Background: Schizophrenia is a heterogeneous disorder with a burden that can vary greatly depending on the severity and the duration. Previous research has suggested that patients in the earlier stages of schizophrenia (typically first-episode schizophrenia) benefit from effective early treatment, however, a comprehensive review of the burden specifically in this population has not been undertaken. A systematic literature review was therefore conducted to characterize the clinical, economic, and humanistic burden, as reported in naturalistic studies of schizophrenia populations specifically at an early stage of disease in comparison with healthy controls, patients with chronic schizophrenia, and patients with other psychiatric disorders.

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Background: Antipsychotics are a class of medications primarily used to treat individuals with psychotic disorders. They have also been indicated for patients with other psychiatric conditions, such as post-traumatic stress disorder and major depressive disorder. Non-adherence is prominent amongst individuals prescribed antipsychotics, with medication-related self-stigma and social stigma identified as major factors. No previous reviews have focused on stigma associated specifically with antipsychotic medication. This systematic literature review aimed to synthesise evidence on the prevalence of stigmatising attitudes and behaviours related to antipsychotic treatment and understand their impact on antipsychotic treatment initiation and continuation. Methods: Two independent reviewers screened studies from databases, congress proceedings, ClinicalTrials.gov, and PsychU.org; relevant studies reported quantitative or qualitative data on antipsychotic-related stigma in adults with psychotic disorders, mood disorders, borderline personality disorder or anxiety disorders, or healthcare providers or caregivers of these patients, and any impact on treatment. Framework synthesis facilitated extraction and synthesis of relevant information; quantitative and qualitative data were coded and indexed against a pre-specified thematic framework by two independent reviewers. Results: Forty-five articles reporting on 40 unique studies were included; 22 reported quantitative data, 16 reported qualitative data, and two reported quantitative and qualitative data relating to antipsychotic-related stigma. Framework synthesis identified four themes: 1) impact of antipsychotic treatment on a) social stigma or b) self-stigma; 2) impact of side effects of antipsychotic treatment on a) social stigma or b) self-stigma; 3) impact of route of administration of antipsychotic treatment on stigma; 4) impact of stigma on the use of antipsychotics. Conclusion: This systematic literature review found that antipsychotic-related social and self-stigma is a factor in non-adherence to antipsychotics. Further research should examine stigma in a wider range of patients and the extent to which clinicians' treatment decisions are impacted by the potential stigma associated with antipsychotic medications.

BACKGROUND Approximately 20% of patients with neuroendocrine tumours (NETs) develop carcinoid syndrome (CS), characterised by flushing and diarrhoea. Somatostatin analogues or telotristat can be used to control symptoms of CS through inhibition of serotonin secretion. Although CS is often the cause of diarrhoea among patients with gastroenteropancreatic NETs (GEP-NETs), other causes to consider include pancreatic enzyme insufficiency (PEI), bile acid malabsorption and small intestinal bacterial overgrowth. If other causes of diarrhoea unrelated to serotonin secretion are mistaken for CS diarrhoea, these treatments may be ineffective against the diarrhoea, risking detrimental effects to patient quality of life. AIM To identify and synthesise qualitative and quantitative evidence relating to the differential diagnosis of diarrhoea in patients with GEP-NETs. METHODS Electronic databases (MEDLINE, Embase and the Cochrane Library) were searched from inception to September 12, 2018 using terms for NETs and diarrhoea. Congresses, systematic literature review bibliographies and included articles were also hand-searched. Any study designs and publication types were eligible for inclusion if relevant data on a cause(s) of diarrhoea in patients with GEP-NETs were reported. Studies were screened by two independent reviewers at abstract and full-text stages. Framework synthesis was adapted to synthesise quantitative and qualitative data. The definition of qualitative data was expanded to include all textual data in any section of relevant publications. RESULTS Forty-seven publications (44 studies) were included, comprising a variety of publication types, including observational studies, reviews, guidelines, case reports, interventional studies, and opinion pieces. Most reported on PEI on/after treatment with somatostatin analogs; 9.5%-84% of patients with GEP-NETs had experienced steatorrhoea or confirmed PEI. Where reported, 14.3%–50.7% of patients received pancreatic enzyme replacement therapy. Other causes of diarrhoea reported in patients with GEP-NETs included bile acid malabsorption (80%), small intestinal bacterial overgrowth (23.6%-62%), colitis (20%) and infection (7.1%). Diagnostic approaches included faecal elastase, breath tests, tauroselcholic (selenium-75) acid (SeHCAT) scan and stool culture, although evidence on the effectiveness or diagnostic accuracy of these approaches was limited. Assessment of patient history or diarrhoea characteristics was also reported as initial approaches for investigation. From the identified evidence, if diarrhoea is assumed to be CS diarrhoea, consequences include uncontrolled diarrhoea, malnutrition, and perceived ineffectiveness of CS treatment. Approaches for facilitating differential diagnosis of diarrhoea include improving patient and clinician awareness of non-CS causes and involvement of a multidisciplinary clinical team, including gastroenterologists. CON...

Spoilage of grain and oilseeds by storage molds, fungi which attack seeds during storage and cause deterioration, amounts to over 1% of the world's production (14). These losses include decrease in germinability, discoloration of seed, increase in free fatty acids, heating, mustiness, and production of mycotoxins (5). Previous studies concerning grain infected with storage fungi have been concerned with detection of these organisms or chemical changes which occur after infection. In this study electron microscopic examination of wheat (Triticum aestivum L., Pa 151X107) embryos was undertaken to determine the ultrastructural changes which may occur in wheat seeds infected with storage fungi of the Aspergillus glaucus group. The most striking change found in cells of infected tissue was the coalescence of lipid bodies (spherosomes) to form large masses of amorphous material. In addition, the protoplast was frequently withdrawn from the cell wall, and the plasmalemma appeared to be damaged. Aside from the ultrastructural changes in infected tissue, we report observations on the membrane-like boundary surrounding the lipid bodies (spberosomes). This boundary is ' half the thickness of mitochondrial membrane elements, and does not show convincingly the typical trilaminar structure observed in other biological membranes.Wheat seeds were infected by the natural seed-borne mycoflora when placed in storage at 25 C and 75 % relative humidity. After 26 weeks conidiophores of A. glaucus spp. were observed extending from the embryo end of some seeds. Control seeds were kept at -20 C. Small pieces of tissue were dissected from the embryonic axis of seeds, either dry or imbibed for 2 hr, fixed in glutaraldehyde followed by OS04, dehydrated in ethanol, embedded in Epon 812, and further processed for electron microscopy according to procedures reported earlier (2).The bodies referred to as "lipid bodies" (spherosomes) generally range from 0.2 to 0.5 Aum, but occasionally approach 1.0 Am in diameter or length, are spherical to ovoid and appear identical to bodies termed "spherosomes" in epithelial cells of barley scutellum (6, 18), coleorhiza cells of Zea mays (9), aleurone cells of barley (16,20), and hypocotyl parenchyma cells of Acer platanoides (8). It is not clear whether these bodies are the same as the bodies termed "spherosomes" in Campanula persicifolia guard cells (21) and fungal mycelia (1,25). Except for their smaller size, they are similar in appearance to the bodies, termed "spherosomes", found in castor bean, cotton, peanut (13,19,26), and yucca (11). Sorokin (22) has criticized use of the term "spherosome" for these latter bodies, which she considers to be neutral storage lipid. We use the term "spherosome" only to conform with much of the literature concerning ultrastructure of seeds. Prominent features of embryo cells from control wheat seeds are numerous mitochondria, protein bodies, a heavy population of ribosomes distributed uniformly throughout the cytoplasm, proplastids in the case of shoot cells, a large n...