The beginning of human life under time-laps Cinematography

Background and Purpose: The aim of this study was to follow and record the early stages of development of a human embryo using time-lapse cinematography, and to discuss the beginning of human life. Materials and Methods: Human ova were incubated in thermo-stabilized and pH controlled chambers and observed using an inverted microscope fitted with a CCD digital camera. Images were taken at 2-minute intervals for 5–6 days. A total of 30 consecutive images, corresponding to an hour of incubation, could then be replayed in 1 second. This allowed us to watch the development of embryos over 5–6 days in a few minutes. Results and Conclusion: We observed fertilization of an ovum with a single spermatozoon followed by early cleavages, formation of the morula, blastocyst hatching and changes in the embryonic plates and the development of monozygotic twins in 2 of 3 incubated blastocysts. TLC has contributed enormously to our understanding of the morphological mechanisms of fertilization and embryonic development.We would like to suggest that the time at which stem cell-like morula cells form the differentiated blastocyst is the point at which human life begins, and that the ET of blastocyst may increase the risk of monozygotic twins

Efficacy of shared decision making on treatment satisfaction for patients with first-admission schizophrenia: study protocol for a randomised controlled trial

BACKGROUND: Shared decision making is a promising model for patient-centred medicine, resulting in better clinical outcomes overall. In the mental health field, interventions that consider the patient-centred perspective—such as patient quality of life, involvement in the treatment, treatment satisfaction, and working alliance—have increased and better clinical outcomes discovered for patients with schizophrenia. However, few studies have examined the efficacy of shared decision making for schizophrenia treatment. The objective of this study is to evaluate the effect of a shared decision making intervention compared to treatment as usual on patient satisfaction at discharge for first-admission patients with schizophrenia. METHODS/DESIGN: This is a randomised, parallel-group, two-arm, open-label, single-centre study currently being conducted in an acute psychiatric ward of Numazu Chuo Hospital, Japan. We are recruiting patients between 16 and 65 years old who are admitted to the ward with a diagnosis of schizophrenia without prior experience of psychiatric admission. Fifty-eight participants are being randomised into a shared decision making intervention group or a treatment as usual control group in a 1:1 ratio. The intervention program was developed based on a shared decision making model and is presented as a weekly course lasting the duration of the patients’ acute psychiatric ward stay. The primary outcome measure is patient satisfaction at discharge as assessed by the Client Satisfaction Questionnaire. Due to the study’s nature, neither the patient nor staff can be blinded. DISCUSSION: This is the first randomised controlled trial to evaluate the efficacy of shared decision making for patients with early-treatment-stage schizophrenia. The intervention program in this study is innovative in that it includes both of the patient and staff who are involved in the treatment. TRIAL REGISTRATION: The study has been registered with ClinicalTrials.gov as NCT01869660

Eradication rate of Helicobacter pylori according to genotypes of CYP2C19, IL-1B, and TNF-A

<p><b>Background: </b>Lansoprazole, amoxicillin, and clarithromycin are commonly used drugs for eradication of <i>Helicobacter pylori</i> (<i>H. pylori</i>). A few studies reported that the eradication rate was influenced by the functional polymorphism of <i>CYP2C19</i>, whose product metabolizes proton pomp inhibitors including lansoprazole.</p> <p><b>Methods: </b>This study examined the eradication rate among 67 participants in the polymorphism study who visited Daiko Medical Center, Nagoya University from July 2004 to October 2005. The participants aged 20 to 69 years were classified into three group according to <i>CYP2C19</i> genotype; rapid metabolizers (RM) with <i>*1*1</i> genotype, intermediate metabolizers (IM) with <i>*1*2 </i>or <i>*1*3</i> genotype, and poor metabolizers (PM) with <i>*2*2, *2*3, </i>or <i>*3*3</i> genotype. For the genotype classification, G681A (<i>681G</i> for <i>*1</i> and <i>681A</i> for<i> *2</i>) and G636A (<i>636G</i> for <i>*1</i> and <i>636A</i> for <i>*3</i>) were genotyped by PCR with confronting two-pair primers (PCR-CTPP). They were also genotyped for <i>IL-1B</i> T-31C and <i>TNF-A</i> T-1031C by a duplex PCR-CTPP.</p> <p><b>Results: </b>The eradication rate was 70.0% for RM, 93.9% for IM, and 85.7% for PM. The difference in the rate between RM and IM+PM was statistically significant (p=0.025). The eradication rate was highest for those with <i>IL-1B -31CC</i>; the p value was marginal among the whole subjects (&#967;²=3.78, p=0.05) and not significant among the RM group (&#967;²=1.60, p=0.21). The genotypes of <i>TNF-A</i> T-1031C had no associations with the eradication rate. But among the RM group, the odd ratio (OR) of the <i>TNF-A CT</i> for the eradication rate relative to <i>TT</i> was marginally reduced (OR=0.05, 95% confidence interval, 0.002-1.19).</p> <p><b>Conclusions</b>: The present study confirmed the low eradication rate for RM. The reproduced finding provides evidence that the <i>CYP2C19</i> genotype is useful to predict the success of the treatment. For the RM group, alternative regimens expected to be with a higher eradication rate will be recommended, especially to those with the <i>TNF-A -1031C</i> allele.</p