CT, MR, and pathology in HIV encephalitis and meningitis

The value and limitations of CT and MR in human immunodeficiency virus (HIV) infection of the brain was determined by a retrospective analysis of the CT scans (22) and MR images (7) in 22 patients with pathologically proved HIV encephalitis (21) or meningitis (1). Our clinical-radiologic-pathologic correlation suggested that, especially in the early stages of the disease, CT and MR were relatively insensitive in detecting the primary changes of HIV encephalitis. The multiple bilateral diffuse microscopic glial nodules with multinucleated giant cells of HIV found at autopsy in both gray and white matter were usually not directly visualized by either CT or MR. Secondary, nonspecific changes, however, were seen. These included cortical atrophy, found in virtually all patients with HIV encephalitis, and HIV-induced foci of demyelination found in the minority of cases. On CT the latter were seen in the white matter as nonenhancing, nonmass-producing areas of low density; on MR they were seen as frequently progressive high-intensity signal abnormalities on T2-weighted images, usually in the periventricular white matter and centrum semiovale. MR was more sensitive in detecting these demyelinative lesions than was CT. The clinical diagnosis of HIV encephalitis usually antedated the radiographic diagnosis. In HIV meningitis, contrast CT was more definitive than MR, showing striking enhancement of the subarachnoid spaces, although MR was more sensitive in detecting the secondary parenchymal changes.     

A 24 h corticosterone exposure exacerbates excitotoxic insult in rat hippocampal slice cultures independently of glucocorticoid receptor activation or protein synthesis

Elevations in circulating concentrations of glucocorticoids (GC) may increase the expression and/or sensitivity of ionotropic transmitter receptors in brain. For example, recent evidence suggests that acute and chronic GC exposure may alter the number and/or function of N-methyl-D-aspartate (NMDA)-type glutamate receptors, effects that may sensitize the brain to excitotoxic insults. The present studies examined the ability of short-term (24 h) corticosterone (CORT) exposure to potentiate NMDA-induced cytotoxicity in rat hippocampal slice cultures. Additional studies evaluated the role of mineralocorticoid (MR) and glucocorticoid receptor (GR) function, as well as de novo protein synthesis, in potentiation of toxicity by corticosterone exposure. Hippocampal slice cultures were exposed to NMDA (20 microM) for 24 h with cytotoxicity assessed by fluorescent detection of propidium iodide uptake. Exposure to NMDA caused significant propidium iodide uptake in each hippocampal region, while 24 h CORT (0.001-1 microM) exposure alone did not significantly increase propidium iodide uptake. Co-exposure of cultures to CORT and NMDA synergistically increased propidium iodide uptake in each hippocampal region, effects that were prevented by co-exposure to a non-toxic concentration of MK-801 (20 microM). In contrast, 24 h exposure with the MR antagonist spironolactone (1-10 microM), the GR antagonist RU-486 (1-10 microM), or the protein synthesis inhibitor cycloheximide (1 microM) failed to reduce the significant increase in propidium iodide uptake. These data suggest that relatively brief elevations in CORT levels may sensitize the hippocampus to injury independently of GC receptor activity and protein synthesis.     

Caudate nucleus volume and cognitive performance: Are they related in childhood psychopathology?

BACKGROUND: Impaired neuropsychological test performance, especially on tests of executive function and attention, is often seen in children diagnosed with autism spectrum disorders (ASD). Structures involved in fronto-striatal circuitry, such as the caudate nucleus, may support these cognitive abilities. However, few studies have examined caudate volumes specifically in children with ASD, or correlated caudate volumes to cognitive ability. METHODS: Neuropsychological test scores and caudate volumes of children with ASD were compared to those of children with bipolar disorder (BD) and of typically developing (TD) children. The relationship between test performance and caudate volumes was analyzed. RESULTS: The ASD group displayed larger right and left caudate volumes, and modest executive deficits, compared to TD controls. While caudate volume inversely predicted performance on the Wisconsin Card Sorting Test in all participants, it differentially predicted performance on measures of attention across the ASD, BD and TD groups. CONCLUSIONS: Larger caudate volumes were related to impaired problem solving. On a test of attention, larger left caudate volumes predicted increased impulsivity and more omission errors in the ASD group as compared to the TD group, however smaller volume predicted poorer discriminant responding as compared to the BD group.     

The relationship between childhood maltreatment and psychopathology in adults undergoing bariatric surgery

Background

A history of childhood maltreatment and psychopathology are common in adults with obesity.

American Society for Parenteral and Enteral Nutrition and American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalist, Specialty, and Advanced) in Nutrition Support

The Standards of Practice for Registered Dietitians in Nutrition Support and the Standards of Professional Performance for the Registered Dietitian in Nutrition Support are key resources for RDs at all knowledge and performance levels. These standards can and should be used by RDs in daily practice to consistently improve and appropriately demonstrate competency and value as providers of safe and effective nutrition support therapy. The standards development and evaluation process is dynamic—these standards will be reviewed at least every 5 years for applicability to practice. Current and future initiatives of A.S.P.E.N. and ADA will provide information that will be used in these updates and in further clarifying and documenting the specific roles and responsibilities of practitioners at each level. As a quality initiative of A.S.P.E.N., its Dietetics Practice Section, ADA, and their DNS DPG, the standards themselves are an application of continuous quality improvement concepts and represent another very important collaborative endeavor.