One-year efficacy of a lifestyle behavioural intervention on physical and mental health in people with severe mental disorders: results from a randomized controlled trial.

This multicentric randomized controlled trial (RCT), carried out in six Italian University mental health sites, aims to test the efficacy of a six-month psychosocial intervention (LYFESTYLE) on Body Mass Index (BMI), body weight, waist circumference, fasting glucose, triglycerides, cholesterol, Framingham and HOmeostasis Model Assessment of insulin resistance (HOMA-IR) indexes in patients with schizophrenia, bipolar disorder, and major depression. Moreover, the efficacy of the intervention has also been tested on several other physical and mental health domains. Patients were randomly allocated to receive the six-month experimental intervention (LIFESTYLE) or a behavioural control intervention. All enrolled patients were assessed at baseline and after one year. We recruited 401 patients (206 in the experimental and 195 in the control group) with a diagnosis of schizophrenia or other psychotic disorder (29.9%), bipolar disorder (43.3%), or major depression (26.9%). At one year, patients receiving the experimental intervention reported an improvement in body mass index, body weight, waist circumference, HOMA-IR index, anxiety and depressive symptoms and in quality of life. Our findings confirm the efficacy of the LIFESTYLE intervention in improving physical and mental health-related outcomes in patients with severe mental illnesses after one year.

Tracheocutaneous fistula in patients undergoing supracricoid partial laryngectomy: the role of chronic aspiration.

The aim of the present retrospective controlled study was to analyse and compare risk factors for tracheocutaneous fistula in patients who received tracheostomy after supracricoid partial laryngectomy with those who received tracheostomy for other causes. We enrolled 39 patients with tracheocutaneous fistulas who were divided into two groups. The first received temporary tracheostomy for supracricoid partial laryngectomies (n = 21), while the control group consisted of patients who received temporary tracheostomy for other causes (n = 18). Risk factors believed to play a role in the pathogenesis of tracheocutaneous fistula were examined including advanced age, cardiopathy, local infections, radiotherapy, elevated body mass index, malnutrition, decannulation time and aspiration grade. The Leipzig and Pearson scale score was significantly higher in the supracricoid partial laryngectomy group (p = 0.006 and 0.031 for univariate and multivariate analyses, respectively). The penetration/aspiration scale score was significantly higher in the supracricoid partial laryngectomy group as determined by univariate analysis (p = 0.014). The decannulation time was significantly lower in the supracricoid partial laryngectomy group (p = 0.004 and 0.0004 for univariate and multivariate analyses, respectively). The number of surgical closures for tracheocutaneous fistula was significantly higher in the supracricoid partial laryngectomy group by univariate analysis (p = 0.027). These results suggest that chronic aspiration and related cough may be important pathogenic factors for tracheocutaneous fistula and could be responsible for the significantly higher rates of closure failure in patients after supracricoid partial laryngectomy.

Understanding the structural properties of a homologous series of bis-diphenylphosphine oxides

A homologous series of bis-diphenylphosphine oxides (C6H5)2PO(CH2)(n)PO(C6H5)2 (with n = 2-8; denoted 2-8] have been investigated to explore the effects of a range of competing and cooperative intermolecular and intramolecular interactions on the structural properties in the solid state. The important factors influencing the structural properties include intramolecular aspects such as the conformation of the aliphatic chain and the intramolecular interaction between the two P=O dipoles in the molecule, and intermolecular aspects such as long-range electrostatic interactions (dominated by the arrangement of the P=O dipoles), C-H...O interactions, C-H...pi interactions and pi...pi interactions. Compounds 3 and 5 could be crystallized only as solvate co-crystals (3 water and 5 x (toluene)2], whereas the crystal structures of all the other compounds contain only the bis-diphenylphosphine oxide molecule. The crystal structures have been determined from single-crystal X-ray diffraction data, with the exception of 7 (which has been determined here from powder X-ray diffraction data) and 4 (which was known previously). The compounds with even n represent a systematic structural series, exhibiting characteristic, essentially linear P=O...P=O...P=O dipolar arrays, together with C-H...O and C-H...pi interactions. For the compounds with odd n, on the other hand, uniform structural behaviour is not observed across the series, although certain aspects of these crystal structures contribute in a general sense to our understanding of the structural properties of bis-diphenylphosphine oxides. Importantly, for the compounds with odd n, there is "frustration" with regard to the molecular conformation, as the preferred all-anti conformation of the aliphatic chain gives rise to an unfavourable parallel alignment of the two P=O dipoles within the molecule. Clearly the importance of avoiding a parallel alignment of the P=O dipoles becomes greater as n decreases. Local structural aspects (investigated by high-resolution solid-state 31P NMR spectroscopy) and thermal properties of the bis-diphenylphosphine oxide materials are also reported.

Variability of anti-GBM binding in hereditary nephritis.

Anti-GBM staining by indirect immunofluorescence microscopy was performed on renal biopsies from 64 patients with a variety of diseases in which no in vivo bound immunoglobulin or complement components were identified by direct immunofluorescence microscopy. The glomeruli of all of the entities examined bound anti-GBM antibodies except for four of nine cases of hereditary nephritis of the Alport-type. The absence of anti-GBM staining was found to correlate with the severity of GBM splitting identified by electron microscopy.

The glomerular basement membrane in benign familial hematuria.

A total of nineteen children were studied because of asymptomatic hematuria. all had normal renal function, and immunologic and urologic studies. Renal tissue was obtained by percutaneous biopsy and examined by light, immunofluorescence and electron microscopy. On electron microscopy, thickness of the glomerular basement membrane (BGM) was found to distinguish benign familial hematuria (BFH - 10 cases) from non familial idiopathic recurrent hematuria (IRH - 9 cases). Measurements were taken in areas of peripheral glomerular capillary loops (minimum of five) where both cell membranes could be resolved to insure tht determinations were uniform and represented ideal cross sections. The mean thickness +/- SE of GBM in IRH of 303.3 +/- 16.9 nM was greater than that noted in BFH of 207.1 +/- 11.99 nM (P less than .002). The mean thickness +/- SE of the lamina densa in IRH of 236 +/- 15.36 nM was significantly greater than that observed in BFH of 128.5 +/- 11.7 nM (P less than .001). In both BFH and IRH the GBM and LD were uniform in thickness (CV = 20%) and qualitatively normal. The uniform attenuation observed in BFH can be used to distinguish this condition from IRH.

Gold-associated nephropathy.

Renal biopsy specimens from 11 cases of gold-associated nephropathy were studied by light, immunofluorescence, and electron microscopy. Seven biopsy specimens disclosed the typical glomerular lesions of membranous nephropathy. Four cases disclosed other patterns of glomerular injury, including minimal-change nephrotic syndrome. Although a membranous pattern of immune complex deposition is the most frequent type seen in gold nephropathy, our data indicate that other patterns of immune complex deposition may occur in renal biopsy specimens of patients receiving gold therapy.

[Latero-cervical adenopathies due to occult tumors: clinical experience and considerations on the therapeutic treatment]. / Le adenopatie latero-cervicali da tumore occulto: esperienza clinica e considerazioni sul trattamento terapeutico.

The treatment of patients with occult primary tumors presenting cervical metastases is still controversial. Thus the treatment of 10 patients with cervical metastases from unknown primary sites observed from 1978 to 1987 is reviewed. The average age of these patients was 56 years with a male: female ratio of 9:1. Any patients previously treated for cephalic or extracephalic neoplasms were excluded from the study as were those with lymphomas. According to TNM classification (1978) 7 cases (70%) were N1, one (10%) was N2 and two (20%) were N3. Only in one case were the cervical metastases multiple and unilateral, in one case (N2) they were bilateral. Histopathological diagnosis was performed with open biopsy in all cases prior to radical or conservative neck dissection. Five patients (50%) had metastases from epidermoid carcinoma, two (20%) from undifferentiated carcinoma (non nasopharyngeal), one (10%) from a papillary thyroid carcinoma, one (10%) from undifferentiated nasopharyngeal carcinoma and one (10%) from adenocarcinoma. The neck locations of the metastases were as follows: 3 (30%) at the upper cervical nodes (as was the N2 case), 3 (30%) at the mid-jugular nodes, 1 (10%) at the lower cervical nodes, 1 (10%) at the supra-clavicular nodes and 1 (10%) at the jugulo-digastric node. In the only case of multiple and unilateral nodes (10%) a contemporary involvement of the mid-jugular and lower cervical nodes was observed. A complete history was taken and a general physical and E.N.T. examination, X-ray, radioisotope and endoscopic studies were performed for all patients. In all cases treatment was: surgery on N + radiation therapy on the most common sites of unknown primary tumors. In particular, 7 conservative neck dissections (bilateral in one case), 2 radical neck dissections and 1 modified radical neck dissection were performed. The survival rate was 60% at 3 years and 40% at 5 years; it may be due to the radical treatment and to the high number of N1 and epidermoid carcinomas. In conclusion some considerations about the treatment of this pathology were reported.

[Functional recovery in subtotal laryngectomies]. / Il recupero funzionale nelle laringectomie subtotali.

Subtotal laryngectomy, a valid treatment for carefully selected patients, is a safe oncologic procedure which preserves the cricoid-arytenoid unit creating a successful "neo-larynx" with valid phonatory and deglutition functions. At the E.N.T. Clinic of "La Sapienza" University of Rome from Jan. 1984 to Feb. 1992, 85 subjects underwent subtotal laryngectomy, 50 of which then underwent phoniatric examination. The remaining patients were not suitable candidates because of the trachealis cannula (14), or because they were lost at follow up (16). A total of 50 male subjects were examined. Twenty-eight underwent crico-hyoid-pexia, while 22 patients underwent crico-hyoid-epiglotto-pexia. Attention is drawn to the results which appear to be extremely variable with regard to each study group. We obtained better results with crico-hyoid-epiglotto-pexia than with crico-hyoid-pexia and we guaranteed a good social re-insertion in all cases.

Transit time of swallowing after subtotal laryngectomy.

INTRODUCTION: The aim of subtotal laryngeal surgery (Cricohyoidopexy = CHP and Cricohyoidoepiglottopexy = CHEP) is to create a simplified but functional neolarynx. The neolarynx permits the passage of air, the closure of the airway, and ensures phonation through the vibration of the cricoid and arytenoid mucosa; furthermore, it allows the recovery of swallowing, optimizing the closure of the neoglottis with the movement of the remaining arytenoids. The aim of the present study was to evaluate, on a long-term basis, the efficiency of the swallowing function comparing swallowing times in CHEP and CHP with and without functional neck dissection (FND). MATERIALS AND METHODS: A radiological study was conducted on 48 patients selected from a group of 253, who underwent subtotal laryngectomies at the "G. Ferreri" Department of Otorhinolaryngology, Audiology and Phoniatrics of the University of Rome "La Sapienza". The selection of the 48 patients was carried out based on the following criteria: type of surgery, date of surgery (follow up of at least 12 months), patients who were not treated with radiotherapy before or after surgery, patients who were also examined with fibrolaryngoscopy and videofluoroscopy, patients not affected by motor deficits involving phonatory and swallowing regions (stroke, lesions of the central nervous system), negative follow up (no evidence of disease). The parameters for evaluating the functional recovery were the times the nasogastric tube and tracheotomy tube were kept in place. The functional recovery times of the groups thus formed were compared to one another Through videofluoroscopy the authors evaluated oral transit times (OTT) and pharyngeal transit times (PTT) as parameters of deglutition. RESULTS: The results consistently showed that swallowing time remains under one second as in individuals with normal swallowing functions. CONCLUSION: The study of deglutition times, conducted at least 12 months after surgery, does not show any substantial differences between CHEP and CHP with reference to pharyngeal transit and oral transit times.

A short communication. Congenital renal alkalosis.

Patients with idiopathic hypokalemic metabolic alkalosis and hyperrenienmia have been lumped under the heading of Bartter's syndrome. However, the clinical picture is not totally uniform. Recently, Gullner et al. described a familial disorder with hypokalemic metabolic alkalosis, hyperreninemia, and aldosteronism, but without juxtaglomerular hyperplasia. They suggested that this family had a condition other than Bartter's syndrome. The present report details the followup from infancy to adulthood of a patient with hypokalemic metabolic alkalosis, salt wasting, and hyperreninemia, but with normal aldosterone level and without juxtaglomerular hyperplasia. The authors suggest that this new condition be termed renal alkalosis. The studies suggest that the distal tubular reabsorptive capacity was defective in this patient.

Autoantibodies in minimal change nephrotic syndrome.

The presence of low level antibody (AAb) activity and circulating immune complexes (CIC) were studied in 17 patients with minimal change nephrotic syndrome (MCNS). Study groups include 12 MCNS without mesangial deposits (Group I) and 5 MCNS with mesangial deposits (Group II). In Group I reactivity against normal tissue antigens was demonstrated (kidney tubular microsomal antigen - 8, smooth muscle - 5, gastric cell - 5). In Group II reactivity against kidney basement membrane was demonstrated in all five patients. CIC were detected in eight (Group I - 6, Group II - 2). Dissociation of the CIC showed that they all contained antibodies with a corresponding autoantibody activity which could be removed by prior incubation with their complexed antigen. The presence of these AAb's and their formation of CIC may indicate their role in initiating a primary immunological insult to the kidney.

Competition between two microbial populations in a nonmixed environment: effect of cell random motility.

In a nonmixed environment, bacterial population growth can be influenced significantly by cell motility properties as well as by growth kinetic properties. Therefore, in a situation of competition between two bacterial populations for a single chemical nutrient in a nonmixed environment, the outcome may depend upon the respective cell motility properties. In this article, the authors have presented a simple mathematical model for competitive growth of two randomly motile (i.e., possessing no chemotactic behavior) populations in a finite nonmixed region. An understanding of the behavior of this model should provide insight into the behavior of a number of common microbial competition problems. Analysis of this model yields the following results: (1) There may be as many as three possible non-trivial steady-state (or long-time) configurations: when species 1 survives, species 2 dies out; when species 2 survives, species 1 dies out; and species 1 and species 2 coexist. (2) The coexistence state can exist even though one species possesses a smaller intrinsic growth rate constant at all nutrient concentrations, if that same species is sufficiently less motile than the other species. (3) In fact, the species with the smaller maximum specific growth rate may grow to a larger population than the other. (4) The possibility of coexistence can be decided essentially from the results for single population growth.

Functional results of sub-total laryngectomy.

Sub-total laryngectomy (crico-hyoido-pexy and crico-hyoido-epiglotto-pexi), while achieving a radical oncological control results in a functional neolarynx efficacious in swallowing as well as in phonatory activities. 102 out of the 122 patients, treated with sub-total laryngectomy, underwent functional evaluations: the results appear to be extremely variable within each group. A better performance in crico-hyoido-epiglotto-pexi (CHEP) rather than in crico-hyoido-pexi (CHP) has been observed in these patients. However, a good life quality and social rehabilitation was assured to patients in both cases.

Ontogeny of single nephron filtration distribution in canine puppies.

The ontogeny of single nephron filtration distribution was studied in 29 canine puppies two hr to 42 days old using the [14C] ferrocyanide method as modified by Coehlo (9). The ratio of 14C counts in outer cortical nephrons (OC) to counts in juxtamedullary nephrons (JM) were plotted against age for each puppy. This ratio (OC:JM) provided an index for comparing the single nephron glomerular filtration between regions. A four-fold increase in OC:JM occurred from two days to four wk. The youngest puppy, two hr old, showed a ratio of zero because no counts were detected in OC at that age. The most rapid increase occurred in the first 8 days of life. By the fourth wk, the mean OC:JM ratio was 0.72 +/- 0.06, approaching values reported by other laboratories for adult dogs. In contrast to age-related changes in OC:JM ratio, the ratio of middle cortical to JM counts showed no age-related increase. Cortical blood flow distribution was determined by the microsphere method. The ratio of blood flow to outer and inner cortex increased from 0.43 at one-half a day to a mean of 2.93 after one wk. The ratio of OC:JM single nephron filtration of OC/inner cortical nephron renal blood flow was 0.36 from 3 days to 26 days (n = 12) and did not change significantly with age, indicating that changes in zonal filtraion matched the alterations in cortical blood flow distribution.

Renal alpha-adrenoceptors and sodium excretion in the dog.

The purpose of this study was to characterize the age-dependent role of alpha-adrenergic activity on renal vascular resistance (RVR) and renal blood flow (RBF) and the role of alpha 2-receptors in sodium transport. Intrarenal infusion of phentolamine in hydropenic anesthetized pups and adult dogs increased RBF and glomerular filtration rate (GFR) only in pups. The effect was most marked in the youngest pups (15.67 +/- 0.67 days). At 1.0 micrograms X kg-1 X min-1, phentolamine increased RBF from 1.38 +/- 0.04 to 1.64 +/- 0.04 ml X min-1 X g kidney wt-1 and GFR from 0.19 +/- 0.01 to 0.23 +/- 0.01 ml X min-1 X g kidney wt-1. Absolute (UNaV) and fractional (FENa) sodium excretions increased in all animals, but mean percent increases were greatest in adult dogs. Intrarenal yohimbine infusion in adult dogs (10-100 micrograms X kg-1 X min-1) produced a dose-related increase in UNaV and FENa without affecting RBF and GFR. UNaV increased from 0.22 +/- 0.05 to 0.54 +/- 0.12 mueq X min-1 X g kidney wt-1 and FENa increased from 0.32 +/- 0.05 to 0.63 +/- 0.06% at the dose of 100 micrograms X kg-1 X min-1. These studies confirm a modest role for alpha-adrenoreceptors in the high RVR characteristic of newborn pups and provide evidence for a role of alpha 2-adrenoceptors in the renal transport of sodium; the extent of the contribution of renal alpha-adrenergic system could not be tested in this experiment.

Dopamine receptors in the proximal tubule of the rabbit.

Our laboratory has characterized dopamine receptors in glomeruli and tubular homogenates. Since the heterogeneity of kidney homogenates limits the interpretation of these studies, the [3H]haloperidol binding site and adenylate cyclase sensitivity to dopamine were studied in the isolated proximal convoluted tubule and pars recta of the rabbit kidney. [3H]Haloperidol binding sites were saturable, stereoselective, and of high affinity. The apparent dissociation constant was 31.5 X 10(-9) M (+/- 8.5) and the maximum receptor density was 0.31 X 10(-15) M (+/- 0.08) per millimeter. In pars recta specific binding was 53% of total [3H]-haloperidol binding. Dopamine stimulated adenylate cyclase activity in a dose-related manner, which was inhibited by cis-flupenthixol but not by trans-flupenthixol or (-)-propranolol. Moreover, the stimulatory effect of the dopamine 1 (D1) agonist SKF 82526 on adenylate cyclase activity was blocked by the D1 antagonist SCH 23390. Dopamine receptors in the proximal convoluted tubule appear to be of the D1 subtype since they are linked to stimulation of adenylate cyclase. This is further substantiated by the stereoselectivity for (+)-sulpiride (a D1 antagonist), which had a greater affinity for the [3H]haloperidol binding site than (-)-sulpiride (a D2 antagonist).

Ontogeny of myocardial adrenoceptors II. Alpha adrenoceptors.

The maturation of myocardial alpha adrenoceptors was investigated in dogs. Alpha adrenoceptors were characterized by radioligand binding using [3H]-WB4101. In neonatal cardiac membranes, the binding of the ligand was rapid, reversible, of high affinity, saturable and stereoselective. The competition studies with adrenergic agonists and antagonists were indicative of alpha adrenoceptors. In adult dog cardiac membranes, consistent specific binding of the ligand could be demonstrated. These studies indicate that there is a decrease in alpha adrenergic receptor density of canine cardiac membranes during maturation.

Hyperlipidemia in children with chronic renal insufficiency.

Total serum cholesterol, phospholipids, and triglyceride levels, lipoprotein fractionation, and plasma parathormone levels were measured in a group of 31 nonnephrotic children with various levels of renal function and on hemodialysis. Group A served as controls and consisted of eight healthy children with glomerular filtration rate (GFR) greater than 110 ml/min/1.73 m2. Group B consisted of six children with GFR on 60 to 95 ml/min/1.73 m2. Group C consisted of nine children with GFR of 10 to 40 ml/min/1.73 m2, and group D consisted of eight children on maintenance hemodialysis with GFR of 0 to 5 ml/min/1.73 m2. Among the groups, there were no significant differences in total serum cholesterol and phospholipid levels. A significant (P less than 0.05) increase in triglyceride levels was observed in patient groups C and D. Lipoprotein fractionation revealed a significant increase (P less than 0.05) in the pre-beta lipoprotein levels (very low density lipoproteins) in patients in groups D with 63% of these patients demonstrating a type IV lipoprotein pattern. There were no significant differences observed in the beta lipoproteins (low-density lipoproteins). However, the alpha lipoproteins (high-density lipoproteins) decreased significantly (P less than 0.05) in patients whose GFR was below 40 ml/min/1.73 m2 (group C) as well as patients in group D. Absolute plasma parathormone levels did not significantly correlate with serum triglyceride levels did not significantly correlate with serum triglyceride levels and remained normal until after the onset of hemodialysis when they increased significantly in all patients.