been shown to be increased in several tumor tissues. PGE2 and PGF1-alpha Radioimmunoassays (RIAs) have been widely used for quantitative PG-measurements in cancer patients. Our results indicate that optimal processing of plasma samples for the determination of bicyclo-PGE2 is of the highest importance in order to get reproducible results. Therefore it is necessary to fulfill the following requirements: 1. 30 minutes rest before sampling; 2. Avoid venous occlusion; 3. Use constant needle diameter; 4. Precooled anticoagulant; 5. Addition of a cyclooxygenase inhibitor is necessary; 6. Control of processing temperature; 7. Storage at -70 degrees C less than -20 degrees C; 8. Control of storage time; 9. The samples have to be examined after thawing once; 10. Only blood samples processed under the above discovered optimal conditions are of clinical relevance; 11. An international standardization for the processing of plasma samples seems to be necessary considering all these requirements; 12. In 41 patients with maxillo-facial carcinomas the PG-value was significantly higher than in the controls; 13. A RIA-evaluation methodologically properly done may be used as an additional aid for clinical monitoring of the patients.

Enhancement of human dental cyst PGI2 formation by platelet derived growth factor and its role in cyst growth and bone resorption.

Various prostaglandins, particularly PGE2 and PGI2, appear to play a major role in osteolytic processes. Radiochromatographic studies have demonstrated that 6-oxo-PGF1-alpha is a major product of exogenously added arachidonic acid in human dental cysts. As platelets may also act as inflammatory cells, platelet-derived growth factor might also have a PGI2-stimulating influence in such cysts. Eleven human dental cysts were examined by a radioimmunoassay and bioassay which can show PGI2 synthesis in human dental cysts without addition of PDGF. Incremental PDGF addition caused a highly significant increase in the rate of PGI2 synthesis. PGDF thus stimulates PGI2 synthesis in chronic inflammatory processes in vitro and may thereby elicit or accelerate osteolysis.

Incidence and suggested surgical management of septa in sinus-lift procedures.

A variable number of septa, also referred to as Underwood's septa, divide the floor of the maxillary sinus into several recesses and may thus cause various complications during sinus-lift procedures. The incidence of Underwood's septa was evaluated by examining 41 edentulous maxillas. In 13 of these maxillas (31.7% of the cases), sinus floors with at least one septum were observed. Most of the septa were located in the region between the second premolar and the first molar. A possible cause of septal formation could be the variable phases of maxillary sinus pneumatization of the empty alveolar process following tooth extraction.

Sonographic imaging of the soft-tissue thickness of the edentulous maxilla.

For preimplantologic evaluation and diagnosis, there are various mechanical methods for measuring the thickness of the soft tissue and thus indirectly measuring the osseous bed of the implant. This study evaluated the use of real-time sonography for analyzing the soft-tissue thickness of the entire edentulous maxilla in an anatomic examination of human cadaver specimens. The data obtained were compared with findings from the usual needle measurement method. The ultrasound measurement method produced realistic data in all measurement points of all sectional planes selected.

Local prostaglandin E2 in patients with oral malignancies undergoing chemo- and radiotherapy.

Patients undergoing chemo- and/or radiotherapy for malignancies were often found to develop annoying inflammation of the oral mucosa. As prostaglandins are known to be cytoprotective. Prostaglandin E2 was given to 10 patients who received combined radio- and chemotherapy for oral neoplasms. Patients receiving PGE2 reported substantially less intense pain then those in the control group. Our statistically significant results indicate that topical treatment of side effects produced by combined radio- and chemotherapy of oral neoplasms with PGE2 holds promise and is clearly superior to conventional treatment modalities.

The edentulous maxillary alveolar process in the region of the maxillary sinus--a study of physical dimension.

From 47 anatomic specimens, vertical sections were cut in the molar region, and computer-assisted measurements of both height and width of the alveolar ridge were made to assess the available bone volume for endosseous implant placement. The mean ridge heights ranged between 9.30 and 3.23 mm, the highest and lowest values being 13.8 and 0.8 mm, respectively. The ridge widths generally proved to be sufficient for placement of endosseous implants. Small knife-edge ridges are rarely found in the posterior maxilla. Reduction of the cancellous portion of the posterior maxilla seems to be influenced by the duration of edentulousness, as well as by osteoporotic changes, without being directly related to ridge configuration and bone volume.

[Abuse of phenacetin-containing analgesics and carcinoma of the renal pelvis (author's transl)]. / Phenacetinabusus und Nierenbeckenkarzinom.

39 carcinomas of the renal pelvis diagnosed between 1968 and 1979 were retrospectively examined for capillary sclerosis in the ureters, which is pathognomonic of phenacetin abuse by the patient. We detected that 40% of the patients displayed capillary sclerosis; abuse was recorded in the case histories in only one quarter of these patients with capillary sclerosis. Hence if follows that 1. the sale of phenacetin-containing analgesics without medical prescription should be prohibited by legislation; 2. physicians, as well as patients, should be informed much more intensively about this problem; 3. patients who are known to abuse phenacetin-containing analgesics must be submitted to regular cytological examination of the urine.

Epidermal Langerhans cells in mycosis fungoides and Sézary syndrome.

The purpose of the study was to examine whether apposition between epidermal Langerhans cells and atypical lymphoid cells is a constant finding in mycosis fungoides (MF) and whether it also occurs in the Sézary syndrome (SS). Biopsies of 8 patients with MF and 2 patients with SS were examined by transmission electron microscopy. In both cases of SS and in 7 cases of MF appositions between the 2 types of cells were observed. The appositions were less frequently seen in stage III MF lesions than in MF stage II. The cell membranes of the Langerhans cells and the apposed atypical lymphoid cells formed gap junction-like structures in several instances. Our results indicate that the phenomenon of cellular interaction between epidermal Langerhans cells and atypical lymphoid cells is a constant finding in cutaneous T-cell lymphomas.