No abstract available.
Endocrinology* ; Metabolism*

Objectives: The adherence to antipsychotics is essential for relapse prevention in schizophrenia. Although 40–60% of schizophrenia patients suffer from non-adherence problems, some patients had consistently good adherence. They are clinically desirable examples of non-adherent patients. This qualitative study aimed to explore the actors influencing medication adherence in people with schizophrenia with good adherence to the patients’ perspectives. Methods: In-depth semi-structured interviews were conducted with 23 subjects with schizophrenia. Narratives were elicited on the attitudes toward illness and treatment, familiar support for treatment, and perceived stigma about psychosis over time. Results: In the process of changing from non-adherence to adherence, symptomatic relapse, involuntary treatment, and familial support played leading roles. The patients’ experiences on their own made them accept the illness and necessity of medications. Once the patients accepted the need for treatments, side effects and social stigma did not influence their adherence. Reducing psychotic symptoms was the priority of the treatment effects on the patients’ perspectives. Conclusion Adherence in schizophrenia requires multiple factors that affect the attitude toward illness and medication over time. Therefore, it is necessary to understand the specific process of adherence and develop the relevant interventions to facilitate those processes over time.

OBJECTIVES: Clozapine is the drug of choice in treatment-resistant schizophrenia. However, its use is often delayed and a significant proportion of clozapine treated patients fails to respond and experience potentially dangerous side-effects. The aim of this retrospective study was to describe the clinical characteristics of patients started on clozapine and the rate and reason of discontinuation of clozapine. METHODS: Medical records of 83 patients started on clozapine during the period of 2012–2016 were reviewed. RESULTS: Clozapine started on patients in chronic phase; the mean age of start was 38.1 years old and the mean number of psychiatric admission was 6.5. A majority (80.7%) of the patients had been subjected to antipsychotic polypharmacy prior to clozapine and most (61.5%) of them were being treated with polypharmacy including clozapine. Overall, 39 (47.0%) subjects had continued clozapine whereas 15 (18.1%) discontinued it; 29 (34.9%) were lost to follow-up. The most common reason for discontinuation was side-effects (n=13) including six life-threatening cases, most of which occurred within 6 months of its start. CONCLUSION: This study demonstrated that there is some evidence of delays to clozapine use, high rates of polypharmacy and significant rate of discontinuation during the early phase of clozapine treatment.
Antipsychotic Agents ; Clozapine ; Humans ; Lost to Follow-Up ; Medical Records ; Polypharmacy ; Retrospective Studies ; Schizophrenia

Systemic lupus erythematosus(SLE) is a disease of unknown etiology in which multiple organs are damaged by pathogenic autoantibodies and immune complexes. Neuropsychiatric manifestations in SLE were first described by Kaposi in 1872. These are so diverse that they include psychosis, depression, stroke, seizure and cognitive dysfunction etc. These patients are frequently consulted for psychiatric evaluation. Neuropsychiatric manifestations in SLE are also among the leading causes of morbidity and mortality and associated with poor long-term outcome. So it is essential to recognize and intervene these symptoms early. But the clear diagnostic criteria for CNS involvement in SLE have not been formulated, and diversity and fluctuation of illness make it difficult to confirm it. The authors reported three cases of SLE with severe neuropsychiatric manifestations. These patients showed symptoms such as disorientation, auditory and visual hallucibation, delusion and mood instability. They became frequently impulsive and violent and had risks to injure themselves or others. Although CNS involvement in SLE is not well known, we reviewed the pathogenesis, classification, diagnosis, clinical manifestation and treatment of them.
Antigen-Antibody Complex ; Autoantibodies ; Classification ; Delusions ; Depression ; Diagnosis ; Humans ; Lupus Erythematosus, Systemic* ; Mortality ; Psychotic Disorders ; Seizures ; Stroke

PURPOSE: This study assessed the association between the ratio of leukotriene E4 (LTE4) to fractional exhaled nitric oxide (FENO) in the response of children with exercise-induced bronchoconstriction (EIB) enrolled in a therapeutic trial with montelukast or inhaled corticosteroid (fluticasone propionate [FP]). METHODS: Children aged 6 to 18 years with EIB were randomized in a 4-week, placebo-controlled, double-blinded trial with montelukast or FP. Before and after treatment, treadmill exercise challenges were performed. The LTE4 levels in the induced sputum and urine and the FENO levels were measured in subjects before and 30 minutes after the exercise challenges. The same tests were conducted after treatment. RESULTS: A total of 24 patients completed the study: 12 in the montelukast group and 12 in FP group. Both study groups displayed a similar postexercise maximum decrease in forced expiratory volume in one second (FEV1) before treatment as well as after treatment. However, there were significant differences in the magnitude of change between the two (Delta; -18.38+/-14.53% vs. -4.67+/-8.12% for the montelukast and FP groups, respectively; P=0.021). The Delta logarithmic sputum baseline and postexercise LTE4/FENO ratio were significantly lower in the montelukast group than in the FP group (baseline; -0.09+/-0.21 vs. -0.024+/-0.03, P=0.045; postexercise, -0.61+/-0.33 vs. -0.11+/-0.28, P=0.023). CONCLUSIONS: These data indicate that the efficacy of montelukast for preventing a maximum decrease in FEV1 after exercise is significantly higher than that of FP, and the high LTE4/FENO ratio is associated with a greater response to montelukast than to FP for EIB therapy. These results suggest that LTE4 may play an important role in EIB.
Acetates ; Aged ; Bronchoconstriction ; Child ; Diethylpropion ; Forced Expiratory Volume ; Humans ; Leukotriene E4 ; Nitric Oxide ; Quinolines ; Sputum

PURPOSE: The social and economic impact of asthma is remarkable worldwide. To date, there have been many unanswered questions about factors related to asthma progression and persistence. This study focused on possible risk factors for persistent asthma that had developed between infancy and late childhood. METHODS: Sixty-seven children with persistent mild-to-moderate asthma were enrolled in this study. They were classified into 2 groups according to the Global Initiative for Asthma (GINA) guideline 2006: early-onset (<3 years, n=28) and late-onset (>3 years, n=39) asthmatics. All patients were interviewed on the personal and familial history of atopy, breast feeding, parental smoking and the recent use of inhaled corticosteroids. We performed spirometry, and skin prick tests and measured body mass index, serum allergen-specific IgE, serum eosinophil counts and serum ECP in asthmatics. All asthmatics underwent the bronchial challenge by methacholine inhalation and outdoor free running. RESULTS: Risk factors such as eczema and frequent wheezing were more common in early-onset asthmatics than in late-onset asthmatics (P<0.05). However, there was no difference between the 2 groups in the overall incidence of airway hyperresponsiveness (AHR) determined by the PC20 and postexercise decrease of FEV1 (P>0.05). Inhaled corticosteroids were more frequently used in early-onset asthmatics than in late-onset asthmatics (P<0.0001). A reciprocal relationship between FEV1/FVC and the duration of asthma was also detected in persistent asthmatics (n=57, r=-0.398, P=0.002). CONCLUSION: The results of this study suggest that atopic dermatitis and frequent wheezing may be important risk factors for the persistence of asthma and lung function decline from early to late childhood.
Adrenal Cortex Hormones ; Asthma ; Body Mass Index ; Breast Feeding ; Bronchial Provocation Tests ; Child ; Dermatitis, Atopic ; Eczema ; Eosinophils ; Humans ; Immunoglobulin E ; Incidence ; Inflammation ; Inhalation ; Lung ; Methacholine Chloride ; Parents ; Respiratory Sounds ; Risk Factors ; Running ; Skin ; Smoke ; Smoking ; Spirometry

PURPOSE: The prevalence of asthma and obesity is increasing concomitantly, but the link between asthma and obesity is unclear. We sought to address possible roles of leptin and adiponectin in the development of asthma, and changes in pulmonary function in overweight children. METHODS: Four study groups of 61 children aged 6 to 18 years (mean age, 9.69+/-2.16) were enrolled: (1) 14 mild-to-moderate asthmatics with overweight, (2) 16 mild-to-moderate asthmatics with normal weight, (3) 16 obese subjects without asthma, and (4) 15 healthy controls. We measured biomarkers in blood, including total and allergen-specific IgE, eosinophil, eosinophilc cationic protein (ECP), leptin, adiponectin, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), lipid profiles, insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein 3 (IGF-BP3). Body mass index (BMI), antioxidants and micronutrients in a daily diet were evaluated by the questionnaire. We performed the bronchial challenge test by methacholine inhalation and free running, respectively. RESULTS: The leptin levels was apparently high, and the adiponectin level was low in the over-weight children, as depicting a significant inverse correlation between the 2 variables (R=-0.479; P<0.001). The FEV(1)/FVC ratio was low in the overweight children regardless of the presence of asthma. However, the effect of IL-6, TNF-alpha, nutrients, and other variables on asthma development in the overweight children with asthma was not verified. CONCLUSION: In this study, the levels of leptin, adiponectin or other obesity-related biomarkers were not independently associated with asthma. Therefore, it is concluded that obesity may not be an important factor in pulmonary function impairment.
Adiponectin ; Aged ; Aluminum Hydroxide ; Antioxidants ; Asthma ; Biomarkers ; Body Mass Index ; Bronchial Provocation Tests ; Carbonates ; Child ; Diet ; Eosinophils ; Humans ; Immunoglobulin E ; Inhalation ; Insulin-Like Growth Factor Binding Protein 3 ; Interleukin-6 ; Interleukins ; Leptin ; Methacholine Chloride ; Micronutrients ; Obesity ; Overweight ; Prevalence ; Surveys and Questionnaires ; Running ; Tumor Necrosis Factor-alpha

PURPOSE: The present study investigates the long-term effects of intravenous immunoglobulin (IVIg) therapy for the treatment of moderate to severe childhood atopic dermatitis (AD). Previous research indicates that IVIg can treat severe AD; however, the effectiveness of IVIg has not been confirmed in prospective, blinded clinical trials. METHODS: Forty eligible children with moderate to severe AD, as defined by the criteria of Hanifin and Rajka, were enrolled in a randomized, placebo-controlled study. After the completion of an initial screening visit (V0), the patients were randomly allocated into therapy (n=30) and control (n=10) groups (V1). Thirty children were each treated with three injections of 2.0 g/kg IVIg at 1-month intervals over a 12-week period. Ten children were treated with placebo. Assessments were conducted after each injection (V2, V3, and V4) and at 3 (V5) and 6 months (V6) after completed treatment. RESULTS: The disease severity index was significantly decreased at V5 compared with the value at V1 (P<0.05). There were no significant changes in the total IgE level or total eosinophil count in peripheral blood at the last injection (V4) compared with the value at V1. The interleukin (IL)-5/interferon (IFN)-gamma ratio was assessed in T-helper 1 (Th1) and Th2 cells. The ratio significantly decreased between V1 and V5, after which it increased, such that the ratio at V6 was not significantly different from that at V1. Compared with the level at V1, the intercellular cell adhesion molecule-1 level at V4 did not differ significantly, but the level at V5 was lower. CONCLUSIONS: This study suggests that IVIg therapy may clinically improve AD in patients after 3 months of therapy, but the improvement may decline by 6 months after therapy.
Cell Adhesion ; Child ; Dermatitis, Atopic ; Eosinophils ; Humans ; Immunization, Passive ; Immunoglobulin E ; Immunoglobulins ; Immunoglobulins, Intravenous ; Interleukins ; Mass Screening ; Prospective Studies ; Th2 Cells

Redox-regulating molecule, recombinant human thioredoxin (rhTRX) which shows anti-inflammatory, and anti-oxidative effects against lipopolysaccharide (LPS)-stimulated inflammation and regulate protein expression levels. LPS-induced reactive oxygen intermediates (ROI) and NO production were inhibited by exogenous rhTRX. We identified up/downregulated intracellular proteins under the LPS-treated condition in exogenous rhTRX-treated A375 cells compared with non-LPS-treated cells via 2-DE proteomic analysis. Also, we quantitatively measured cytokines of in vivo mouse inflammation models using cytometry bead array. Exogenous rhTRX inhibited LPS-stimulated production of ROI and NO levels. TIP47 and ATP synthase may influence the inflammation-related lipid accumulation by affecting lipid metabolism. The modulation of skin redox environments during inflammation is most likely to prevent alterations in lipid metabolism through upregulation of TIP47 and ATP synthase and downregulation of inflammatory cytokines. Our results demonstrate that exogenous rhTRX has anti-inflammatory properties and intracellular regulatory activity in vivo and in vitro. Monitoring of LPS-stimulated pro-inflammatory conditions treated with rhTRX in A375 cells could be useful for diagnosis and follow-up of inflammation reduction related with candidate proteins. These results have a therapeutic role in skin inflammation therapy.
Animals ; Antioxidants/*pharmacology ; Cell Line, Tumor ; Humans ; Inflammation/metabolism ; *Lipid Metabolism ; Lipopolysaccharides/pharmacology ; Mice ; Mice, Inbred C57BL ; Nitric Oxide/metabolism ; Proteome/genetics/metabolism ; Skin/drug effects/metabolism/pathology ; Thioredoxins/*pharmacology

Purpose: This study investigated the orthodontic tooth movement after weekly parathyroid hormone (PTH) injection in mongrel dogs and analyzes bone formation activity on the tension and pressure sides of the tooth movement in mongrel dogs. Materials and Methods: Three mongrel dogs were used in this study. The first premolar was extracted and orthodontic force using 150 g of closed coil springs between the canine and second premolar was applied. The low-dose PTH group (PTH_1) and high-dose PTH group (PTH_2) received weekly injections of 1.61 μg/kg and 3.23 μg/kg of PTH, respectively. The control group received weekly injections of 1 ml of saline. Clinical, histomorphometric analysis were carried out.Result: The orthodontic tooth movement was greatest in the PTH_2 group and the lowest in the control group. Fluorescence staining images showed higher bone remodeling on the tension side of the tooth movement in the PTH_1 and PTH_2 groups. PTH_2 group showed a thicker labeling band than the PTH_1 group. PTH_2 group showed the highest mineral apposition rate and bone formation rate, followed by the PTH_1 group and the control group. Conclusion Weekly intermittent PTH injection, especially in the short-term and at higher doses with orthodontic force, successfully increased orthodontic tooth movement and bone remodeling in mongrel dogs.