Plasma neurofilament light in behavioural variant frontotemporal dementia compared to mood and psychotic disorders

OBJECTIVE

Blood biomarkers of neuronal injury such as neurofilament light (NfL) show promise to improve diagnosis of neurodegenerative disorders and distinguish neurodegenerative from primary psychiatric disorders (PPD). This study investigated the diagnostic utility of plasma NfL to differentiate behavioural variant frontotemporal dementia (bvFTD, a neurodegenerative disorder commonly misdiagnosed initially as PPD), from PPD, and performance of large normative/reference data sets and models.

METHODS

Plasma NfL was analysed in major depressive disorder (MDD, n = 42), bipolar affective disorder (BPAD, n = 121), treatment-resistant schizophrenia (TRS, n = 82), bvFTD (n = 22), and compared to the reference cohort (Control Group 2, n = 1926, using GAMLSS modelling), and age-matched controls (Control Group 1, n = 96, using general linear models).

RESULTS

Large differences were seen between bvFTD (mean NfL 34.9 pg/mL) and all PPDs and controls (all < 11 pg/mL). NfL distinguished bvFTD from PPD with high accuracy, sensitivity (86%), and specificity (88%). GAMLSS models using reference Control Group 2 facilitated precision interpretation of individual levels, while performing equally to or outperforming models using local controls. Slightly higher NfL levels were found in BPAD, compared to controls and TRS.

CONCLUSIONS

This study adds further evidence on the diagnostic utility of NfL to distinguish bvFTD from PPD of high clinical relevance to a bvFTD differential diagnosis, and includes the largest cohort of BPAD to date. Using large reference cohorts, GAMLSS modelling and the interactive Internet-based application we developed, may have important implications for future research and clinical translation. Studies are underway investigating utility of plasma NfL in diverse neurodegenerative and primary psychiatric conditions in real-world clinical settings.

The Associations Between Neuropsychiatric Symptoms and Cognition in People with Dementia: A Systematic Review and Meta-Analysis

Most people with dementia experience neuropsychiatric symptoms (NPS), including anxiety, depression or disinhibition. There is growing interest in the relationship between NPS and cognitive impairment, but data is still limited. This study aimed to investigate the specific associations between NPS and cognition in people with dementia. MEDLINE, EMBASE and PsycINFO were searched for published, peer-reviewed studies of associations between at least one NPS and one cognitive ability in people with dementia. The quality of the studies was assessed with the NIH National Heart, Lung and Blood Institute's quality assessment tools. A meta-analysis was conducted using Robumeta package for R. Ninety studies were included. We found significant associations between NPS, global cognition and cognitive domains, e.g. apathy was associated with global cognitive and memory impairment; dysphoria was associated with worse attention; delusions with executive dysfunction. Increased NPS in people with dementia are associated with worse cognitive performance. There were few studies looking at associations between some neuropsychiatric clusters and cognitive abilities, and there was little research on causal relationships. Our review was limited by the inclusion of studies that reported associations in specific formats, and most included people with a diagnosis of Alzheimer's disease (AD). However, given the large number of studies, this is unlikely to have biased results. More research is needed that includes diverse people with different dementia syndromes. Registration: PROSPERO 2020 CRD42020165565.

Carer burden and behavioral disturbance is similar between younger-onset Alzheimer's disease and behavioral variant frontotemporal dementia

OBJECTIVES

Carer burden is common in younger-onset dementia (YOD), often due to the difficulty of navigating services often designed for older people with dementia. Compared to Alzheimer's disease (AD), the burden is reported to be higher in behavioral variant frontotemporal dementia (bvFTD). However, there is little literature comparing carer burden specifically in YOD. This study hypothesized that carer burden in bvFTD would be higher than in AD.

DESIGN

Retrospective cross-sectional study.

SETTING

Tertiary neuropsychiatry service in Victoria, Australia.

PARTICIPANTS

Patient-carer dyads with YOD.

MEASUREMENTS

We collected patient data, including behaviors using the Cambridge Behavioral Inventory-Revised (CBI-R). Carer burden was rated using the Zarit Burden Inventory-short version (ZBI-12). Descriptive statistics and Mann-Whitney U tests were used to analyze the data.

RESULTS

Carers reported high burden (ZBI-12 mean score = 17.2, SD = 10.5), with no significant difference in burden between younger-onset AD and bvFTD. CBI-R stereotypic and motor behaviors, CBI-R everyday skills, and total NUCOG scores differed between the two groups. There was no significant difference in the rest of the CBI-R subcategories, including the behavior-related domains.

CONCLUSION

Carers of YOD face high burden and are managing significant challenging behaviors. We found no difference in carer burden between younger-onset AD and bvFTD. This could be due to similarities in the two subtypes in terms of abnormal behavior, motivation, and self-care as measured on CBI-R, contrary to previous literature. Clinicians should screen for carer burden and associated factors including behavioral symptoms in YOD syndromes, as they may contribute to carer burden regardless of the type.

An exploration of prevalence and associated factors of nonalcoholic Fatty liver disease in the taiwanese police service

BACKGROUND

The purpose of this study was to explore any gender-related differences in prevalence of and condition-associated factors related to non-alcoholic fatty liver disease (NAFLD) amongst police population in Taipei, Taiwan.

METHODS

We studied a total of 1016 healthy adults with police work (972 males and 44 females) voluntarily admitted to physical check-up between January 2006 and December 2006. Blood samples and ultrasound-proved fatty liver sonography results were collected.

RESULTS

The prevalence of NAFLD for this sub-population was found to be 52.2%, the prevalence revealing a statistically significant decrease with increasing population age (P<0.001). Males exhibited a greater prevalence of NAFLD than did females (53.6% vs 20.5%, P<0.0001). Using multiple logistic regression analysis, in addition to male gender, an older age, higher BMI, higher ALT, presence of hyperuricemia, hypercholesterolemia, and hypertriglyceridemia were the significant factors associated with NAFLD. Gender-related differences as regards associated factors were also revealed. For males, hyperuricemia (OR=1.35, 95%CI: 1.07-1.86), higher ALT (OR=2.31, 95%CI: 1.50-3.56), hypercholesterolemia (OR=1.33, 95%CI: 1.01-1.82), and hypertriglyceridemia (OR=1.55, 95%CI: 1.01-2.37) were significantly related to NAFLD but these were not so for females.

CONCLUSION

several gender-related differences were noted pertaining to the prevalence of and relationship between hyperuricemia, higher ALT, hypercholesterolemia, and hypertriglyceridemia and NAFLD in the present study.

Low maternal serum levels of placenta growth factor as an antecedent of clinical preeclampsia

OBJECTIVE

Maternal serum placenta growth factor levels have been shown to be significantly reduced in women with established preeclampsia. However, the temporal change in serum placenta growth factor levels before the clinical onset of preeclampsia is not known.

STUDY DESIGN

Serum samples were collected from patients at the first prenatal (5-15 weeks' gestation), second-trimester (16-20 weeks' gestation), and third-trimester (26-30 weeks' gestation) visits. Serum placenta growth factor levels were determined and analyzed according to pregnancy outcome.

RESULTS

Maternal placenta growth factor levels during normal gestation increased dramatically from the first to the third trimester. At the same gestational time points, in contrast, significantly lower serum placenta growth factor levels were found in patients in whom mild or severe preeclampsia eventually developed (P <.01). Low maternal serum placenta growth factor levels during early gestation were associated with a significant odds ratio for development of preeclampsia (P <.005).

CONCLUSION

Relatively decreased levels of serum placenta growth factor occur before the onset of clinical preeclampsia, which suggests that placenta growth factor measurement could be used to discriminate those pregnancies predisposed to development of preeclampsia.

Cervical pregnancy: assessment with three-dimensional power Doppler imaging and successful management with selective uterine artery embolization

Cervical pregnancy is frequently associated with extensive hemorrhage which, in severe cases, may be stopped only by hysterectomy. We report a case of an anembryonic cervical pregnancy diagnosed at 10 weeks, and associated with a large arteriovenous malformation. The patient was conservatively managed with simple selective uterine artery embolization. After embolization, her vaginal bleeding ceased and the level of serum beta-human chorionic gonadotropin decreased rapidly. No additional treatment was given. The patient's postoperative course was uneventful and the cervical mass had disappeared at the follow-up 4 months later. To the best of our knowledge, this is the first report of conservative management of cervical pregnancy simply by uterine artery embolization. The role of three-dimensional power Doppler ultrasonography in the assessment of cervical pregnancy and in monitoring the therapeutic response is discussed.

[Midazolam and Meperidine for colonoscopy]

We studied the sedative, analgesic and amnesic effects of intravenous midazolam and meperidine for colonoscopy, and also compared patient's satisfaction, changes of vital signs, safety and complications with intramuscular meperidine during the colonoscopy. Two hundred and ninety-nine patients undergoing physical check-up were randomized to receive intramuscular meperidine 50 mg and Hyoscine-N-Butylbromide (buscopan) 20 mg (Group IM-MB, n = 57) or intravenous midazolam 0.05 mg/kg, meperidine 1 mg/kg and buscopan 20 mg (Group IV-MMB, n = 242) before colonoscopy. All patients were closely observed and arterial oxygen saturations (SaO2) were monitored with pulse oximeter in Group IV-MMB. The demographic data of both groups were similar. There were significantly more severe pain responses (grimacing, moaning, shouting for pain, abdominal rigidity and body moving during colonoscopy) in Group IM-MB (51%) than in Group IV-MMB (13%) (p < 0.01). In immediate procedure recall after recovery from medications, 39% of Group IM-MB remembered severe pain during colonoscopy and only 3% of Group IV-MMB did (p < 0.01). 92% of Group IV-MMB who felt satisfactory with the medications were significantly higher than 21% in Group IM-MB (p < 0.01). Both groups significantly increased in heart rate after the injection of medications (p < 0.01). Group IM-MB increased 15 +/- 18% and Group IV-MMB 61 +/- 28% with significant difference between groups (p < 0.01). This might be caused by meperidine, buscopan, and relative hypovolemia of patients. There were significant decreases in SaO2 in Group IV-MMB, mean 4.5 +/- 1.7% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Sympathy and support for industrial actions: a justice analysis

The authors investigated the effects of different causes of grievance and different types of industrial action on observers' justice perceptions and their sympathy toward and support for grievants in industrial actions. Results indicated that grievances based on interactional injustice generated a stronger perception of unfairness, more sympathy, and more support than did grievances based on procedural injustice, which in turn generated a stronger perception of unfairness, more sympathy, and more support than did grievances based on distributive injustice. Ss also expressed less support for strikes than for sit-ins, but no such difference because of the types of industrial action taken was found for perceived fairness and sympathy. Finally, the ratings on perceived fairness, sympathy, and support were more discrepant among the three types of grievance for sit-ins than for strikes.

Comparison of the combined effects of atropine and neostigmine with atropine and edrophonium on the occurrence of postoperative nausea and vomiting

To investigate the effects of different types of anticholinesterase on the incidence of the postoperative nausea and vomiting, 100 ASA class I-II adult premenopausal female patients undergoing elective lower abdominal surgery were randomized into two groups. In both groups, anesthesia was induced with thiopental and fentanyl and 50% nitrous oxide and 0.5-1.5% of isoflurane were used for anesthetic maintenance with succinylcholine 1 approximately 1.5 mg/kg for intubation and atracurium 0.3 mg/kg/hr for maintenance of muscle relaxation. Patients received reversal agents for neuromuscular blockade after operation when the evoked train-of-four (TOF) count returned to four visual responses. A mixture of atropine 8 micrograms/kg and edrophonium 0.75 mg/kg was given to the first group of patients while atropine 15 micrograms/kg and neostigmine 40 micrograms/kg was given to another group of patients. All the patients were observed for the occurrence of nausea or vomiting for 2 hours after the operation in the recovery room. The incidence of nausea was not statistically significantly different in both groups (20% in neostigmine group and 26% in edrophonium group). The occurrence of vomiting was also similar in both groups (8% in neostigmine group and 6% in edrophonium group). We concluded that there were no difference in the incidence of postoperative nausea or vomiting with the use of either neostigmine or edrophonium with atropine for antagonizing neuromuscular blockade after the lower abdominal surgery.

[An index for childhood nutrition--"chung-hsin" index]

For evaluation of growth and development of children, a nutritional index is one of the most important guides. Many methods have been proposed to estimate the index. Kaup's Index is one, used frequently to check the nutritional condition, but it is unsuitable for evaluation of infants under three-months-old. From July 1, 1986 to June 30, 1989, random selection of 274 normal, full-term newborns was made at Taipei Municipal Chung-Hsin Hospital; others studied were 477 normal healthy infants and preschool children from the well-baby clinic, and 629 normal healthy students from kindergartens and elementary schools in nearby downtown and rural area of Taipei County. Body weights (by gram) and body heights (by centimeter) were checked before eating. Naked for children under 3-years-old; those older were checked when wearing only underwear. The nutritional index was calculated by formula of 3 square root of W/Lx100 (Temporarily called "Chung-Hsin Index"). The distribution of Chung-Hsin Index was comparable to kaup's Index for children of three months or older. Under three months the distribution of Kaup's Index cannot be adapted as well as the Chung-Hsin Index. In conclusion, it was found that extraction of the cubic root of body weight and body height among normal newborns showed normal distribution. The Chung-Hsin Index, 3 square root of W/Lx100, which was based on the idea of normal distribution, is suitable for evaluation of the balance of body weight and body height not only in children under 3 months, but also in children up to 15 years old.

Syntheses and biological activities of 7 beta-methyl steroids

The preparation of 7 beta-methyl-5 alpha-dihydrotestosterone acetate and its 2-thia-A-nor analogue is described. Biological evaluation shows that a 7 beta-Me largely decreases myotrophic-androgenic activity in both 5 alpha-dihydrotestosterone and the 2-thia-A nor analogue. Testing for antitumor activity shows that the reduction in breast tumor weight was not significant for either compound, but the final tumor size in the animals treated with 7 beta-methyl-2-thia-A nor steroid at 10 (mg/kg)/day was significantly reduced. The effects of 7 beta-Me steroids on the various organ weights are also described. The influence of 7 beta-Me substituent on the biological activities of androgens may be mediated through direct interaction of the substituent with the receptor surface in contact with the third dimension of the steroid molecule.

Selective catalytic reduction of 7-methyl-6-dehydrotestosterone acetate to 7 beta-methyltestosterone acetate by benzyl alcohol

Using benzyl alcohol as a hydrogen donor in the presence of Pd on charcoal, 7-methyl-6-dehydrotestosterone acetate was selectively reduced to 7 beta-methyltestosterone acetate in 90% yield. The addition of hydrogen atoms to the 6, 7 double bond proceeded from the less hindered alpha-face of the steroid molecule, giving rise to the 7 beta-methyl product. Gas chromatograph analysis indicated small amounts of the 7 alpha-methyl epimer, 7 beta-methyl-5 alpha-dihydrotestosterone acetate and the 5 beta-epimer. The 6,7 double bond was hydrogenated in preference to 4,5 double bond, although both are trisubstituted.

Apparent bioisosteric replacement of--S--by NCN: synthesis of N--cyano-2-aza-A-nor-5alpha-androstan-17beta-ol acetate, an aza steroid androgen

The synthesis of N-cyano-2-aza-A-nor-5alpha-androstan-17beta-ol acetate is described. Cyclization of 1,4-dibromo-1,4-seco-2,3bisnor-5alpha-androstan-17beta-ol acetate with benzylamine in the presence of potassium iodide gives the N-benzyl-2-aza-A-nor steroid. Debenzylation with cyanogen bromide (Von Braun reaction) affords the N-cyano-2-aza-A-nor steroid, which has androgenic activity slightly weaker than that of the corresponding thia compound. The results indicate that NCN may be substituted for--S--as well as for =S. This compound is the first hormonally active steroid containing nitrogen as a heteroatom in the perhydrocyclopentanophenanthrene nucleus.