What is the best approach to treating schizophrenia in developing countries?

BACKGROUND TO THE DEBATE: Schizophrenia affects an estimated 25 million people in low- and middle-income countries, with an average lifetime risk of about 1%. The illness is associated with excess mortality from a variety of causes. A 2001 Institute of Medicine report on mental illness in developing countries found that in 1990, over two-thirds of people with schizophrenia in these countries were not receiving any treatment (http://www.nap.edu/catalog/10111.html). The report found no evidence that the proportion of treated people in the developing world had increased since 1990. There is now a debate among mental health professionals in low-income countries over how best to improve patient care. In this article, three psychiatrists give their different viewpoints on the current status of treatment efforts for schizophrenia in the developing world and the measures that can be taken to increase the proportion of patients receiving treatment.     

What is the best reference RNA? And other questions regarding the design and analysis of two-color microarray experiments

The reference design is a practical and popular choice for microarray studies using two-color platforms. In the reference design, the reference RNA uses half of all array resources, leading investigators to ask: What is the best reference RNA? We propose a novel method for evaluating reference RNAs and present the results of an experiment that was specially designed to evaluate three common choices of reference RNA. We found no compelling evidence in favor of any particular reference. In particular, a commercial reference showed no advantage in our data. Our experimental design also enabled a new way to test the effectiveness of pre-processing methods for two-color arrays. Our results favor using intensity normalization and foregoing background subtraction. Finally, we evaluate the sensitivity and specificity of data quality filters, and we propose a new filter that can be applied to any experimental design and does not rely on replicate hybridizations.     

What is the best approach to reducing birth defects associated with isotretinoin?

BACKGROUND TO THE DEBATE: Isotretinoin is an effective treatment for severe acne, a condition which can be physically, emotionally, and socially disabling. Because the drug is teratogenic, causing severe birth defects, women taking the drug are directed to avoid pregnancy. In the United States, a series of risk reduction programs have been implemented that aim to prevent pregnant women from taking the drug and to prevent women taking it from getting pregnant. The most recent, and most stringent, is an Internet-based, performance-linked system called iPLEDGE, which tries to ensure that the drug is dispensed only when there is documentary proof that the patient is not pregnant and is using two forms of birth control. Is iPLEDGE the best way to reduce isotretinoin birth defects, or is it an unproven and overly burdensome system?     

What is happening to the monocotyledons?

An attempt is made to elucidate some of the more pronounced departures from traditional classifications in the book The families of the monocotyledons byDahlgren and collaborators, which embodies the latest opinions of the lateRolf Dahlgren on the subject. Consideration is given to the treatment of theLiliiflorae (especiallyLiliales andAsparagales) andBromeliiflorae, and to the theory offered for the origin of the monocots which identifies theDioscoreales as the most primitive order of the subclass.Dahlgren aimed at an eclectic classification (one based on a combination of similarity criteria and phylogenetic criteria) and the results of his use of cladistic methods (in association withF. N. Rasumssen) to supply the phylogenetic input are assessed. The resulting system itself is considered in the light of the distinction drawn byJ. S. L. Gilmour between natural and artificial classifications and their respective uses.Dedicated to the memory of JohnS. L. Gilmour.     

What is the minimum age for applying the forbes equation between body density and body fat to the elderly?

In order to determine the age above which the FORBES equation for calculating percent body fat (%BF) in the elderly is to be applied, 9 persons in their 60s, 7 persons in their 70s and 3 persons older than 80 took part in this study. %BF was measured using dual-energy X-ray absorptiometry (DEXA). In each subject, body density was measured using densitometry. %BF was then calculated by substituting body density for the Siri or FORBES equation. Based on the value of %BF measured with DEXA, the calculated %BF was criticized for each decade of subjects. It was concluded that the Siri equation should be applied to those who are younger than 80 and that the FORBES equation should be applied to those who are 80 and older.     

What is the best option to cure patients with resistant/relapsing Hodgkin's disease?

Nearly 80% of patients with Hodgkin's disease (HD) are cured with chemotherapy with or without radiotherapy. However, in patients with primary refractory or relapsed disease, high-dose therapy (HDT) and autologous or peripheral-blood stem-cell transplantation (ASCT or PBSCT) represents the best curative option. Several prognostic factors to identify patients at high risk for relapse or progression have been analyzed. However, in almost all analyzed series, disease status before high-dose chemotherapy with PBSC support remains the most important factor predicting the outcome of these patients. Nonetheless, the benefit of cytoreduction before HDT has yet to be fully determined and efforts to identify the best active regimen, combining therapeutic activity and CD34+ stem-cell mobilizing potential, represent a challenging issue for these patients. Furthermore new approaches like myeloablative and non-myeloablative allogeneic transplants have been assessed to improve long-term in such patients. In this review we analyzed the results of the most important salvage chemotherapy combinations as well as allogeneic transplantations to clarify the optimal treatment options for patients with resistant/relapsing HD.     

What is the clinical and ethical importance of incidental abnormalities found by knee MRI?

Introduction

Magnetic resonance imaging (MRI) is increasingly used to examine joints for research purposes. It may detect both suspected and unsuspected abnormalities. This raises both clinical and ethical issues, especially when incidental abnormalities are detected. The prevalence of incidental, potentially clinically significant abnormalities identified by MRI and their clinical significance in a population undergoing knee MRI in research studies are unknown.

Methods

We examined the prevalence of such lesions in healthy asymptomatic adults and those with symptomatic knee osteoarthritis (OA) undergoing knee MRI with limited sequences for the purpose of research. The MRI findings in 601 asymptomatic subjects and 132 with knee OA who underwent at least one limited knee MRI scan for cartilage volume measurement were examined by an MRI radiologist for the presence of potentially clinically significant abnormalities.

Results

These were present in 2.3% of healthy and 2.3% of OA subjects. All required further investigation to exclude non-benign disease, including four with bone marrow expansion (0.7%), requiring further investigation and management. A single potentially life-threatening lesion, a myeloma lesion, was identified in a subject with symptomatic knee OA on their second MRI scan in a longitudinal study.

Conclusion

As musculoskeletal MRI is increasingly used clinically and for research purposes, the potential for detecting unsuspected abnormalities that require further investigation should be recognized. Incorporating a system to detect these, to characterize unexpected findings, and to facilitate appropriate medical follow-up when designing studies using this technology should be considered ethical research practice.     

What is the epipleurite? A contribution to the subcoxal theory as applied to the insect abdomen

The epipleurites were originally described by Hopkins in 1909 on the imago and larva of a beetle. Then this term was widely used in insect morphology, mainly for larvae, to designate certain sclerites of the pleural region. They have recently been interpreted as tergopleural (i.e. pleural but not strictly appendicular) by Deuve in 2001, but a study of embryonic development by Kobayashi et al. in 2013 has shown that they are instead eupleural (i.e. appendicular) and correspond to a dorsal part of the subcoxa. Their presence in the abdominal segments of insects illustrates the fundamental importance of the subcoxa in segmental structure, with a function of anchoring and supporting the appendage when the latter is present. However, the epipleurites are normally separated and functionally dissociated from the coxosternum, which integrates the ventral component of the subcoxa. In females, the epipleurite of segment IX of the abdomen corresponds to the gonangulum, as already pointed out by Deuve in 1994 and 2001, and it is involved in gonopod articulation. At segments VIII and IX of both males and females of holometabolans, the formation process of the genital ducts leads to an internalisation of the whole subcoxosternum (i.e. the coxosternum with the exception of the coxal and telopodal territories), and it is the two flanking epipleurites that ventrally close the abdomen in relation to the rearward displacement of the gonopore. This model may be generalised, in its broad lines, to a large part of the hemimetabolans. The body plan of the insect abdomen underlines the morphological and functional importance of the subcoxa in its fundamental structure, but the study of the Hexapoda in general also indicates the presence of a more proximal segment, the precoxa, which would belong to the groundplan but is more cryptic because it is often closely associated with the subcoxa and/or the paranotal lobe. Its location, which is sometimes on the ventral flank of the paranotal lobe, is in line with the hypothesis of a dual origin of the pterygote wing.     

What is the best control strategy for multiple infectious disease outbreaks?

Effective control of infectious disease outbreaks is an important public health goal. In a number of recent studies, it has been shown how different intervention measures like travel restrictions, school closures, treatment and prophylaxis might allow us to control outbreaks of diseases, such as SARS, pandemic influenza and others. In these studies, control of a single outbreak is considered. It is, however, not clear how one should handle a situation where multiple outbreaks are likely to occur. Here, we identify the best control strategy for such a situation. We further discuss ways in which such a strategy can be implemented to achieve additional public health objectives.