The Movement Disorders Society criteria for the diagnosis of Parkinson’s disease dementia: their usefulness and limitations in elderly patients

The aim of this study was to assess the performance of the Movement Disorders Society (MDS) criteria for the diagnosis of Parkinson’s disease dementia (PDD) in the elderly, and also to evaluate the relevance of applying other tests in this patient population. The MDS criteria include a first short part in checklist form, and a second part which is used as a basis for reference and consists of an in-depth neuropsychological examination. Forty consecutive PD patients presenting with cognitive complaints were enrolled. An assessment was made of the performances of the MDS checklist compared with the MDS exhaustive cognitive examination which was used as a basis for reference, and with other cognitive tests including the Mattis Dementia Rating Scale (MDRS), the French version of the Grober and Buschke test, the verbal fluency test, the Rey–Osterreith complex figure and the paced auditory serial addition test. Out of a total of 40 PD subjects (mean age: 80.5 ± 4.9 years), 20 were diagnosed with PDD according to the checklist and 31 on the basis of the exhaustive examination, i.e. with 11 more patients diagnosed via the latter. The sensitivity of the checklist for the diagnosis of PDD was 0.64, with a specificity of 1.00. The use of the MDRS for PDD diagnosis with a cut-off at ≤120 showed a sensitivity of 0.80 and a specificity of 1.00, while at ≤132 it displayed a sensitivity of 1.00 and a specificity of 0.444. The specificity of the checklist for the diagnosis of PDD in the elderly was confirmed, but it was lacking in sensitivity. It was also found that the MDRS could be helpful in the diagnosis and screening of PDD.     

Developments in autotransplantation of teeth

Transplantation of teeth has been done for hundreds of years. In the late 18th and early 19th century transplants of teeth between individuals were relatively common at specialist dental practices in London. Surprisingly tooth allotransplants have been found to last 6 years on average. In Scandinavia during the 1950 and 1960's autotransplantation of teeth began to be carried out under increasingly controlled conditions. These have proved to be very successful in long term studies with autotransplants surviving up to 45 years post-surgery. Recent developments in cone beam CT and rapid 3D prototyping have enabled the fabrication of accurate surgical templates which can be used to prepare the recipient site immediately prior to transplantation. This has resulted in a drastically reduced extra-oral time for the transplant teeth which can be expected to improve success rates further. Autotransplants provide significant advantages compared to single tooth implants and should be considered the treatment of choice in the growing child.     

Ethical Issues Related to the Presence of Third Party Observers in Clinical Neuropsychological Evaluations

The presence of third parties during neuropsychological examinations has long been permitted for training or assisting examiners. Recently, clinical neuropsychologists have been requested to allow third party observers who are working in the interest of parties in legal disputes. This paper examines the ethical implications of the use of third party observers and makes recommendations as to how clinical neuropsychologists might handle requests for their presence.     

<Superscript>18</Superscript>F-fluorodeoxyglucose-positron emission tomography is more sensitive than computed tomography in initial staging of patients with an anaplastic T-cell lymphoma first presenting in the skin

Background

The role of ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) in the evaluation of anaplastic large-cell lymphoma (ALCL) first presenting in the skin is not well established, while computed tomography (CT) is used as a standard procedure.

Objectives

The aim of this study was to evaluate the use of FDG-PET versus CT at initial staging of ALCL first presenting in the skin.

Materials & methods

Eleven cases of ALCL first presenting in the skin who underwent both FDG-PET and CT were retrospectively analysed. There were six males and five females, with a mean age of 59.7 years. Results of FDG-PET were compared with those of CT. Biopsy results of lesions served as a reference for the accuracy of PET and CT in the evaluation of local and metastatic lesions.

Results

In seven cases (64%), imaging revealed extracutaneous ALCL. FDG-PET results were concordant with CT results in five cases (45%); in four of these cases, FDG-PET was negative, consistent with CT, and one case had cutaneous and extracutaneous lesions detectable on both CT and FDG-PET. FDG-PET and CT were discordant in six cases (55%). Among these six cases, FDG-PET revealed extracutaneous lesions undetected on CT which consequently influenced the therapeutic decision in five cases (45%).

Conclusion

The sensitivity of CT and FDG-PET was 18% and 64%, respectively.

     

New classification of HLA–DRB1 alleles supports the shared epitope hypothesis of rheumatoid arthritis susceptibility

Objective

The shared epitope hypothesis was formulated to explain the involvement of HLA–DRB1 in rheumatoid arthritis (RA). However, several studies, which considered only the HLA–DRB1 alleles shown to be associated with RA risk, rejected this hypothesis. In this report, we propose that a different classification of HLA–DRB1 alleles be considered, based on the amino acid sequence at position 70–74.

Methods

The fit of both HLA–DRB1 classifications was tested in 2 groups of RA patients. All subjects were recruited through the European Consortium on Rheumatoid Arthritis Families, and included 100 patients with isolated RA and 132 patients with at least 1 affected sibling.

Results

The new classification produced risk estimates that fit all of the observed data, i.e., the distribution of the HLA–DRB1 genotype in the 2 patient groups, and the distribution of parental alleles shared by affected sibpairs. The risk of developing RA under this new classification depends on whether the RAA sequence occupies position 72–74 but is modulated by the amino acid at position 71 (K confers the highest risk, R an intermediate risk, A and E a lower risk) and by the amino acid at position 70 (Q or R confers a higher risk than D).

Conclusion

A new classification based on amino acid sequence allows us to show that the shared epitope RAA sequence at position 72–74 explains the data, with the risk of developing RA modulated by the amino acids at positions 70 and 71.

     

First-in-man Phase 1 Clinical Trial of Gene Therapy for Advanced Pancreatic Cancer: Safety,Biodistribution, and Preliminary Clinical Findings

This phase 1 trial was aimed to determine the safety, pharmacokinetics, and preliminary clinical activity of CYL-02, a nonviral gene therapy product that sensitizes pancreatic cancer cells to chemotherapy. CYL-02 was administrated using endoscopic ultrasound in 22 patients with pancreatic cancer that concomitantly received chemotherapy (gemcitabine). The maximum-tolerated dose (MTD) exceeded the maximal feasible dose of CYL-02 and was not identified. Treatment-related toxicities were mild, without serious adverse events. Pharmacokinetic analysis revealed a dose-dependent increase in CYL-02 DNA exposure in blood and tumors, while therapeutic RNAs were detected in tumors. No objective response was observed, but nine patients showed stable disease up to 6 months following treatment and two of these patients experienced long-term survival. Panels of plasmatic microRNAs and proteins were identified as predictive of gene therapy efficacy. We demonstrate that CYL-02 nonviral gene therapy has a favorable safety profile and is well tolerated in patients. We characterize CYL-02 biodistribution and demonstrate therapeutic gene expression in tumors. Treated patients experienced stability of disease and predictive biomarkers of response to treatment were identified. These promising results warrant further evaluation in phase 2 clinical trial.     

Fracture apparemment spontanée de la pointe de l’omoplate. Rôle possible de la toux

We report a case of a fracture of the inferior angle of the scapula related to prolonged cough, without triggering trauma, sport or occupational activity. Bone insufficiency was present in this patient. Stress fractures of the scapula are rare; the fatigue type is the most frequent, associated with sports or occupational activity. We don’t find any published case report about scapula stress fracture related to cough, until rib fractures are frequent in this situation. Repetitive muscular activity of the serratus anterior and major rhomboid on the inferior angle of the scapula during cough may explain this avulsion fracture.     

Clinique lacanienne de la phobie

Behavioral and cognitive therapies currently constitute a popular response to phobic anxiety. The deplacement of phobic anxiety, and more particularly of the symptom’s that represents the aim of cognitive, treatment; there is no consideration for the Freudian structure. The method used is based on the exploitation of an object which proceeds from phobic logic itself, that is to say the “counterphobic object”, which corresponds to the phallic of the phobic aspect, which we know acts as a screen to another object the “objet a, cause aspect ” according to Jacques Lacan. A contrario, Lacanian psychoanalysis considers that the phobic symptom proceeds from the “significant”, and has a use: for the child, it witnesses the structure of desire and of its installation, where for the adult, it corresponds more to the effort of the construction of the fantasm which is particularly lacking and does not manage to support the desire. The handling of the psychoanalytic cure does not use the counterphobic mechanism, as it orients itself with anxiety. It does not smother the “objet a” by a systematic positivation of the phallic “signifier”, but it rather creates separation between the two so as to allow the construction of the fantasm without recourse to phobic or counterphobic help. Such a clinical position concerns ethics as we first consider the dimension of the subject desire.