[123I]beta-CIT SPECT imaging assessment of the rate of Parkinson's disease progression

BACKGROUND

[123I]beta-CIT and SPECT imaging of the dopamine transporter is a sensitive biomarker of PD onset and severity.

OBJECTIVE

In this study, the authors examine the change in [123I]beta-CIT uptake in sequential SPECT scans to assess the rate of progression of the dopaminergic terminal loss in patients with PD.

METHODS

Patients with PD (n = 32) and healthy controls (n = 24) recruited from the Yale Movement Disorders Center underwent repeat [123I]beta-CIT SPECT imaging during a 1- to 4-year period. The primary imaging outcome was the ratio of specific to nondisplaceable striatal activity. Disease severity was assessed by Hoehn and Yahr staging, and Unified Parkinson Disease Rating Scale after 12 hours off drug.

RESULTS

Sequential SPECT scans in PD subjects demonstrated a decline in [123I]beta-CIT striatal uptake of approximately 11.2%/year from the baseline scan, compared with 0.8%/year in the healthy controls (p < 0.001). Although [123I]beta-CIT striatal uptake in the PD subjects was correlated with clinical severity, the annual percentage loss of [123I]beta-CIT striatal uptake did not correlate with the annual loss in measures of clinical function.

CONCLUSIONS

- The rate of dopaminergic loss in PD is significantly greater than that of healthy controls, and [123I]beta-CIT SPECT imaging provides a quantitative biomarker for the progressive nigrostriatal dopaminergic degeneration in PD. As new protective and restorative therapies for PD are developed, dopamine transporter imaging offers the potential to provide an objective endpoint for these therapeutic trials.

[Anxiety-depressive disorder in women after hysterectomy. Own study]

Hysterectomy is a surgical procedure that significantly affects the quality in which the operated person views herself, lowers self-esteem and brings about changes in the quality of life. The results of the presented study show the necessity of a more accurate and specific dealing with the problem of affective disorders and anxiety states in women who have undergone such an operation. The course of the post-operative period and the return of the patients to full health are largely affected by their psychological state and the quality of life they experience. A successful (in a medical sense) surgical procedure is not a guarantee of the bringing back health in a holistic sense. The results of studies and clinical observations show that half of the group of women operated suffer from anxiety-depressive disorders as a cause of the operation, and a quarter of all those operated require specialist help. No psychological preparation for the operation, absence of closest people in the decision making before the operation, lack of knowledge on the surgical operational-span, lacking psychological aid after the operation--all these can significantly affect the rehabilitation and the process of regaining the social functions. It appears vital to introduce a psychological programme and special care taking of the women who declare having symptoms which appear to lead to the development of depressive disorders. The appearance of depressive symptoms post-operatively as well as the earlier presence of affective disorder symptoms can be prognostic in the further development of the disorder. The early diagnosis of the affective disorder and the higher level of anxiety in women post-hysterectomy and the fast application of appropriate treatment can inhibit further symptom elevation and persistence. Catamnestic studies on women post-hysterectomy due to non-oncologic causes will allow seeing the dynamics of the changes in the affective disorders at different time intervals from the operation.

[Anxiety-depressive disorders in women after hysterectomy. Literature review]

In the common opinion amongst woman, the surgical removal of the uterus and ovaries can be a cause of limited physical and sexual activity and have an effect on their attractiveness. The majority of women after hysterectomy can be permanently depressed and can also show symptoms of mixed anxiety-depressive disorder. The review of literature allows for an assumption that the topic of anxiety and depression should not be underrated, by treating it as an exaggerated theme, as some researchers do. By considering the research quoted in this paper the collected directions of diagnostic and therapeutic procedures undertaken by the psychiatrist and psychologist can be used before the planned operation. Special consideration must be given to patients who have a history of affective disorders or sexual abuse. Pharmacotherapy and psychotherapy should applied in order to prevent post-operative affective disorders.

A randomized, controlled trial of remacemide for motor fluctuations in Parkinson's disease

BACKGROUND

Preclinical studies suggest that glutamate antagonists help ameliorate motor fluctuations in patients with PD treated with levodopa.

METHODS

In a multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study, the authors assessed the safety, tolerability, and efficacy of the glutamate receptor blocker remacemide hydrochloride in 279 patients with motor fluctuations treated with levodopa. The primary objective was to assess the short-term tolerability and safety of four dosage levels of remacemide during 7 weeks of treatment. Patients were also monitored with home diaries and the Unified PD Rating Scale (UPDRS) to collect preliminary data on treatment efficacy.

RESULTS

Remacemide was well tolerated up to a dosage of 300 mg/d on a twice daily schedule and 600 mg/d on a four times daily schedule. The most common dosage-related adverse events were dizziness and nausea, as observed in previous studies of remacemide. The percent "on" time and motor UPDRS scores showed trends toward improvement in the patients treated with 150 and 300 mg/d remacemide compared with placebo-treated patients, although these improvements were not significant.

CONCLUSION

Remacemide is a safe and tolerable adjunct to dopaminergic therapy for patients with PD and motor fluctuations. Although this study had limited power to detect therapeutic effects, the observed improvement is consistent with studies of non-human primates with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced parkinsonian signs and symptoms. Additional studies are warranted to confirm these results over an extended period of observation, and to explore the potential neuroprotective effects of remacemide in slowing the progression of PD.

Genetic remodeling of protein glycosylation in vivo induces autoimmune disease

Autoimmune diseases are among the most prevalent of afflictions, yet the genetic factors responsible are largely undefined. Protein glycosylation in the Golgi apparatus produces structural variation at the cell surface and contributes to immune self-recognition. Altered protein glycosylation and antibodies that recognize endogenous glycans have been associated with various autoimmune syndromes, with the possibility that such abnormalities may reflect genetic defects in glycan formation. We show that mutation of a single gene, encoding alpha-mannosidase II, which regulates the hybrid to complex branching pattern of extracellular asparagine (N)-linked oligosaccharide chains (N-glycans), results in a systemic autoimmune disease similar to human systemic lupus erythematosus. alpha-Mannosidase II-deficient autoimmune disease is due to an incomplete overlap of two conjoined pathways in complex-type N-glycan production. Lymphocyte development, abundance, and activation parameters are normal; however, serum immunoglobulins are increased and kidney function progressively falters as a disorder consistent with lupus nephritis develops. Autoantibody reactivity and circulating immune complexes are induced, and anti-nuclear antibodies exhibit reactivity toward histone, Sm antigen, and DNA. These findings reveal a genetic cause of autoimmune disease provoked by a defect in the pathway of protein N-glycosylation.

Postsynaptic signaling via the [mu]-opioid receptor: responses of dorsal horn neurons to exogenous opioids and noxious stimulation

Although both pre- and postsynaptic mechanisms have been implicated in the analgesia produced by mu-opioids at the spinal cord, it is not known under what conditions these different controls come into play. Because the mu-opioid receptor (MOR) can be visualized in individual lamina II excitatory interneurons and internalizes into endosomes on ligand binding, we tested whether MOR internalization could be monitored and used to measure postsynaptic MOR signaling. To test whether endogenous opioids modulate these lamina II interneurons during noxious stimulation, we next assessed the magnitude of postsynaptic MOR internalization under a variety of nociceptive conditions. As observed in other systems, we show that MOR internalization in dorsal horn interneurons is demonstrated readily in response to opioid ligands. The MOR internalization is dose-dependent, with a similar dose-response to that observed for opioid-induced increases in potassium conductance. We demonstrate that MOR internalization in lamina II neurons correlates precisely with the extent of analgesia produced by intrathecal DAMGO. These results suggest that MOR internalization provides a good marker of MOR signaling in the spinal cord and that postsynaptic MORs on lamina II interneurons likely participate in the analgesia that is produced by exogenous opioids. We found, however, that noxious stimuli, under normal or inflammatory conditions, did not induce MOR internalization. Thus, endogenous enkephalins and endomorphins, thought to be released during noxious peripheral stimuli, do not modulate nociceptive messages via postsynaptic MORs on lamina II interneurons. We suggest that any endogenous opioids that are released by noxious stimuli target presynaptic MORs or delta-opioid receptors.

Occurrence and prevention of coal miners' pneumoconiosis in Poland

BACKGROUND

Coal production is one of the largest industries in Poland and incidence of coal miners' pneumoconiosis is high.

METHODS

Data concerning the epidemiology of coal miners' pneumoconiosis stem from the national register and previous investigations performed in Poland. Improvements in medical and technical methodologies for the prevention of pneumoconiosis is discussed.

RESULTS

Analysis of the dust concentration measurements shows that TLV values are exceeded in 90% of underground workplaces. The number of new pneumoconiosis cases diagnosed annually ranges from 400-800 and has been showing a diminishing tendency in the last five years. Recently, a new system of medical and technical prevention has been introduced in seven collieries.

CONCLUSIONS

The current epidemiological situation of coal miners pneumoconiosis in Poland is unfavorable and needs vast improvement.

Iodine-123-beta-CIT and iodine-123-FPCIT SPECT measurement of dopamine transporters in healthy subjects and Parkinson's patients

Iodine-123-beta-carbomethoxy-3 beta-(4-iodophenyltropane) (CIT) has been used as a probe of dopamine transporters in Parkinson's disease patients using SPECT. This tracer has a protracted period of striatal uptake enabling imaging 14-24 hr postinjection for stable quantitative measures of dopamine transporters, and it binds with nanomolar affinity to the serotonin transporter. Iodine-123 fluoropropyl (FP)CIT is an analog of [123I]-beta-CIT and has been shown to achieve peak tracer uptake in the brain within hours postinjection and to provide greater selectivity for the dopamine transporter. The purpose of the present study was to compare [123I]-beta-CIT with [123I]-FPCIT in a within-subject design.

METHODS

Six Parkinson's disease patients and five healthy control subjects participated in one [123I]-beta-CIT and one [123I]-FPCIT SPECT scan separated by 7-21 days. Controls were imaged at 24 hr postinjection 222 MBq (6 mCi) [123I]-beta-CIT and serially from 1-6 hr postinjection 333 MBq (9 mCi) [123I]-FPCIT. Two imaging outcome measures were evaluated: (a) the ratio of specific striatal activity to nondisplaceable uptake, also designated V"3, at each imaging time point; and (b) the rate of striatal washout of radiotracer expressed as a percent reduction per hr for [123I]-FPCIT. In addition, venous plasma was obtained from the five control subjects after the [123I]-FPCIT injection for analysis of radiometabolites.

RESULTS

Both [123I]-FPCIT and [123I]-beta-CIT demonstrated decreased striatal uptake in Parkinson's disease patients compared with the controls with a mean of V"3=3.5 and 6.7 for [123I]-beta-CIT (Parkinson's disease and controls, respectively) and a mean of V"3=1.34 and 3.70 for [123I]-FPCIT (Parkinson's disease and controls, respectively). For [123I]-beta-CIT, the mean Parkinson's disease values represented 52% of the control uptake, while the mean [123I]-FPCIT value for Parkinson's disease patients was 37% of the control values. Analysis of [123I]-FPCIT time-activity curves for specific striatal counts showed washout rates of 8.2%/hr for Parkinson's disease and 4.9%/hr for controls.

CONCLUSION

These data suggest that SPECT imaging with [123I]-FPCIT visually demonstrates reductions in striatal uptake similar to [123I]-beta-CIT. iodine-123-FPCIT washed out from striatal tissue 15-20 times faster than [123I]-beta-CIT, and estimates of dopamine transporter loss in Parkinson's disease patients were higher for [123I]-FPCIT than for [123I]-beta-CIT. This was most likely due to the faster rate of striatal washout and establishment of transient equilibrium binding conditions at the dopamine transporter, which the modeling theory suggests produces an overestimation of dopamine transporter density with relatively greater overestimates in healthy control subjects by [123I]-FPCIT.

Challenges and issues related to implementation of nursing vocabularies in computer-based systems

As key stakeholders from the clinical setting and vendor communities, the authors share a summary of their collective experience related to the challenges and issues associated with implementing the vocabularies recognized by the American Nurses Association in several installations of commercially available clinical information systems. Although the focus of the article is on summarizing the challenges and issues, it is of note that the authors' experiences across care settings suggest that the experience and effort of using one of the ANA-recognized vocabularies in a computer-based system are essentially worthwhile and positive. The issues and challenges fall into two categories: 1) those related to the developmental status of nursing vocabularies, and 2) those related to the adoption or implementation of new technology.

Culture of human nasal epithelial cells from nasal polyps on collagen matrix

Epithelial cell cultures became an experimental model employed for both animal and human studies. We established a modified method of culture of human nasal epithelial cells from nasal polyps using serum-free, hormonally supplemented Ham's F-12 medium and Vitrogen 100 collagen matrix. Cells reached confluent monolayer structures in 5 to 7 days (mean time 6 +/- 0.89 days) of culture. The confluent cultures consisted of pure epithelial cells, which was confirmed by light and electron microscopy, and immunohistochemical staining with anticytokeratin antibody. The success ratio of cultures was 61.5%. The culture system described is efficient enough to provide pure epithelial cells for further functional studies.

Test/retest reproducibility of iodine-123-betaCIT SPECT brain measurement of dopamine transporters in Parkinson's patients

Iodine-123-beta-CIT has been used as a probe of dopamine transporters in Parkinson's disease patients using SPECT. We studied the test/retest reproducibility of SPECT measures in Parkinson's disease patients and healthy controls obtained after injection of [123I])beta-CIT in part to assess the utility of this tracer for longitudinal evaluation of striatal dopamine transporters as a marker of disease progression.

METHODS

Seven Parkinson's disease patients and seven healthy control subjects participated in two [123I]beta-CIT SPECT scans separated by 7-21 days. Subjects were imaged at 24 hr post injection of 360 MBq (9.7 mCi) of [123I]beta-CIT. Two outcome measures were evaluated; 1) the ratio of specific striatal (activity associated with DA transporter binding) to nondisplaceable uptake, also designated V3," and 2) the total specific striatal uptake (%SSU) expressed as a percentage of injected radiotracer dose. For both measures, test/retest variability was calculated as the absolute difference of test minus retest divided by the mean of test/retest and expressed as a percent. In addition, the reproducibility of left and right striatal asymmetry and putamen:caudate ratios were determined.

RESULTS

The two outcome measures demonstrated excellent test/retest reproducibility for both the Parkinson's disease and healthy subject groups with variability of striatal V3" = 16.8 +/- 13.3% and percent striatal uptake = 6.8 +/- 3.4% for Parkinson's disease patients and V3" = 12.8 +/- 8.9% and %SSU = 7.0 +/- 3.9% for control subjects. There were no statistically significant differences in test/retest variability between control subjects and Parkinson's disease patients for either outcome measure. The reproducibility of left/right asymmetry indices and putamen-to-caudate ratios showed no patient versus control subject differences. The asymmetry index had greater test/retest variability than the other outcome measures.

CONCLUSION

These data suggest that SPECT imaging performed at 24 hr postinjection of [123I]beta-CIT permits calculation of reliable and reproducible measures of dopamine transporters in both Parkinson's disease patients and control subjects and supports the feasibility of using [123I]beta-CIT in the evaluation of disease progression in Parkinson's disease.

Nursing Information and Data Set Evaluation Center

The American Nurses Association (ANA) has established the Nursing Information and Data Set Evaluation Center (NIDSEC). The purpose of this Center is to develop and disseminate standards pertaining to information systems that support the documentation of nursing practice, and to evaluate voluntarily submitted information systems against these standards. The target audience for these standards includes both consumers and vendors of clinical information systems. The need for an evaluation center arises out of a long history of calls for standards pertaining to nursing data and to information systems. These calls have come from the Secretary of Health and Human Services Commission on Nursing, the National Commission on Nursing Implementation Project (NICNIP). Standards will be developed to evaluate the completeness, accuracy and appropriateness of four dimensions of nursing data sets and the systems that contain them: 1) Nomenclature; 2) Clinical Content; 3) Clinical Data Repository; and 4) General System Characteristics.

Mortality among different occupational groups of workers with pneumoconiosis: results from a register-based cohort study

A mortality cohort study was carried out on 11,224 men with pneumoconiosis diagnosed during the period 1970-1985. The cohort was selected from among subjects entered into the National Register of Occupational Diseases and included 7,065 coal miners, 924 employees of underground work enterprises, 1,796 workers of the metallurgical industry and iron and nonferrous foundries, as well as 1,439 refractory materials, china, ceramics, and quarry workers. The cohort was traced up to the end of 1991. The mortality of all groups enrolled in the study, as compared with that of general male population of Poland, showed a statistically significant excess of overall mortality (SMRs ranging from 105; 95% confidence interval [CI]: 100-110 to 136; CI: 121-153) as well as a great excess of deaths from diseases of the respiratory system (SMRs from 383; 95% CI: 345-424 to 588; 95% CI: 457-744). In workers of the metallurgical industry, foundries, and those from refractory materials, china, and ceramics manufacturing plants as well as quarries, a statistically significant excess of deaths from infectious diseases (mostly tuberculosis) was found (SMRs: 503; 95% CI: 364-677 and 286; 95% CI: 177-437, respectively). Mortality from lung cancer was significantly elevated only in the group of metallurgical industry and iron and nonferrous foundry workers (SMR: 159; 95% CI: 124-201). In the remaining subcohorts, no significant excess of deaths from lung cancer was noted. The study does not support the hypothesis on the role of exposure to crystalline silica in the induction of lung cancer. Significantly lower mortality was seen for diseases of the circulatory system (SMR: 89; 95% CI: 82-96), hypertensive disease (SMR: 63; 95% CI: 38-98), cerebrovascular disease (SMR: 79; 95% CI: 62-99), atherosclerosis (SMR: 79; 95% CI: 66-93), and injuries and poisonings (SMR: 50; 95% CI: 38-64) in coal miners. In addition, lower mortality was noted for cerebrovascular disease (SMR: 56; 95% CI: 32-91) and injuries and poisonings (SMR: 34; 95% CI: 17-61) in metallurgical industry and iron and nonferrous foundry workers.

Mortality among coal miners with pneumoconiosis in Poland

A mortality cohort study was carried out on 7,065 coal miners with pneumoconiosis first diagnosed during the years of 1970-85. The cohort was selected from among subjects entered into the National Register of Occupational Diseases and followed up through to the end of 1991. The general male population of Poland was considered as a reference group. The PYRS-3 programme was used to identify, by means of standardized mortality ratios (SMRs), total and selected cause-specific mortality. An analysis revealed significantly elevated total mortality (SMR = 105; 95% confidence interval (CI): 100-110) in the whole cohort of coal miners. The risk of selected cause-specific mortality was significantly enhanced due to diseases of the respiratory system among which pneumoconiosis predominated (SMR = 383; 95% CI: 345-424). While mortality from all diseases of the circulatory system (SmR = 89; CI: 82-96), arterial hypertension (SMR = 63; 95% CI: 38-98), cerebrovascular diseases (SMR = 79; 95% CI: 62-99), atherosclerosis (SMR = 79; 95% CI: 66-93), and injury in poisoning (SMR = 50; 95% CI: 38-64) was significantly lower. The risk of death from malignant neoplasm of lung in the whole study population as well as in individual groups and categories of coal miners with pneumoconiosis, which varied in the risk of pneumoconiosis and the level of exposure to ionizing radiation, was not increased.

Serial transplants of 7,12-dimethylbenz[a]anthracene-induced mammary tumors in Fischer rats as model system for human breast cancer. 3. Quantitative ultrastructural studies of the pinealocytes and plasma melatonin concentrations in rats bearing an advanced passage of the tumor

The aim of the present study was to investigate the ultrastructure of pinealocytes and plasma melatonin concentrations in Fischer rats bearing an advanced (14th) passage 7,12-dimethylbenz[a]anthracene-induced mammary tumor. Quantitative ultrastructural analysis of the cell size and relative volumes of various cell organelles as well as the number of dense-core vesicles was performed in pinealocytes of the animals killed either during the daytime (15.00 h) or at night (3.00 h) 1 month after tumor transplantation. No significant differences between control and tumor-bearing animals were observed either during the daytime or at night. However, plasma melatonin concentrations in tumor-bearing rats killed at 3.00 h were suppressed by 35% (p < 0.025) when compared to the control animals killed at the same time.

Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome

A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetric (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Although the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic deficits remain unchanged.

Nifedipine in the prophylaxis of classic migraine: a crossover, double-masked, placebo-controlled study of headache frequency and side effects

Twenty-four patients with classic migraine attacks were treated with either nifedipine or placebo for up to 12 weeks. No significant differences were observed between the nifedipine (2.1 +/- 0.2) and placebo (2.3 +/- 0.2) treatment groups in the monthly frequency of headaches. However, the incidence of side effects was significantly greater (p less than 0.001) in the nifedipine (54% of patients) than in the placebo (8% of patients) treatment groups.

Influence of a short light pulse at night on the ultrastructure of the rat pinealocyte: a quantitative study

Although it is generally known that light strongly influences N-acetyltransferase activity and melatonin production in the pineal gland, little information is available concerning morphological changes following light exposure. As exposure of rats to a short light pulse at night rapidly depresses melatonin synthesis, we decided to determine whether this experimental condition produces rapid changes in the pinealocyte organelles. A 30-min light pulse at night (six hours after lights out) provoked rapid changes in the relative volumes of some pinealocyte organelles. The volume fractions of mitochondria, Golgi apparatus and lipid droplets, and the numbers of dense-core vesicles and "synaptic" ribbons decreased, whereas the volume fraction of lysosomes increased. There were no differences in the volumes of granular endoplasmic reticulum and vacuoles containing flocculent material in those animals exposed to light compared with control animals. These results indicate that a short light pulse at night causes ultrastructural changes that can be interpreted as morphological features of diminished activity of pinealocytes.