Adjunctive quetiapine for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A meta-analysis of randomised controlled treatment trials

Small studies have shown positive effects from adding a variety of antipsychotic agents in patients with obsessive–compulsive disorder who are unresponsive to treatment with serotonin reuptake inhibitors. The evidence, however, is contradictory. This paper reports a meta-analysis of existing double-blind randomized placebo-controlled studies looking at the addition of the second-generation antipsychotic quetiapine in such cases. Three studies fulfilled the inclusion criteria. Altogether 102 individuals were subjected to analysis using Review Manager (4.2.7). The results showed evidence of efficacy for adjunctive quetiapine (< 400 mg/day) on the primary efficacy criterion, measured as changes from baseline in total Yale–Brown Obsessive Compulsive Scale scores (P = 0.008), the clinical significance of which was limited by between-study heterogeneity. The mechanism underlying the effect may involve serotonin and/or dopamine neurotransmission

Searching for pitch invariant representations in auditory cortex [oral presentation]

Pitch constancy relates to perceiving the same pitch from tones with differing spectral shapes and is one key criteria for identifying a pitch selective neural representation in auditory cortex. Here we used an event-related potential (ERP) adaptation study and a behavioural task (target same/different) to investigate whether pitch coding is invariant to changes in timbre. Adaptation is observed as a decrease in N100-P200 when the same stimulus is repeated because overlapping neuronal populations encode the stimulus. Reduced adaptation indicates that new neuronal populations are recruited to encode a change in an acoustic feature of interest (i.e. pitch, timbre or both). If neurons are selective to pitch (invariant to timbre), reduced adaptation should occur for pitch changes only. If selective to both (non-invariant to timbre), reduced adaptation should occur for pitch and timbre changes. Similarly, stimulus discrimination during the behavioural task should not require any additional processing resources if neurons are selective to pitch only, and hence reaction times and accuracy should be equivalent across conditions. If neurons are selective to both pitch and timbre, longer reaction times and poorer accuracy should be observed for timbre changes. We found reduced adaptation in the N100-P200 and increased reaction times and poorer accuracy for timbre changes. This suggests that neurons in auditory cortex are selective to both pitch and timbre, i.e. pitch coding is non-invariant to timbre. This supports recent evidence suggesting interdependence between pitch

Austempered ductile iron (ADI) : influence of austempering temperature on microstructure, mechanical and wear properties and energy consumption

Alloyed Ductile iron austenitized at 840°C for 30 min in a special sealed austempering furnace, was austempered for 30 min in molten salt mixture at 4 trial temperatures of 300 °C, 320 °C, 340 °C and 360°C. Tensile strength, yield strength, percentage elongation and impact energy were evaluated for the as-cast and austempered samples. Microstructures were investigated using microscopy coupled with analyzing software and a scanning electron microscopy. The specific wear of samples was tested using pin-on-disc wear testing machine. X-ray diffraction was performed to calculate the amount of retained austenite present in the ausferrite matrix. As cast microstructure consists of ferrite and pearlite, whereas ADI contains a mixture of acicular ferrite and carbon enriched austenite called “ausferrite”. Hardness and strength decreased, whereas ductility and impact strength improved with increase in austempering temperature. XRD analysis revealed that the increase in austempering temperature increases the retained austenite content. Decrease in wear resistance with austempering temperature was observed. Modified Quality Index (MQI) value was envisaged incorporating tensile strength, elongation and wear resistance. MQI for samples austempered at 340°C and 360°C showed better combination of properties. About 8% reduction in energy consumption is gained when the heat treatment parameters are optimized

Etiological factors affecting the clinical features, prognosis and management of acute pancreatitis

Aim: There are various etiological factors causing acute pancreatitis; of them to identify the most common aetiological factor affecting the severity of symptoms, complications and mortality in acute pancreatitis.Patients and methods: The study was conducted in Sungai Petani hospital in the State of Keddah, Malaysia. A total of 64 patients were admitted with symptoms of acute pancreatitis were retrospectively studied for symptoms, investigation results and prognosis.Results: Out of 64 patients admitted for acute pancreatitis gall stone disease was noticed in 38 patients of them Malays were 34 and others were 4.Alcohol consumption was observed in 26 patients of them 24were Indians and 2were Thai. Vomiting, jaundice, fever were more common in Malays. The symptoms are more due to gallstone induced acute pancreatitis than in alcohol induced pancreatitis. Serum enzymes like serum alanine transferase, amylase and LDH level in blood and urine amylase and diastase were elevated more commonly in Malays than in Indians. Serum albumin and PO2 decreased in more Malays than in Indians. Both local and systemic complications were common in Malays. More Malay patients underwent surgery for gall stones.Conclusion: The lipase/amylase ratio index, erythrocyte mean corpuscular volume, and gamma glutamyl transferase could not distinguish alcoholic from non-alcoholic acute pancreatitis. Patients with gallstone pancreatitis should have cholecystectomy, ideally during the same admission.   Early imipenem- cilastatin therapy appears to significantly reduce the need for surgery and complications

How does a cadaver model work for testing ultrasound diagnostic capability for rheumatic-like tendon damage?

To establish whether a cadaver model can serve as an effective surrogate for the detection of tendon damage characteristic of rheumatoid arthritis (RA). In addition, we evaluated intraobserver and interobserver agreement in the grading of RA-like tendon tears shown by US, as well as the concordance between the US findings and the surgically induced lesions in the cadaver model. RA-like tendon damage was surgically induced in the tibialis anterior tendon (TAT) and tibialis posterior tendon (TPT) of ten ankle/foot fresh-frozen cadaveric specimens. Of the 20 tendons examined, six were randomly assigned a surgically induced partial tear; six a complete tear; and eight left undamaged. Three rheumatologists, experts in musculoskeletal US, assessed from 1 to 5 the quality of US imaging of the cadaveric models on a Likert scale. Tendons were then categorized as having either no damage, (0); partial tear, (1); or complete tear (2). All 20 tendons were blindly and independently evaluated twice, over two rounds, by each of the three observers. Overall, technical performance was satisfactory for all items in the two rounds (all values over 2.9 in a Likert scale 1-5). Intraobserver and interobserver agreement for US grading of tendon damage was good (mean κ values 0.62 and 0.71, respectively), with greater reliability found in the TAT than the TPT. Concordance between US findings and experimental tendon lesions was acceptable (70-100 %), again greater for the TAT than for the TPT. A cadaver model with surgically created tendon damage can be useful in evaluating US metric properties of RA tendon lesions

Critical analysis of vendor lock-in and its impact on cloud computing migration: a business perspective

Vendor lock-in is a major barrier to the adoption of cloud computing, due to the lack of standardization. Current solutions and efforts tackling the vendor lock-in problem are predominantly technology-oriented. Limited studies exist to analyse and highlight the complexity of vendor lock-in problem in the cloud environment. Consequently, most customers are unaware of proprietary standards which inhibit interoperability and portability of applications when taking services from vendors. This paper provides a critical analysis of the vendor lock-in problem, from a business perspective. A survey based on qualitative and quantitative approaches conducted in this study has identified the main risk factors that give rise to lock-in situations. The analysis of our survey of 114 participants shows that, as computing resources migrate from on-premise to the cloud, the vendor lock-in problem is exacerbated. Furthermore, the findings exemplify the importance of interoperability, portability and standards in cloud computing. A number of strategies are proposed on how to avoid and mitigate lock-in risks when migrating to cloud computing. The strategies relate to contracts, selection of vendors that support standardised formats and protocols regarding standard data structures and APIs, developing awareness of commonalities and dependencies among cloud-based solutions. We strongly believe that the implementation of these strategies has a great potential to reduce the risks of vendor lock-in

Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA): a randomised controlled trial of an integrated foot care programme for foot problems in JIA

&lt;b&gt;Background&lt;/b&gt;: Foot and ankle problems are a common but relatively neglected manifestation of juvenile idiopathic arthritis. Studies of medical and non-medical interventions have shown that clinical outcome measures can be improved. However existing data has been drawn from small non-randomised clinical studies of single interventions that appear to under-represent the adult population suffering from juvenile idiopathic arthritis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with foot and ankle problems exists. &lt;b&gt;Methods/design&lt;/b&gt;: An exploratory phase II non-pharmacological randomised controlled trial where patients including young children, adolescents and adults with juvenile idiopathic arthritis and associated foot/ankle problems will be randomised to receive integrated podiatric care via a new foot care programme, or to receive standard podiatry care. Sixty patients (30 in each arm) including children, adolescents and adults diagnosed with juvenile idiopathic arthritis who satisfy the inclusion and exclusion criteria will be recruited from 2 outpatient centres of paediatric and adult rheumatology respectively. Participants will be randomised by process of minimisation using the Minim software package. The primary outcome measure is the foot related impairment measured by the Juvenile Arthritis Disability Index questionnaire's impairment domain at 6 and 12 months, with secondary outcomes including disease activity score, foot deformity score, active/limited foot joint counts, spatio-temporal and plantar-pressure gait parameters, health related quality of life and semi-quantitative ultrasonography score for inflammatory foot lesions. The new foot care programme will comprise rapid assessment and investigation, targeted treatment, with detailed outcome assessment and follow-up at minimum intervals of 3 months. Data will be collected at baseline, 6 months and 12 months from baseline. Intention to treat data analysis will be conducted. A full health economic evaluation will be conducted alongside the trial and will evaluate the cost effectiveness of the intervention. This will consider the cost per improvement in Juvenile Arthritis Disability Index, and cost per quality adjusted life year gained. In addition, a discrete choice experiment will elicit willingness to pay values and a cost benefit analysis will also be undertaken

Immigration and recommended care after a suicide attempt in Europe: equity or bias?

This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behaviour in Europe) project. The relationship between immigrant status and type of aftercare recommended was analysed with binary logistic regression, adjusting for gender, age, method of attempt and the Centre collecting the data. Clear disparities were identified in the care recommendation practices toward immigrants, compared with hosts, over and above differing policies by the European Centres

Comparative study on Healing of Diabetic Plantar Foot Ulcers treated by Conventional Measures Alone Vs Conventional Measures along with Bohler Iron Plaster Cast

BACKGROUND AND OBJECTIVES: India, being diabetic capital of the world and the most common complication of diabetes mellitus is diabetic foot ulcer. The aim of the study is to compare the healing of diabetic plantar foot ulcers when treated with conventional measures alone vs conventional measures along with bohler iron plaster cast. Bohler iron plaster cast provides complete offloading of foot thus causing dispersion of pressure points away from ulcer site. METHODS: A prospective comparative study for a duration of 1 year from 2017 – 2018 was undertaken in patients with diabetic plantar foot ulcers in Government Rajaji Hospital, Madurai. A total of 60 patients were recruited for the study based on the eligibility criteria and after obtaining informed written consent. Relevant data regarding history, clinical examination, investigations were collected and properly recorded. The patients would be divided into Group A and Group B. The former (Group A) treated with conventional measures alone and the latter (Group B) treated with conventional measures along with bohler iron plaster cast. The patients were followed up for 1 month and healing of ulcer is assessed by means of Pressure Ulcer Scale for Healing (PUSH) scores before and after intervention in each group. RESULTS: Out of the 60 patients , none of the patients developed any new ulcers .There was a good ulcer healing evidenced by significant reduction in the mean Pressure Ulcer Scale for Healing score after 1 month of intervention. There is a statistical difference as the mean of pre-PUSH scores of 10.27 is greater than Post-PUSH score 7.60 in the group A and the mean of Pre-PUSH scores 8.65 is greater than post PUSH score 5.93 in the group B. CONCLUSION: On analysis ,it is found that there is significant decrease in ulcer size ,exudate amount and change in type of tissue when treated with conventional measures along with bohler iron plaster cast. Thus by using appropriate offloading device which enables pressure dispersion from the ulcer site promotes better wound healing of diabetic plantar foot ulcers thereby preventing major complications which results in morbidity and mortality in most diabetic patients

Nonpsychotropic plant cannabinoids, cannabidivarin (CBDV) and cannabidiol (CBD), activate and desensitize transient receptor potential vanilloid 1 (TRPV1) channels in vitro: potential for the treatment of neuronal hyperexcitability

Epilepsy is the most common neurological disorder, with over 50 million people worldwide affected. Recent evidence suggests that the transient receptor potential cation channel subfamily V member 1 (TRPV1) may contribute to the onset and progression of some forms of epilepsy. Since the two nonpsychotropic cannabinoids cannabidivarin (CBDV) and cannabidiol (CBD) exert anticonvulsant activity in vivo and produce TRPV1-mediated intracellular calcium elevation in vitro, we evaluated the effects of these two compounds on TRPV1 channel activation and desensitization and in an in vitro model of epileptiform activity. Patch clamp analysis in transfected HEK293 cells demonstrated that CBD and CBDV dose-dependently activate and rapidly desensitize TRPV1, as well as TRP channels of subfamily V type 2 (TRPV2) and subfamily A type 1 (TRPA1). TRPV1 and TRPV2 transcripts were shown to be expressed in rat hippocampal tissue. When tested on epileptiform neuronal spike activity in hippocampal brain slices exposed to a Mg2+-free solution using multielectrode arrays (MEAs), CBDV reduced both epileptiform burst amplitude and duration. The prototypical TRPV1 agonist, capsaicin, produced similar, although not identical effects. Capsaicin, but not CBDV, effects on burst amplitude were reversed by IRTX, a selective TRPV1 antagonist. These data suggest that CBDV antiepileptiform effects in the Mg2+-free model are not uniquely mediated via activation of TRPV1. However, TRPV1 was strongly phosphorylated (and hence likely sensitized) in Mg2+-free solution-treated hippocampal tissue, and both capsaicin and CBDV caused TRPV1 dephosphorylation, consistent with TRPV1 desensitization. We propose that CBDV effects on TRP channels should be studied further in different in vitro and in vivo models of epilepsy