Remission and Recovery in the Treatment for Adolescents With Depression Study (TADS): Acute and Long-Term Outcomes

ObjectiveWe examine remission rate probabilities, recovery rates, and residual symptoms across 36 weeks in the Treatment for Adolescents with Depression Study (TADS).MethodThe TADS, a multisite clinical trial, randomized 439 adolescents with major depressive disorder to 12 weeks of treatment with fluoxetine, cognitive–behavioral therapy, their combination, or pill placebo. The pill placebo group, treated openly after week 12, was not included in the subsequent analyses. Treatment differences in remission rates and probabilities of remission over time are compared. Recovery rates in remitters at weeks 12 (acute phase remitters) and 18 (continuation phase remitters) are summarized. We also examined whether residual symptoms at the end of 12 weeks of acute treatment predicted later remission.ResultsAt week 36, the estimated remission rates for intention-to-treat cases were as follows: combination, 60%; fluoxetine, 55%; cognitive–behavioral therapy, 64%; and overall, 60%. Paired comparisons reveal that, at week 24, all active treatments converge on remission outcomes. The recovery rate at week 36 was 65% for acute phase remitters and 71% for continuation phase remitters, with no significant between-treatment differences in recovery rates. Residual symptoms at the end of acute treatment predicted failure to achieve remission at weeks 18 and 36.ConclusionsMost depressed adolescents in all three treatment modalities achieved remission at the end of 9 months of treatment.     

Ocular motor and manual tracking in Parkinson''s disease and the effect of treatment.

A quantitative analysis of unpredictable saccadic and smooth pursuit ocular motor and manual tracking was performed in 15 mildly affected, previously untreated subjects suffering from Parkinson's disease and in age-matched normal controls. The patients' ocular saccades were characterised by an increased variability of their latencies and reduced accuracy, with normal velocity profiles apart from saccadic duration. Their smooth pursuit had a decreased velocity gain. Similar abnormalities were found with manual tracking. Clinical improvement with dopaminergic drugs was associated with an improvement of saccadic accuracy and smooth pursuit gain. It is postulated that the ocular motor changes seen in Parkinson's disease are contingent upon functional dopamine levels in the basal ganglia.     

腹部外科常见感染性疾病的病原菌及药敏试验研究

为了了解本地区本医院腹部外科感染性疾病病原菌的构成比和药物敏感率的变化,指导临床用药,我们采用美国BD公司生产的6B和7D两种增菌瓶采集标本和培养细菌,并用该公司生产的生化板和药敏板,对1994～1996年269例常见的普外科感染性疾病患者的手术标本进行前瞻性的细菌培养和药敏试验研究.     

Visual experience and the maturation of the ipsilateral visuotectal projection in Xenopus laevis

The effect of visual deprivation upon the maturation of the ipsilateral visuotectal projection has been studied in Xenopus laevis. This topographically ordered projection is polysynaptic. The first stage involves the retinal projection to the contralateral optic tectum. The tectum projects to the nucleus isthmi on the same side. The final stage is the crossed isthmotectal projection from the nucleus isthmi to the tectum ipsilateral to the eye. The topographic precision of connections at various points in this polysynaptic pathway has been investigated by quantifying single-unit and multi-unit receptive field sizes in the contralateral and ipsilateral visuotectal projections. Observations have been made on normal animals of different ages to plot the normal maturational course of events. The effects of visual deprivation on this maturational process has been studied. Between one week and one year after metamorphosis there is an increase in the precision of connections in both the contralateral and ipsilateral visuotectal projections. Visual deprivation had no effect upon the parameters of the contralateral visuotectal projection. Ipsilateral visuotectal single units in dark-reared animals had normal receptive field sizes. Ipsilateral multi-unit receptive fields in dark-reared animals were considerably larger than in normal animals. It was concluded that the effects of visual deprivation are limited to effects on the crossed isthmotectal component of the intertectal system. In this component, however, visual experience seems to play an important role in the normal development and modification of connections. It is suggested that visual experience is utilized to accommodate changes in the system required to respond to normal changes in interocular geometry that take place with development in Xenopus.     

Long-term regulation of N-methyl-D-aspartate receptor subunits and associated synaptic proteins following hippocampal synaptic plasticity

Synaptic plasticity in the dentate gyrus is dependent on activation of the N-methyl-D-aspartate (NMDA)-subtype of glutamate receptors. In this study, we show that synaptic plasticity in turn regulates NMDA receptors, since subunits of the NMDA receptor complex are bidirectionally and independently regulated in the dentate gyrus following activation of perforant synapses in awake animals. Low-frequency stimulation that produced a mild synaptic depression resulted in a decrease in the NMDA receptor subunits NR1 and NR2B 48 h following stimulation. High-frequency stimulation that produced long-term potentiation resulted in an increase in NR1 and NR2B at the same time point. Further investigations revealed that in contrast to NR2B, NR1 levels increased gradually after long-term potentiation induction, reaching a peak level at 48 h, and were insensitive to the competitive NMDA receptor antagonist 3-3(2-carboxypiperazin-4-yl) propyl-1-phosphate. The increased levels of NR1 and NR2B at 48 h were found associated with synaptic membranes and with increased NMDA receptor-associated proteins, postsynaptic density protein 95, neuronal nitric oxide synthase and Ca(2+)/calmodulin-dependent protein kinase II, alpha subunit. These data suggest that the persistence of long-term potentiation is associated with an increase in the number of NMDA receptor complexes, which may be indicative of an increase in synaptic contact area.     

Neuro-ophthalmology of degenerative neurological disorders

A number of degenerative disorders of the nervous system are associated with visual or ocular motor disturbances. Over recent years, these problems have attracted a great deal of interest because they may aid diagnosis and also improve our understanding of pathophysiology. In this review, we discuss both of these aspects of the study of degenerative conditions and attempt to demonstrate the clinical significance of a number of new findings.     

Computed tomography diagnosis of tracheobronchopathia osteochondroplastica

Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease characterized by the presence of osseous and cartilaginous submucosal nodules projecting into the tracheobronchial tree. Most cases are asymptomatic and discovered incidentally at post‐mortem. We identified a case of TO on thoracic spiral CT and confirmed the diagnosis on bronchoscopy. This article reviews the imaging characteristics of TO, and shows the 3‐D virtual bronchoscopic and multiplanar reconstruction appearances of TO.