Establishing the limits of the Mini-Mental State. Examination of 'subtests'.

It has been suggested that the Mini-Mental State examination can be used to examine a patient's cognitive profile. We therefore examined the validity of Mini-Mental State subtests and individual items. The memory item, attention-concentration items, and constructional item had satisfactory sensitivity-specificity and correlated significantly with scores on neuropsychological tests. In contrast, four of the five Mini-Mental State language items had very low sensitivity, and three of five failed to correlate with neuropsychological test scores. These findings establish limits with regard to the ability of the Mini-Mental State to generate a cognitive profile. Our data also provide information regarding validity, difficulty level, and optimal cutoff scores for widely used mental status tasks.     

Arcus senilis

The arcus senilis (or the arcus lipoides) is studied by lipid histochemical and polarization optical methods. Lipid accumulation is found in the peripheral corneal stroma, Bowman's membrane and Descemet's membrane as well as in the perilimbal region of the sclera. The areas of the cornea and sciera near the limbus and the perivascular areas of the sciera are never involved. The lipids are sudanophilic and contain saturated carbohydrate chains. The primary alteration of the arcus senilis is a genetically determined disturbance in the metabolism of the endothelial cells and the pericytes of the pericorneal vessels, which results in an abnormal capillary permeability. There seems to be a genetic relationship between familial hyper -lipoproteinemia, atherosclerosis, xanthelasma, tendinous xanthoma and arcus senilis.

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Résumé L'arc sénile (ou l'arc lipoïdique) est étudié à l'aide de méthodes histochimiques et du microscope par polarisation. Une accumulation de lipides est trouvée dans la périphérie du stroma cornéen, de la membrane de Bowman et de la membrane de Descemet, ainsi que dans la région périlimbique de la sclérotique. Les zones juxtalimbiques de la cornée et de la sclérotique et les parties périvasculaires de la sclérotique ne sont jamais intéressées. Les lipides sont soudanophiles et contiennent des chaines carbohydratées saturées. L'altération primaire de l'arc sénile est un trouble génétique du métabolisme des cellules endothéliales et des péricytes des vaisseaux péricornéens, ce qui donne lieu à une augmentation anormale de la perméabilité capillaire. Il semble y avoir une relation génétique entre l'hyper-bêta-lipoprotéinémie familiale, l'artériosclérose, le xanthélasma, le xanthome tendineux et l'arc sénile.

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From the Ophthalmological Clinic of the University of Ghent. Director: Professor jules françois.

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This paper has been written for Professor H. Burian as a token of esteem and affection.     

139. Möglichkeiten und erste Erfahrungen mit der Ganzkörpertomographie in der Extremitätenchirurgie

ZusammenfaBung Die zweite Generation von Computertomographen kann transversale, axiale Schnitte von einer beliebigen Stelle des menschlichen Körpers anfertigen. Diese neue Untersuchungsmethode, die zu den konventionellen Röntgenbildern eine neue Dimension hinzufügt, gibt Informationen, die mit konventionellen radiologischen Mitteln nicht gewonnen werden können. Die Ganzkörpertomographie ist deshalb nach unseren bisherigen Erfahrungen eine wertvolle Ergänzung der Diagnostik in der Extremitätenchirurgie von Calcaneusfrakturen, Hüftpfannenschädigungen, Weichteil- und Knochentumoren.     

Progressive nonfluent aphasia with dementia: a case report.

We report a patient with progressive nonfluent aphasia and mild dementia. On 9-month follow-up evaluation, there was significant deterioration in both language and cognition. Unlike in Alzheimer's disease, the aphasia was of the Broca's type. In contrast with primary progressive aphasia, a dementia was present and the cognitive and language decline showed a rather rapid course.     

3.2 Ensuring research productivity in the future faculty

The group concluded that the research productivity of a dental school depended to a large extent on the availability of resources, human and economic. Firstly it requires a group of individuals trained and educated to conduct independent research. Secondly, it requires that these individuals had time to spend on research activities. Thirdly, appropriate space and equipment in which to conduct the research were considered prerequisites. Fourthly, they require an ongoing and appropriate budget. Fifthly, it is essential to have an appropriate climate in the school that encourages and rewards research achievement.     

Glycoprotein IIIA gene (PlA) polymorphism and aspirin resistance: is there any correlation?

BACKGROUND: Platelet glycoprotein (GP) IIb/IIIa receptors play an inevitable role in platelet aggregation. The GP IIIa gene is polymorphic (PlA1/PlA2) and the presence of a PlA2 allele might be associated with an increased risk for acute coronary syndrome (ACS). OBJECTIVE: To examine the prevalence of the PlA2 allele in patients with ACS and in subjects with or without aspirin resistance. METHODS: The prevalence of the PlA2 allele was assessed in 158 patients with ACS and PlA2 compared with its prevalence in 199 healthy volunteers. The antiplatelet efficacy of aspirin was examined in all patients with ACS, as well as in 69 individuals who had suffered ischemic stroke and in 58 high-risk subjects without any known ischemic vascular events. RESULTS: PlA2 prevalence was significantly higher in patients with ACS (59/158) than in the control group (51/199; p < 0.05). Carriers of the PlA2 allele had a significantly higher risk of developing ACS, even after an adjustment to the risk factors (OR 5.74; 95% CI 1.75 to 18.8; p = 0.004). The occurrence of the PlA2 allele was significantly higher among patients with aspirin resistance than in subjects who demonstrated an appropriate response to the drug (allele frequencies, 0.21 vs 0.14; p < 0.05). All patients homozygous for the PlA2 allele had an inadequate platelet response to aspirin. CONCLUSIONS: Our results support the hypothesis that carriers of the PlA2 allele might have an increased risk for ACS. PlA2 homozygosity was associated with an inadequate response to aspirin therapy. Our data further suggest that patients with PlA2 allele homozygosity might benefit from antiplatelet therapy based on adenosine diphosphate antagonists throughout secondary treatment for prevention of ACS.     

Irritable Eye Syndrome: Neuroimmune Mechanisms and Benefits of Selected Nutrients

Previous studies showed comorbidity of some ocular, enteral, and affective symptoms comprising irritable eye syndrome. Aims of the present study were to learn more about the pathogenic mechanisms of this syndrome and to evaluate benefits of food supplements on these disorders. In in vitro assay, Lactobacillus acidophilus lysate inhibited interleukin (IL)-1β and tumor necrosis factor (TNF)-α generation of lipopolysaccharide (LPS)-stimulated macrophages in dose- and size-dependent manner. For a prospective, open-label phase I/II controlled clinical trial, 40 subjects affected by ocular dysesthesia and hyperesthesia and comorbid enteral and anxiety-depression symptoms were randomly assigned either into the treated group, which received a composition containing probiotic lysate, vitamins A, B, and D and omega 3 fatty acids, or into the control group, which received vitamins and omega 3 fatty acids. For reference, 20 age- and sex-matched healthy subjects were also selected. White blood count (WBC) and lymphocyte and monocyte counts, as well as IL-6 and TNF-α levels, were significantly above the reference levels in both treated and control groups. After 8 weeks, WBC and lymphocyte and monocyte counts, and cytokine levels significantly decreased, and ocular, enteral, and anxiety-depression symptoms significantly improved in the treated group as compared to the control group. This proof-of-concept study suggested that subclinical inflammation may be a common mechanism connecting ocular, enteral, and anxiety/depression symptoms, and supplements affecting dysbiosis may be a new approach to treating this syndrome.     

Age-related changes in the human retina

BACKGROUND: In a previous study, scanning electron microscopy (SEM) showed age-related changes in the rat retina. We carried out a study to evaluate age-related changes in the human retina. METHODS: Samples of fresh retinal tissue obtained from younger (age 22 years or less) and older (age 66 years or more) donors were studied by means of traditional histologic methods and by SEM. Eight retinas were obtained from four donors whose corneas had been used for transplantation, and four retinas were obtained from four subjects whose eyes had been enucleated owing to injury. All morphologic results were subjected to quantitative analysis of images. The concentration of cytoplasmic (free) and structural (tissue-associated) protein in retinal tissue homogenates was determined by means of biochemical methods. RESULTS: There was a decrease in all features studied with the exception of structural protein concentration. The mean retinal thickness (and standard error of the mean) was 426 (34.2) microm in the younger subjects and 261 (18.9) microm in the older subjects. The mean numbers of ganglion cells (and standard error of the mean) were 413.5/mm2 (32.3/mm2) and 256.2/mm2 (26.8/mm2) respectively, of capillaries 3.6/mm2 (1.4/mm2) and 1.8/mm2 (1.2/mm2) respectively, of synaptic bodies 122.4 (4.9) conventional units (CU)/area observed and 38.5 (1.6) CU/area observed respectively, of cellular processes 82.3 (3.1) CU/area observed and 13.1 (1.5) CU/ area observed respectively, and of intercellular connections 36.4 (2.5) CU/area observed and 14.3 (1.4) CU/area observed respectively. The mean concentration of total protein per milligram of fresh tissue (and standard error of the mean) was 92.1 (1.8) microg in the younger subjects and 78.7 (1.3) microg in the older subjects; the corresponding values for cytoplasmic protein were 27.6 (1.3) microg and 11.8 (0.8) microg, and for structural protein, 64.4 (1.6) microg and 86.9 (1.4) microg. All differences between the younger and older subjects were significant (p < 0.001) with the exception of mean concentration of cytoplasmic and of structural protein. INTERPRETATION: The human retina undergoes specific changes with aging. SEM provides new morphometric information regarding age-related changes in photoreceptor cells, bipolar cells and ganglion cells that increases our understanding of this topic. Our results may be adopted as a model or as normal values when studying other changes that may occur in the human retina in pathological conditions.