Cerebrospinal fluid diagnostics in first-episode schizophrenia

We evaluated the clinical use and the safety of cerebrospinal fluid diagnostics in 155 patients with the suspected diagnosis of first-episode schizophrenia. Five patients (3.2%) revealed pathological findings that lead to diagnostic re-evaluation and changes in clinical management. No serious adverse events occurred, but we documented 16 (10.3%) cases of mild to moderate headache or local pain at the puncture site. Our results underline the value of lumbar puncture in the clinical workup of first-episode patients with suspected schizophrenia

Characterization and Correction of Diffusion Gradient-Induced Eddy Currents in Second-Order Motion-Compensated Echo-Planar and Spiral Cardiac DTI

Purpose Very high gradient amplitudes played out over extended time intervals as required for second-order motion-compensated cardiac DTI may violate the assumption of a linear time-invariant gradient system model. The aim of this work was to characterize diffusion gradient-related system nonlinearity and propose a correction approach for echo-planar and spiral spin-echo motion-compensated cardiac DTI. Methods Diffusion gradient-induced eddy currents of 9 diffusion directions were characterized at b values of 150 s/mm2 and 450 s/mm2 for a 1.5 Tesla system and used to correct phantom, ex vivo, and in vivo motion-compensated cardiac DTI data acquired with echo-planar and spiral trajectories. Predicted trajectories were calculated using gradient impulse response function and diffusion gradient strength- and direction-dependent zeroth- and first-order eddy current responses. A reconstruction method was implemented using the predicted -space trajectories to additionally include off-resonances and concomitant fields. Resulting images were compared to a reference reconstruction omitting diffusion gradient-induced eddy current correction. Results Diffusion gradient-induced eddy currents exhibited nonlinear effects when scaling up the gradient amplitude and could not be described by a 3D basis alone. This indicates that a gradient impulse response function does not suffice to describe diffusion gradient-induced eddy currents. Zeroth- and first-order diffusion gradient-induced eddy current effects of up to −1.7 rad and −16 to +12 rad/m, respectively, were identified. Zeroth- and first-order diffusion gradient-induced eddy current correction yielded improved image quality upon image reconstruction. Conclusion The proposed approach offers correction of diffusion gradient-induced zeroth- and first-order eddy currents, reducing image distortions to promote improvements of second-order motion-compensated spin-echo cardiac DTI.ISSN:0740-3194ISSN:1522-259

Very early anthropometric changes after antiretroviral therapy predict subsequent survival in Karonga, Malawi

BACKGROUND: Antiretroviral (ART) scale-up in Malawi has been achieved on a large scale based mainly on clinical criteria. Simple markers of prognosis are useful, and we investigated the value of very early anthropometric changes in predicting mortality.PRINCIPAL FINDINGS: Adult patients who initiated ART in Karonga District, northern Malawi, between September 2005 and August 2006 were included in a prospective cohort study, and followed for up to one year. We used Cox regression to examine the association between anthropometric changes at 2 and 6 weeks and deaths within the first year. 573 patients were included, of whom 59% were women; the median age at initiation was 37 and 64% were in WHO stage 4. Both body mass index (BMI) and mid-upper arm circumference (MUAC) increased linearly with increased time on ART, and were closely correlated with each other. There were 118 deaths. After 2 weeks on ART, a BMI increase of <0.5 kg/m(2) (HR 2.47, 95%CI 1.24-4.94, p=0.005) or a MUAC increase of <0.5cm (HR 2.79, 95%CI 1.19-6.55, p=0.008) were strong predictors of death, and these associations were stronger after adjusting for baseline charactertistics. Similar results were found after 6 weeks on ART.CONCLUSIONS: Very early anthropometric changes, after 2 and 6 weeks on ART, are strong predictors of survival, independent of baseline characteristics. This should help identify patients requiring more detailed assessment where facilities are limited. MUAC is particularly valuable, requiring the simplest equipment and being appropriate for patients who have problems standing

Familial abnormalities of endocannabinoid signaling in schizophrenia

Objectives: Epidemiological and experimental evidence suggests that the endocannabinoid system plays a pathophysiological role in schizophrenia. This is reflected by elevated cerebrospinal levels of the endocannabinoid anandamide in schizophrenia and its initial prodromal states. Methods: We analyzed plasma concentrations of anandamide, 2-arachidonoyl-sn-glycerol, palmitoylethanolamide and oleoylethanolamide from 25 twin pairs discordant for schizophrenia, six discordant for bipolar disorder and eight healthy twin pairs to determine hereditary traits. Results: Twin pairs discordant for schizophrenia or bipolar disorder had significantly higher levels of anandamide and palmitoylethanolamide compared to healthy twins (both P < 0.002). Non-affected twins discordant for schizophrenia, who developed a psychotic disorder within 5 years follow-up showed lower anandamide (P = 0.042) and 2-arachidonoyl-sn-glycerol levels (P = 0.049) than twins who remained healthy. Conclusions: We suggest that the protective upregulation of endocannabinoid signalling reflects either a hereditary trait or mirrors a modulating response to genetically influenced cerebral function involving, e.g., other neurotransmitters or energy metabolism