Off-label utilization of antidepressants

Rapport de synthèse : De nombreuses études sont effectuées sur les antidépresseurs avant leur mise sur le marché, puis des règles précises sont établies pour leur prescription dans des indications délimitées. Leur utilisation dans des indications «off-label » (hors indication officiellement admise) manque souvent de validation par des bases de données scientifiques et leur prescription se base le plus souvent sur un consensus proposé par des experts. Le but du présent travail a été d'étudier les habitudes de prescription de psychiatres d'hôpitaux en ce qui concerne les antidépresseurs, en comparant des patients traités pour une dépression et des troubles anxieux avec des patients recevant un traitement «off-label ». Pour cette étude, les données d'utilisation de médicaments sont celles recueillies lors de 6 jours de référence, entre avril 1999 et novembre 2001, à l'hôpital psychiatrique de Lausanne (Suisse) comprenant 98 lits. La prescription de médicaments chez 174 patients a été prise en compte. Tandis que le diagnostic n'influençait pas le choix entre des nouveaux et anciens antidépresseurs, les patients présentant un trouble anxieux avaient un risque 4.5 fois (p < 0.05) plus élevé et les patients présentant un autre diagnostic 8 fois plus élevé de recevoir une comédication antipsychotique, en comparaison avec des patients dont le diagnostic primaire était un trouble dépressif. De plus, les patients recevant comme comédication un hypnotique non-benzodiazépine avaient moins de risque que l'on prescrive un ancien antidépresseur (p < 0.05). Alors que les patients avec un trouble anxieux et ceux souffrant d'une dépression majeure recevaient un antidépresseur à des doses comparables, les patients répondant à une indication off-label étaient de préférence traités avec des doses plus faibles. Les résultats de cette étude suggèrent que les psychiatres d'hôpitaux développent des préférences en ce qui concerne le choix de la classe d'antidépresseurs, et qu'ils les utilisent alors aussi bien dans des indications reconnues que non-reconnues. Puis ils semblent adapter la dose et la comédication en tenant compte du diagnostic, ce qui confirme l'hypothèse initiale de l'étude,

Glucose uptake, utilization, and signaling in GLUT2-null islets.

We previously reported that pancreatic islet beta-cells from GLUT2-null mice lost the first phase but preserved the second phase of glucose-stimulated insulin secretion (GSIS). Furthermore, we showed that the remaining secretory activity required glucose uptake and metabolism because it can be blocked by inhibition of oxidative phosphorylation. Here, we extend these previous studies by analyzing, in GLUT2-null islets, glucose transporter isoforms and glucokinase expression and by measuring glucose usage, GSIS, and glucose-stimulated insulin mRNA biosynthesis. We show that in the absence of GLUT2, no compensatory expression of either GLUT1 or GLUT3 is observed and that glucokinase is expressed at normal levels. Glucose usage by isolated islets was increased between 1 and 6 mmol/l glucose but was not further increased between 6 and 20 mmol/l glucose. Parallel GSIS measurements showed that insulin secretion was not stimulated between 2.8 and 6 mmol/l glucose but was increased by &gt;4-fold between 6 and 20 mmol/l glucose. Stimulation by glucose of total protein and insulin biosynthesis was also markedly impaired in the absence of GLUT2. Finally, we re-expressed GLUT2 in GLUT2-null beta-cells using recombinant lentiviruses and demonstrated a restoration of normal GSIS. Together, these data show that in the absence of GLUT2, glucose can still be taken up by beta-cells, albeit at a low rate, and that this transport activity is unlikely to be attributed to GLUT1 or GLUT3. This uptake activity, however, is limiting for normal glucose utilization and signaling to secretion and translation. These data further demonstrate the key role of GLUT2 in murine beta-cells for glucose signaling to insulin secretion and biosynthesis.

Metabolic predictors of obesity. Contribution of resting energy expenditure, thermic effect of food, and fuel utilization to four-year weight gain of post-obese and never-obese women.

This prospective study was designed to identify abnormalities of energy expenditure and fuel utilization which distinguish post-obese women from never-obese controls. 24 moderately obese, postmenopausal, nondiabetic women with a familial predisposition to obesity underwent assessments of body composition, fasting and postprandial energy expenditure, and fuel utilization in the obese state and after weight loss (mean 12.9 kg) to a post-obese, normal-weight state. The post-obese women were compared with 24 never-obese women of comparable age and body composition. Four years later, without intervention, body weight was reassessed in both groups. Results indicated that all parameters measured in the post-obese women were similar to the never-obese controls: mean resting energy expenditure, thermic effect of food, and fasting and postprandial substrate oxidation and insulin-glucose patterns. Four years later, post-obese women regained a mean of 10.9 kg while control subjects remained lean (mean gain 1.7 kg) (P < 0.001 between groups). Neither energy expenditure nor fuel oxidation correlated with 4-yr weight changes, whereas self-reported physical inactivity was associated with greater weight regain. The data suggest that weight gain in obesity-prone women may be due to maladaptive responses to the environment, such as physical inactivity or excess energy intake, rather than to reduced energy requirements.

The TREAT-NMD Duchenne Muscular Dystrophy Registries: Conception, Design, and Utilization by Industry and Academia.

Duchenne muscular dystrophy (DMD) is an X-linked genetic disease, caused by the absence of the dystrophin protein. Although many novel therapies are under development for DMD, there is currently no cure and affected individuals are often confined to a wheelchair by their teens and die in their twenties/thirties. DMD is a rare disease (prevalence <5/10,000). Even the largest countries do not have enough affected patients to rigorously assess novel therapies, unravel genetic complexities, and determine patient outcomes. TREAT-NMD is a worldwide network for neuromuscular diseases that provides an infrastructure to support the delivery of promising new therapies for patients. The harmonized implementation of national and ultimately global patient registries has been central to the success of TREAT-NMD. For the DMD registries within TREAT-NMD, individual countries have chosen to collect patient information in the form of standardized patient registries to increase the overall patient population on which clinical outcomes and new technologies can be assessed. The registries comprise more than 13,500 patients from 31 different countries. Here, we describe how the TREAT-NMD national patient registries for DMD were established. We look at their continued growth and assess how successful they have been at fostering collaboration between academia, patient organizations, and industry.

Body fat distribution in white and black women: different patterns of intraabdominal and subcutaneous abdominal adipose tissue utilization with weight loss.

BACKGROUND: Intraabdominal adipose tissue (IAAT) is the body fat depot most strongly related to disease risk. Weight reduction is advocated for overweight people to reduce total body fat and IAAT, although little is known about the effect of weight loss on abdominal fat distribution in different races. OBJECTIVE: We compared the effects of diet-induced weight loss on changes in abdominal fat distribution in white and black women. DESIGN: We studied 23 white and 23 black women, similar in age and body composition, in the overweight state [mean body mass index (BMI; in kg/m(2)): 28.8] and the normal-weight state (mean BMI: 24.0) and 38 never-overweight control women (mean BMI: 23.4). We measured total body fat by using a 4-compartment model, trunk fat by using dual-energy X-ray absorptiometry, and cross-sectional areas of IAAT (at the fourth and fifth lumbar vertebrae) and subcutaneous abdominal adipose tissue (SAAT) by using computed tomography. RESULTS: Weight loss was similar in white and black women (13.1 and 12.6 kg, respectively), as were losses of total fat, trunk fat, and waist circumference. However, white women lost more IAAT (P < 0.001) and less SAAT (P < 0.03) than did black women. Fat patterns regressed toward those of their respective control groups. Changes in waist circumference correlated with changes in IAAT in white women (r = 0.54, P < 0.05) but not in black women (r = 0.19, NS). CONCLUSIONS: Despite comparable decreases in total and trunk fat, white women lost more IAAT and less SAAT than did black women. Waist circumference was not a suitable surrogate marker for tracking changes in the visceral fat compartment in black women.

Influence of micronutrients on dry matter yield and interaction with other nutrients in annual crops

The objective of this work was to determine the influence of Zn, Mn and Cu on shoot dry matter yield and uptake of macro and micronutrients in upland rice, common bean and corn. Six greenhouse experiments were conducted using a Dark Red Latosol (Typic Haplusthox). Treatments consisted of application of Zn at 0, 5, 10, 20, 40, 80 and 120 mg kg-1, of Mn at 0, 10, 20, 40, 80, 160, 320 and 640 mg kg-1 and of Cu application at 0, 2, 4, 8, 32, 64 and 96 mg kg-1. Zinc increased yield of rice, Mn increased yields of corn and bean and Cu improved yields of rice and bean. Uptake of N, Ca, and Cu in rice was decreased by zinc treatment. In common bean, uptake of N, Mg, and Cu was increased by zinc application, whereas, uptake of P was decreased. Manganese increased uptake of Mg, Zn and Fe and decreased uptake of Ca, in corn. Uptake of K, Zn and Mn was increased and uptake of P and Cu was decreased by Mn application, in bean. Copper had positive and negative interactions in the uptake of macro and micronutrients, depending on crop species and nutrients involved.

Foods, nutrients and the risk of oral and pharyngeal cancer.

Background:Besides tobacco and alcohol, dietary habits may have a relevant role in oral cavity and pharyngeal (OCP) cancer.Methods:We analysed the role of selected food groups and nutrients on OCP cancer in a case-control study carried out between 1997 and 2009 in Italy and Switzerland. This included 768 incident, histologically confirmed squamous cell carcinoma cases and 2078 hospital controls. Odds ratios (ORs) were estimated using logistic regression models including terms for tobacco, alcohol and other relevant covariates.Results:Significant inverse trends in risk were observed for all vegetables (OR=0.19, for the highest vs the lowest consumption) and all fruits (OR=0.39), whereas significant direct associations were found for milk and dairy products (OR=1.50), eggs (OR=1.71), red meat (OR=1.55), potatoes (OR=1.85) and desserts (OR=1.68), although trends in risk were significant only for potatoes and desserts. With reference to nutrients, significant inverse relations were observed for vegetable protein (OR=0.45, for the highest vs the lowest quintile), vegetable fat (OR=0.54), polyunsaturated fatty acids (OR=0.53), α-carotene (OR=0.51), β-carotene (OR=0.28), β-cryptoxanthin (OR=0.37), lutein and zeazanthin (OR=0.34), vitamin E (OR=0.26), vitamin C (OR=0.40) and total folate (OR=0.34), whereas direct ones were observed for animal protein (OR=1.57), animal fat (OR=2.47), saturated fatty acids (OR=2.18), cholesterol (OR=2.29) and retinol (OR=1.88). Combinations of low consumption of fruits and vegetables, and high consumption of meat with high tobacco and alcohol, led to 10- to over 20-fold excess risk of OCP cancer.Conclusion:Our study confirms and further quantifies that a diet rich in fruits and vegetables and poor in meat and products of animal origin has a favourable role against OCP cancer.

Symptomatic complex partial status epilepticus manifesting as utilization behavior of a mobile phone.

Utilization behavior (UB) consists of reaching out and using objects in the environment in an automatic manner and out of context. This behavior has been correlated to frontal lobe dysfunction, especially of the right hemisphere. We describe a 60-year-old woman, affected by a glioblastoma located in the right frontal region, who presented with intermittent UB of the mobile phone as the main clinical manifestation of partial complex status epilepticus. Video/EEG studies showed a striking correlation between mobile phone utilization and ictal epileptic activity. Clinical and EEG findings were markedly reduced after the introduction of antiepileptic drugs. This case study suggests that UB may be added to the symptoms described for partial seizures originating from frontal areas.

Efecte sobre la capacitat d'intercanvi catiònic del sòl i la retenció de nutrients de les aplicacions de biochar en sòls agrícoles

El biochar, o biocarbó, és un material produït a partir de la piròlisi de biomassa, consistent en la descomposició tèrmica de la matèria orgànica a baixa o nul·la concentració d’oxigen. La seva definició més acceptada és la d’un material pirolitzat destinat a ser utilitzat en el sòl, quedant fora d’aquesta denominació materials produïts per a ser utilitzats com a combustible. La gran varietat de materials pirolitzables i de tecnologies de piròlisi determinen un ampli ventall de biochars amb propietats físiques, químiques i biològiques molt contrastades, i que determinen la seva idoneïtat o no per a ser utilitzat com a esmena orgànica, sent la biomassa de partida un dels factors més determinants. Els processos de piròlisis generen gasos inflamables, gasos condensables inflamables (bioolis) i biochar en proporcions variables segons el tipus de piròlisi. Aquests grans tipus principals de piròlisi per la producció de biochar són: Piròlisi lenta, Piròlisi ràpida, i Gasificació. El producte biochar, totalment en procés d’investigació, es creu que pot tenir grans beneficis ambientals en diferents àmbits: Biochar com a millora de la fertilitat, Biochar com a via de gestió de residus, Biochar per producció d’energia, i Biochar per la mitigació del canvi climàtic. Cal tenir en compte possibles riscos a l’hora d’aplicar biochar en sòls. Ja que el producte final varia segons el material de partida. En especial quan es genera biochar a partir de residus, ja siguin de depuradora, industrials o ramaders, degut que el seu contingut en contaminants pot ser perjudicial pel medi ambient i per la salut de les plantes. Els contaminats presents, sobretot metalls pesats i hidrocarburs aromàtics policíclics (PAH), són difícilment eliminats o es produeixen “de novo” durant el procés de piròlisi, respectivament, de manera que amb les aplicacions de biochar poden causar impactes negatius. En aquest projecte, es centre especial atenció en una única característica del sòl, com es la capacitat d’intercanvi catiònic (CIC). La CIC és la capacitat que té el sòl per retenir i alliberar ions amb càrrega positiva. Per les seves característiques, l’argila i la matèria orgànica són les que condicionen la CIC total d’un sòl, ja que aquestes contenen carregues negatives a la seva superfície. La CIC proporciona als sòls la capacitat de retenir nutrients, necessaris per el creixement de les plantes, per tant una major CIC incrementa la fertilitat dels sòls, així com permet reduir les pèrdues d’aquests nutrients per lixiviació i mitigar possible contaminació de les aigües. L’objectiu principal del projecte doncs, és estudiar el potencial ús d’un biochar de gasificació com esmena orgànica per a sòls agrícoles alcalins mediterranis, i més concretament el seu paper per a millora de la retenció de nutrients en relació al potencial augment de la capacitat d’intercanvi catiònic (CIC) del sòl 18 mesos després de la seva aplicació en parcel·les de camp. Les conclusions finals no han estat del tot satisfactòries, degut que no s’han trobat diferències en la CIC, havent de rebutjar la hipòtesi de partida. Tot i que hi ha diferents factors que poden ser la causa d’aquests resultats. Una possibilitat, probablement la que dona major explicació, és el poc temps transcorregut des de l’aplicació de biochar fins al moment de les anàlisis.

The Utilization of Agriculturally Derived Lignin as an Antioxidant in Asphalt Binder, TR-557, 2008

Oxidation is the primary cause of long-term aging in asphalt pavements. As a pavement oxidizes, it stiffens and can eventually crack. The use of an antioxidant as a performance enhancer in an asphalt binder could delay aging, thus increasing the life of an asphalt pavement. Lignin is a highly available and well-studied antioxidant. A wet-mill ethanol plant produces several co-products, some of which contain lignin. The use of lignin from ethanol production could provide a benefit to asphalt pavements and also give more value to the co-products. The following research examined the effects of lignin on asphalt pavements. Three lignin-containing co-products were separately combined with four asphalt binders in varying amounts to determine the optimum amount of co-product that would provide the greatest benefit to the asphalt binders. The asphalt binder and co-product blends were evaluated according to Superpave specifications and performance graded on a continuous scale. The data indicated a stiffening effect on the binder caused by the addition of the co-products. The more a co-product was added, the more a binder stiffened. Binder stiffening benefited the high temperature properties and the low temperature binder properties were negatively affected. However, the low temperature stiffening effects were small and in many cases not significant. The co-products had an overall effect of widening the temperature range of the binders. This result suggests some antioxidant activity between the binder and the lignin. Testing with a fourth co-product with no lignin supported the idea that lignin acts as an antioxidant. The samples with no lignin aged significantly more than the samples with lignin. Infrared spectrometry also supported the idea that lignin acts as an antioxidant by observing decreases in some oxidative aging products.

Phosphorus acquisition and internal utilization efficiency in tropical maize genotypes

The objective of this work was to determine the relative importance of phosphorus acquisition efficiency (PAE - plant P uptake per soil available P), and phosphorus internal utilization efficiency (PUTIL - grain yield per P uptake) in the P use efficiency (PUE - grain yield per soil available P), on 28 tropical maize genotypes evaluated at three low P and two high P environments. PAE was almost two times more important than PUTIL to explain the variability observed in PUE, at low P environments, and three times more important at high P environments. These results indicate that maize breeding programs, to increase PUE in these environments, should use selection index with higher weights for PAE than for PUTIL. The correlation between these two traits showed no significance at low or at high P environments, which indicates that selection in one of these traits would not affect the other. The main component of PUTIL was P quotient of utilization (grain yield per grain P) and not the P harvest index (grain P per P uptake). Selection to reduce grain P concentration should increase the quotient of utilization and consequently increase PUTIL.

Effects of nutrients and turbulence on the production of transparent exopolymer particles: a mesocosm study

The production of transparent exopolymer particles (TEP) in response to several environmental variables was studied in 2 mesocosm experiments. The first (Expt 1) examined a gradient of 4 nutrient levels; the second (Expt 2) examined different conditions of silicate availability and zooplankton presence. Tanks were separated in 2 series, one subjected to turbulence and the other not influenced by turbulence. In tanks with nutrient addition, TEP were rapidly formed, with net apparent production rates closely linked to chl a growth rates, suggesting that phytoplankton cells were actively exuding TEP precursors. High nutrient availability increased the absolute concentration of TEP; however, the relative quantity of TEP produced was found to be lower, as TEP concentration per unit of phytoplankton biomass was inversely related to the initial nitrate dose. In Expt 1, an increase in TEP volume (3 to 48 µm equivalent spherical diameter) with nutrient dose was observed; in Expt 2, both silicate addition and turbulence enhanced TEP production and favored aggregation to larger TEP (>48 µm). The presence of zooplankton lowered TEP concentration and changed the size distribution of TEP, presumably by grazing on TEP or phytoplankton. For lower nutrient concentrations, the ratio of particulate organic carbon (POC) to particulate organic nitrogen (PON) followed the Redfield ratio. At higher nutrient conditions, when nutrients were exhausted during the post-bloom, a decoupling of carbon and nitrogen dynamics occurred and was correlated to TEP formation, with a large flow of carbon channeled toward the TEP pool in turbulent tanks. TEP accounted for an increase in POC concentration of 50% in high-nutrient and turbulent conditions. The study of TEP dynamics is crucial to understanding the biogeochemical response of the aquatic system to forcing variables such as nutrient availability and turbulence intensity.