Cerebrospinal fluid Aβ levels correlate with structural brain changes in Parkinson's disease

ParkWest is a large Norwegian multicenter study of newly diagnosed drug‐naïve subjects with Parkinson's disease (PD). Cognitively normal PD subjects (PDCN) and PD subjects with mild cognitive impairment (PDMCI) from this cohort have significant hippocampal atrophy and ventricular enlargement, compared to normal controls. Here, we aimed to investigate whether the same structural changes are associated with cerebrospinal fluid (CSF) levels of amyloid beta (Aβ)₃₈, Aβ₄₀, Aβ₄₂, total tau (t‐tau), and phosphorylated tau (p‐tau). We performed three‐dimensional radial distance analyses of the hippocampi and lateral ventricles using the MRI data from ParkWest subjects who provided CSF at baseline. Our sample consisted of 73 PDCN and 18 PDMCI subjects. We found significant associations between levels of all three CSF Aβ analytes and t‐tau and lateral ventricular enlargement in the pooled sample. In the PDCN sample, all three amyloid analytes showed significant associations with the radial distance of the occipital and frontal horns of the lateral ventricles. CSF Aβ₃₈ and Aβ₄₂ showed negative associations, with enlargement in occipital and frontal horns of the lateral ventricles in the pooled sample, and a negative association with the occipital horns in PDMCI. CSF Aβ levels in early PD correlate with ventricular enlargement, previously associated with PD dementia. Therefore, CSF and MRI markers may help identify PD patients at high risk for developing cognitive decline and dementia in the course of their illness. Contrary to Alzheimer's disease, we found no associations between CSF t‐tau and p‐tau and hippocampal atrophy. © 2013 Movement Disorder Society     

“If It’s Worth My Time, I will Make the Time”: School-Based Providers’ Decision-Making About Participating in an Evidence-Based Psychotherapy Consultation Program

This study evaluated influences on school-based clinicians’ decision-making surrounding participation in a modular psychotherapy training and consultation program lasting one academic year. Clinicians were recruited from three participation groups: those who never engaged, those who engaged and then discontinued, and those who participated fully. Qualitative interviews explored influences on initial and continued participation, as well as differences in decision-making by participation group, knowledge about evidence-based practices, and attitudes toward evidence-based practices. Eight major themes were identified: time, practice utility, intervention/training content, training process, attitudes toward training, social influences, commitment to training, and expectations. Some themes were discussed universally across all comparison groups, while others varied in frequency or content. Recommendations for increasing participation are presented, based on the findings.     

带蒂结膜瓣移植联合MMC治疗翼状胬肉合并结膜松弛症

目的：探讨带蒂结膜瓣移植联合丝裂霉素治疗翼状胬肉合并结膜松弛症的疗效。 方法：对翼状胬肉合并结膜松弛症患者122例156眼进行翼状胬肉切除,下方带蒂结膜瓣移植联合术中使用0.2g/L丝裂霉素C。 结果：患者122例156眼术后2mo眼部症状有不同程度改善。泪河恢复正常者136眼（87.18％）;泪膜破裂时间（BUT）≥10s者117眼（75.00％）;裂隙灯显微镜检查眼球与下睑缘、内外眦部之间无松弛结膜皱褶者147眼（94.23%）;下睑缘位置正常者142眼（91.03%）。手术后观察6mo~4a,胬肉复发5眼（3.21%）,结膜松弛复发15眼（9.62%）。 结论：翼状胬肉切除术中,下方带蒂结膜瓣移植联合术中使用丝裂霉素C治疗翼状胬肉合并结膜松弛症,手术简单易行,取材容易,安全可靠,损伤小,并发症少,复发率低,适合临床开展。     

Effect of caffeine on SPECT myocardial perfusion imaging during regadenoson pharmacologic stress: a prospective,randomized, multicenter study

A multicenter, double-blind, randomized study was conducted to assess the effect of caffeine on regadenoson stress myocardial perfusion imaging (MPI). Subjects with a high likelihood of coronary artery disease underwent a rest single-photon emission computed tomography MPI on day 1 (MPI-1) and a stress MPI with regadenoson on day 3 (MPI-2). Individuals with ≥1 segment with a reversible defect received double-blind caffeine tablets (200 or 400 mg) or placebo 90 min before a repeat regadenoson stress MPI (MPI-3) on day 5. Overall, 207 subjects completed the study (caffeine 200 mg, n = 70; caffeine 400 mg, n = 71; placebo, n = 66). The mean number of segments with reversible defects decreased from MPI-2 to MPI-3 in the caffeine 200 and 400 mg groups versus no significant change in the placebo group [mean ± standard deviation: ?0.61 ± 1.097, ?0.62 ± 1.367, and 0.12 ± 0.981, respectively (overall treatment effect, P < 0.001)]. The majority of subjects who received caffeine shifted to a lower ischemia size category from MPI-2 to MPI-3, with no clear pattern observed in subjects who received placebo. For caffeine exposed patients with ≥3 segments with reversible defects at MPI-2, 21/23 had fewer detected at MPI-3. Both the 200 and 400 mg doses of caffeine significantly reduced the number of segments with reversible defects detected by regadenoson stress MPI.     

Adolescent sexual risk assessment

This article describes the use of a self-administered event history calendar and interviews about sexual partners, sexual activity, and contraception within the broader context of the adolescent's life. Constant comparative analysis was used to analyze the event history calendar interview data. Detailed 5- to 9-year sexual histories were obtained on the event history calendars, including patterns of sexual activity progression and triggers for unintended sexual intercourse. Discussions of protective and risky sexual decision making were stimulated by adolescents' self-report of sexual risk behavior in their own words and reflective responses on the event history calendar. Both the adolescents and the interviewers thought the calendars encouraged recall and discussion of sexual risk behavior.