Nonpharmacologic Treatments for Depression Related to Reproductive Events

With the rapid and ubiquitous acceptance of new technologies, algorithms will be used to estimate new measures of mental state and behavior based on digital data. The algorithms will analyze data collected from sensors in smartphones and wearable technology, and data collected from Internet and smartphone usage and activities. In the future, new medical measures that assist with the screening, diagnosis, and monitoring of psychiatric disorders will be available despite unresolved reliability, usability, and privacy issues. At the same time, similar non-medical commercial measures of mental state are being developed primarily for targeted advertising. There are societal and ethical implications related to the use of these measures of mental state and behavior for both medical and non-medical purposes.     

Gut feelings about smoking and coffee in Parkinson's disease

Strong epidemiologic evidence suggests that smokers and coffee drinkers have a lower risk of Parkinson's disease (PD). The explanation for this finding is still unknown, and the discussion has focused on two main hypotheses. The first suggests that PD patients have premorbid personality traits associated with dislike for coffee‐drinking and smoking. The second posits that caffeine and nicotine are neuroprotective. We propose an alternative third hypothesis, in which both cigarette and coffee consumption change the composition of the microbiota in the gut in a way that mitigates intestinal inflammation. This, in turn, would lead to less misfolding of the protein alpha‐synuclein in enteric nerves, reducing the risk of PD by minimizing propagation of the protein aggregates to the central nervous system, where they otherwise can induce neurodegeneration. © 2014 International Parkinson and Movement Disorder Society     

The ABC’s of Teaching Social Skills to Adolescents with Autism Spectrum Disorder in the Classroom: The UCLA PEERS ® Program

Social skills training is a common treatment method for adolescents with autism spectrum disorder (ASD), yet very few evidence-based interventions exist to improve social skills for high-functioning adolescents on the spectrum, and even fewer studies have examined the effectiveness of teaching social skills in the classroom. This study examines change in social functioning for adolescents with high-functioning ASD following the implementation of a school-based, teacher-facilitated social skills intervention known as Program for the Education and Enrichment of Relational Skills (PEERS ^® ). Seventy-three middle school students with ASD along with their parents and teachers participated in the study. Participants were assigned to the PEERS ^® treatment condition or an alternative social skills curriculum. Instruction was provided daily by classroom teachers and teacher aides for 14-weeks. Results reveal that in comparison to an active treatment control group, participants in the PEERS ^® treatment group significantly improved in social functioning in the areas of teacher-reported social responsiveness, social communication, social motivation, social awareness, and decreased autistic mannerisms, with a trend toward improved social cognition on the Social Responsiveness Scale. Adolescent self-reports indicate significant improvement in social skills knowledge and frequency of hosted and invited get-togethers with friends, and parent-reports suggest a decrease in teen social anxiety on the Social Anxiety Scale at a trend level. This research represents one of the few teacher-facilitated treatment intervention studies demonstrating effectiveness in improving the social skills of adolescents with ASD in the classroom: arguably the most natural social setting of all.     

Vascular Compromise from Soft Tissue Augmentation: Experience with 12 Cases and Recommendations for Optimal Outcomes

The popularity of soft tissue fillers is, in part, due to their favorable side-effect profile. However, serious complications can occur. The authors describe their extensive clinical experience with soft-tissue augmentation and the rare complication of vascular compromise, which can lead to necrosis and scarring. Over a 10-year period between January 2003 and January 2013, the authors observed a total of 12 cases of vascular compromise. Eight patients in their clinical practice showed evidence of vascular compromise out of a total of 14,355 filler injections (0.05%). In addition, four patients treated with an experimental particulate filler had vascular complications. All cases were examined for filler type, location of complication, risk factors, treatment, and outcomes. Although treatment plans differed for each patient in their series, all cases of vascular compromise resolved fully. The authors believe that an office-based protocol for both immediate and ongoing care—including a thorough individualized assessment and treatment plan for each patient—is critical to timely and effective resolution of side effects. They propose key recommendations for the prevention and management of vascular compromise to improve patient outcomes and reduce the risk of permanent complications.Injectable fillers have become an integral part of aesthetic medicine for patients who want noninvasive rejuvenation. They are used to restore volume and to smooth and efface superficial wrinkles and deep folds of the face, among other indications. Widespread use began in the 1980s with the advent of bovine collagen. Since then, use has surged so that soft tissue augmentation is the second most popular nonsurgical aesthetic procedure in North America to botulinum toxin.1 In 2007, more than 1.5 million soft tissue filler procedures were performed in the United States, with hyaluronic acid (HA) being the most frequently used.2 As of 2010, more than 200 types of fillers were available for soft tissue augmentation worldwide.1The popularity of soft tissue fillers is in part due to their favorable side-effect profile. Adverse effects from soft tissue filler injection are generally mild and self-limited. However, there are some well-documented serious complications. The most feared and potentially serious complications are vascular in nature. Collectively referred to as vascular compromise, these complications include partial or complete interruption of vascular supply by extravascular compression, or a complete occlusion of vascular supply from intravascular injection. Subsequent necrosis and scarring are potentially permanent sequelae.2-4In the authors’ clinical practice, 14,355 filler injections were performed between January 2003, when they first instituted their computer database, and January 2013. Fillers that are used in their office include hyaluronic acid (HA) (Juv''derm Ultra, Ultra plus, Voluma [Allergan, Irvine, California] and Restylane [Medicis Aesthetics Inc., Scottsdale, Arizona]); poly-L-lactic acid (Sculptra, Sanofi-Aventis, Bridgewater, New Jersey); calcium hydroxylapatite (Radiesse, Merz USA, Greensboro, North Carolina); silicone oil; and collagen (Evolence Breeze, Ortho Dermatologics, Skillman, New Jersey). During this 10-year period, a total of 12 cases of vascular compromise were observed and managed, eight of which occurred in the authors’ clinical practice and four in their clinical trials practice. Those cases that developed vascular compromise after soft tissue augmentation are reviewed and treatment discussed (Appendix 1).Over a 10-year period between January 2003 and January 2013, eight patients in the authors'' clinical practice showed evidence of vascular compromise out of a total of 14,355 filler injections (0.05%). They observed four cases after injection with calcium hydroxylapatite (CaHA) (out of 1,482 total injections; 0.27%), four cases after injection with volumizing monophasic HA (Juvéderm Voluma) (out of 4,321 total injections; 0.09%), and one case resulting from treatment with biphasic HA (Restylane) (out of 3,348 injections; 0.03%). One patient was treated with both CaHA and volumizing monophasic HA, and is counted in both groups (

Inhibition of the liver expression of arylalkylamine N-acetyltransferase increases the expression of angiogenic factors in cholangiocytes

Background and aims

Reduction of biliary serotonin N-acetyltransferase (AANAT) expression and melatonin administration/secretion in cholangiocytes increases biliary proliferation and the expression of SR, CFTR and Cl^–/HCO₃^– AE2. The balance between biliary proliferation/damage is regulated by several autocrine neuroendocrine factors including vascular endothelial growth factor-A/C (VEGF-A/C). VEGFs are secreted by several epithelia, where they modulate cell growth by autocrine and paracrine mechanisms. No data exists regarding the effect of AANAT modulation on the expressions of VEGFs by cholangiocytes.

Methods

In this study, we evaluated the effect of local modulation of biliary AANAT expression on the cholangiocytes synthesis of VEGF-A/C.

Results

The decrease in AANAT expression and subsequent lower melatonin secretion by cholangiocytes was associated with increased expression of VEGF-A/C. Overexpression of AANAT in cholangiocyte lines decreased the expression of VEGF-A/C.

Conclusions

Modulation of melatonin synthesis may affect the expression of VEGF-A/C by cholangiocytes and may modulate the hepatic microvascularization through the regulation of VEGF-A/C expression regulating biliary functions.     

A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients

OBJECTIVE: To compare duration of mechanical ventilation for patients randomized to receive lorazepam by intermittent bolus administration vs. continuous infusions of propofol using protocols that include scheduled daily interruption of sedation. DESIGN: A randomized open-label trial enrolling patients from October 2001 to March 2004. SETTING: Medical intensive care units of two tertiary care medical centers. PATIENTS: Adult patients expected to require mechanical ventilation for >48 hrs and who required > or =10 mg of lorazepam or a continuous infusion of a sedative to achieve adequate sedation. INTERVENTIONS: Patients were randomized to receive lorazepam by intermittent bolus administration or propofol by continuous infusion to maintain a Ramsay score of 2-3. Sedation was interrupted on a daily basis for both groups. MEASUREMENTS AND MAIN RESULTS: The primary outcome was median ventilator days. Secondary outcomes included 28-day ventilator-free survival, intensive care unit and hospital length of stay, and hospital mortality. Median ventilator days were significantly lower in the daily interruption propofol group compared with the intermittent bolus lorazepam group (5.8 vs. 8.4, p = .04). The difference was largest for hospital survivors (4.4 vs. 9.0, p = .006). There was a trend toward greater ventilator-free survival for patients in the daily interruption propofol group (median 18.5 days for propofol vs. 10.2 for lorazepam, p = .06). Hospital mortality was not different. CONCLUSIONS: For medical patients requiring >48 hrs of mechanical ventilation, sedation with propofol results in significantly fewer ventilator days compared with intermittent lorazepam when sedatives are interrupted daily.     

Caring for patients with Alzheimer's disease. Recommendations for nursing education

1. Most educational programs for healthcare professionals stress acute rather than chronic care and provide little education or training related to caregiving of persons with dementia. 2. Long-term care facilities employ a minimum of licensed staff with the bulk of direct caregiving done by nursing assistants. 3. Licensed nurses and nursing assistants who work with the cognitively impaired should have specialized training and education in caring for persons with AD or other dementias. 4. Annual ongoing training and education should be provided for all caregivers of persons with a dementing illness.