Course Of PD Research Articles

Timing of imagery rescripting during schema therapy for borderline personality disorder: the LUCY trial.

Early childhood adversity plays an important role in the etiology of borderline personality disorder (BPD). Current evidence suggests that trauma treatment for patients with BPD can be performed safely and that early trauma treatment has a positive effect on the course of PD. However, there is a scarcity of RCTs comparing the effects of the timing of trauma treatment during schema therapy (ST) for BPD on BPD severity. Therefore, the LUCY trial investigates the effects of the timing of trauma treatment by comparing early trauma treatment using imagery rescripting (ImRs) on the course of BPD during ST to trauma treatment in the middle of the treatment course. In this multicenter RCT, two conditions are compared among 73 individuals with BPD. The participants receive combined individual and group ST in both conditions. However, in condition (A), participants directly start ImRs in the individual sessions in months 2-4, and in condition (B), participants receive ST-as-Usual (STAU), in which ImRs is not allowed during months 2-4. The treatment follows ST treatment protocols, consists of a fixed combination of individual sessions and group sessions with a maximum of nine patients, and has a maximum duration of 25 months. The primary outcome is change in BPD severity, which is assessed using the Borderline Personality Disorder Severity Index-5 by independent raters blinded to the treatment. Secondary outcome measures include treatment retention, disconnection/rejection schemas, general functioning, posttraumatic stress disorder symptoms, general psychopathological complaints, quality of life, happiness, schemas, and schema modes. Multilevel analysis will be performed to analyze and compare changes in BPD severity between conditions and generalized linear mixed model analyses to test predictors and moderators. This study will increase the knowledge on whether trauma treatment early in therapy positively affects the course of BPD manifestations during ST. When the early application of ImRs leads to a faster decrease in BPD manifestations, the treatment of BPD patients might be shortened, leading to improved treatment outcomes and decreased healthcare expenses. Moreover, the planned sub-studies will expand our knowledge of how ST works and the factors that influence the outcome of treatment.

Parkinson's Disease and the Heart: Studying Cardiac Metabolism in the 6-Hydroxydopamine Model.

Parkinson's-disease (PD) is an incurable, age-related neurodegenerative disease, and its global prevalence of disability and death has increased exponentially. Although motor symptoms are the characteristic manifestations of PD, the clinical spectrum also contains a wide variety of non-motor symptoms, which are the main cause of disability and determinants of the decrease in a patient's quality of life. Noteworthy in this regard is the stress on the cardiac system that is often observed in the course of PD; however, its effects have not yet been adequately researched. Here, an untargeted metabolomics approach was used to assess changes in cardiac metabolism in the 6-hydroxydopamine model of PD. Beta-sitosterol, campesterol, cholesterol, monoacylglycerol, α-tocopherol, stearic acid, beta-glycerophosphoric acid, o-phosphoethanolamine, myo-inositol-1-phosphate, alanine, valine and allothreonine are the metabolites that significantly discriminate parkinsonian rats from sham counterparts. Upon analysis of the metabolic pathways with the aim of uncovering the main biological pathways involved in concentration patterns of cardiac metabolites, the biosynthesis of both phosphatidylethanolamine and phosphatidylcholine, the glucose-alanine cycle, glutathione metabolism and plasmalogen synthesis most adequately differentiated sham and parkinsonian rats. Our results reveal that both lipid and energy metabolism are particularly involved in changes in cardiac metabolism in PD. These results provide insight into cardiac metabolic signatures in PD and indicate potential targets for further investigation.

Prevalence of drooling in patients with parkinson disease

Background and aims: Drooling is the involuntary spillage of saliva from the mouth and is apparent in approximately 75% of individuals with PD and was historically interpreted as resulting from hypersecretion of saliva because of autonomic dysfunction. Alteration in salivary gland function is believed to arise from PD-associated changes in the autonomic nervous system and possibly involves the salivary para-sympathetic ganglia. Irrespective of the amount of saliva produced, drooling probably occurs because of PD-related inability to efficiently swallow with normal frequency, an inability to fully close the mouth, and an anterior flexed head position. Recognizing and managing sialorrhea is an important issue to ensure quality of life for patients with PD. The study aims to identify prevalence of drooling at patients hospitalized at neurology department in Tirana and increasing awareness about the importance of sialorrhea treatment in PD patients. Methods: In this retrospective study we investigated the prevalence of drooling in PD patients. We investigated the distribution of drooling according to sex and age and also the impact of drooling in this population by neurological examination and questionnaires given to them in a 6-month time distance. In addition, we studied the impact of gender in drooling in this population. Results: Our results show that most of the patients participating in the study showed signs of drooling. A significant correlation exists between drooling and stages of disease. Furthermore, in males, the correlation between the prevalence of drooling was found to be clinically significant compared to females. Conclusion: Our findings suggest that drooling is a major concern in the course of PD and should be addressed and treated early in patients with PD. Key word: Parkinson Disease, prevalence, sialorrhea, quality of life

Antagonistic network signature of motor function in Parkinson\u2019s disease revealed by connectome-based predictive modeling

Motor impairment is a core clinical feature of Parkinson’s disease (PD). Although the decoupled brain connectivity has been widely reported in previous neuroimaging studies, how the functional connectome is involved in motor dysfunction has not been well elucidated in PD patients. Here we developed a distributed brain signature by predicting clinical motor scores of PD patients across multicenter datasets (total n = 236). We decomposed the Pearson’s correlation into accordance and discordance via a temporal discrete procedure, which can capture coupling and anti-coupling respectively. Using different profiles of functional connectivity, we trained candidate predictive models and tested them on independent and heterogeneous PD samples. We showed that the antagonistic model measured by discordance had the best sensitivity and generalizability in all validations and it was dubbed as Parkinson’s antagonistic motor signature (PAMS). The PAMS was dominated by the subcortical, somatomotor, visual, cerebellum, default-mode, and frontoparietal networks, and the motor-visual stream accounted for the most part of predictive weights among network pairs. Additional stage-specific analysis showed that the predicted scores generated from the antagonistic model tended to be higher than the observed scores in the early course of PD, indicating that the functional signature may vary more sensitively with the neurodegenerative process than clinical behaviors. Together, these findings suggest that motor dysfunction of PD is represented as antagonistic interactions within multi-level brain systems. The signature shows great potential in the early motor evaluation and developing new therapeutic approaches for PD in the clinical realm.

The Role of Single Nucleotide Polymorphisms of Monoamine Oxidase B, Dopamine D2 Receptor, and DOPA Decarboxylase Receptors Among Patients Treated for Parkinson\u2019s Disease

This study aimed to investigate the association between selected variants of genes related to dopamine metabolism pathways and the risk of and progression of Parkinson’s disease (PD). This prospective cohort study was conducted in one academic teaching hospital. The study was conducted on 126 patients diagnosed with idiopathic Parkinson’s disease. Blood samples were collected to conduct a genotyping of MAOB, DRD1, DRD2, and DDC genes. Genotype and allele frequencies of MAOB (rs1799836) variants were not associated with the course of PD. Genotype and allele frequencies of DRD2 (rs2283265) variants were associated with risk of dementia (p = 0.001) and resulted in parts II and III of the UPDRS scale (p = 0.001). Genotype and allele frequencies of DRD2 (rs1076560) variants were associated with risk of dementia (p = 0.001) and resulted in parts II and III of the UPDRS scale (p = 0.001). Genotype and allele frequencies of DDC (rs921451) variants were not associated with the course of PD.

Parkinson's disease and Covid-19: Is there an impact of ethnicity and the need for palliative care.

Under the traditional models of care for People with Parkinson's Disease (PD, PwP), many of their needs remain unmet and a substantial burden of motor and non-motor symptoms they experience may not be tackled sufficiently. An introduction of palliative care (PC) interventions early in the course of PD offers profound benefits: it may improve quality of life of patients, their families and caregivers through the prevention and relief of medical symptoms, while, at the same time, emphasizing their emotional needs and spiritual wellbeing, establishing goals of care, and engaging in the advance care planning (ACP).The ongoing Coronavirus Disease 2019 (Covid-19) pandemic poses an unprecedented set of challenges for PwP and has in many ways (both directly and indirectly) magnified their suffering, thus rapidly raising the demand for PC interventions. Covid-19, as well as the repercussions of prolonged mobility restrictions and limited health-care access might exacerbate the severity of PD motor symptoms and interact negatively with a range of non-motor symptoms, with a detrimental effect on quality of life. Greater motor disability, higher amount of levodopa-induced motor fluctuations with an increased daily off-time, fatigue, anxiety, depression, sleep disturbances, pain and worsening of cognitive complaints might dominate the clinical presentation in PwP during the Covid-19 pandemic, alongside raising psychological and spiritual concerns and anticipatory grief.Here, we aim to provide a foundation for pragmatic and clinically orientated PC approach to improve quality of life and relieve suffering of PwP in the context of the current, ongoing Covid-19 pandemic.

Влияние современной лекарственной терапии на течение болезни Паркинсона

The impact of the therapy on patients with Parkinson’s disease remains unclear. To date, claims about the pathogenesis-modifying effect of drugs remain controversial. One of the criteria for the effect of therapy on changing the course of Parkinson’s disease should be an increased life expectancy, a reduction in severe forms and, accordingly, disability. It is only possible to assess the impact of modern therapy by comparing it with a group of patients with Parkinson’s disease who never received modern antiparkinsonian drugs. The purpose — to study the impact of modern pharmacotherapy on the course of PD based on the data of medical care quality during five years. Material and methods. A five-year analysis of the conclusions of medical examinations of 1754 patients with Parkinson’s disease, as well as a comparative statistical analysis of the causes of death in the study group compared with the general Russian population in 2018 and a sample of M. Hoehn and M. Yahr 1967, before the use of modern antiparkinsonian drugs. Results. Out of 1754 people, 1480 patients remained in the study after 5 years. Despite the ongoing drug therapy in accordance with clinical recommendations and standards adopted in the Russian Federation, during the observed period, there was a steady progression of Parkinson’s disease and transition to more severe stages. The mortality rate in the study group from circulatory diseases was significantly higher (p < 0.001) compared to the general Russian population and significantly higher (p < 0.01) compared to the group of M. Hoehn and M. Yahr in 1967, which does not exclude the negative impact of antiparkinsonian drugs. It was interesting to find a reliable fact that in the group of our study, the probability of death from respiratory diseases was 2.23 times higher (p < 0.01) than in the group of Russian citizens in 2018, but 2.38 times lower (p < 0.02) than in the group of M. Hoehn and M. Yahr in 1967, which can be explained by the mutually contradictory effect of antiparkinsonian therapy. Conclusions. Тhe study established the fact of clinical progression of the disease, despite the ongoing therapy. Over a five-year period, the number of patients in the group with a more severe course of the disease (stages III–IV for Hoehn and Yahr) increased significantly (p < 0.001). The main causes of death of patients with Parkinson’s disease in our study coincide with the causes of death of Russian citizens in the general population in 2018, as well as with the sample presented by M. Hoehn and M. Yahr in 1967 in the era before the use of modern antiparkinsonian drugs. Modern antiparkinsonian drugs can have both a positive and negative effect on a patient with Parkinson’s disease, having an ambiguous effect on life expectancy.

Parkinson\u2019s disease with a typical clinical course of 17 years overlapped by Creutzfeldt\u2013Jakob disease: an autopsy case report

BackgroundLate-stage Parkinson’s disease (PD) often presents with neuropsychiatric symptoms such as dementia, psychosis, excessive daytime sleepiness, apathy, depression, and anxiety. However, neuropsychiatric symptoms are the cardinal features of Creutzfeldt–Jakob disease (CJD), raising the possibility that CJD may be an overlooked condition when it accompanies late-stage PD.Case presentationWe describe a female autopsy case of PD with a typical clinical course of 17 years, in which CJD overlapped with PD during the final year of the patient’s life. The patient died aged 85 years. Neuropathological features included widespread Lewy body-related α-synucleinopathy predominantly in the brainstem and limbic system, as well as the typical pathology of methionine/methionine type 1 CJD in the brain.ConclusionsOur case demonstrates the clinicopathological co-occurrence of PD and CJD in a sporadic patient. The possibility of mixed pathology, including prion pathology, should be taken into account when neuropsychiatric symptoms are noted during the disease course of PD.

Clinical and imaging features of surgically treated low lumbar osteoporotic vertebral collapse in patients with Parkinson\u2019s disease

Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.

Promoting Active Citizenship in Mathematics and Science Teaching

The world is facing severe global challenges such as climate change, food security, rising migration, social justice, or the current corona crisis. In these times, citizenship education seems more important than ever. How can this citizenship education relate to mathematics and science learning? The research project MaSDiV (Supporting mathematics and science teachers in addressing diversity and promoting fundamental values) connected mathematics and science with citizenship education by modeling real-life problems relevant to society. In this paper, we present the foundational design features of the PD course as well the results from the accompanying evaluation of this PD course, which was implemented by partners in six countries to support teachers in connecting mathematics and science education with citizenship education. More specifically, we investigate how participating teachers experienced the PD program; how their self-efficacy beliefs, learning-related beliefs, as well as teaching practices change; and which factors contributed to that change. In order to investigate the outcome of the PD program, we surveyed N = 311 mathematics and science teachers’ pre- and post-participation of the PD in six different European countries. Among others, our results show that in general, most participating teachers reported a high overall satisfaction with the course across all six participating countries. They also indicate that teachers’ self-efficacy beliefs about using relevant contexts, their learning-related beliefs about the benefits of using contexts, as well as their own teaching practice changed significantly after participating in the MaSDiV PD course.

Evaluation of neurogenic bladder outlet obstruction mimicking sphincter bradykinesia in male patients with Parkinson\u2019s disease

BackgroundLower urinary tract symptoms are one of the most common groups of non-movement symptoms in patients with Parkinson’s disease (PD). Storage symptoms are well-acknowledged, but neurogenic voiding dysfunction caused by PD remains a knowledge gap. This study aimed to evaluate the neurogenic bladder outlet obstruction in male patients with PD and its clinical significance.MethodsMale patients who were diagnosed with PD and underwent urodynamic studies were retrospectively reviewed. The patients with prostate size < 30 ml and bladder outlet obstruction index ≥40 were included in the study. Lower urinary tract symptoms were evaluated by International Prostate Symptom Score (IPSS). Free flowmetry was performed and post void residual (PVR) volume was measured by ultrasound at follow-up.ResultsSix patients were included in the final analysis. The mean age was 68.2 and the mean movement symptom duration was 70.7 months. The patients had a mean IPSS of 12.5 and mean PVR volume of 70.8 ml. All patients had slow stream but none of them reported significant voiding difficulty. Urodynamic studies showed the delayed urinary sphincter relaxation and the special trace pattern. After a mean follow-up of 20 months, they had a mean IPSS of 12.5 and mean PVR volume of 73.3 ml. None of them complained of significant voiding difficulty at follow-up.ConclusionThe delayed urinary sphincter relaxation is a rare but repeatable phenomenon in male patients with PD. It is unlikely to cause disturbing voiding dysfunction, as reported by the patients, and does not progress prominently during the course of PD. Further studies are needed to investigate the nature of this special type of neurogenic BOO and whether it is peculiar to PD in a larger patient cohort.

The TOMM40 \u2018523\u2019 polymorphism in disease risk and age of symptom onset in two independent cohorts of Parkinson\u2019s disease

Abnormal mitochondrial function is a key process in the pathogenesis of Parkinson’s disease (PD). The central pore-forming protein TOM40 of the mitochondria is encoded by the translocase of outer mitochondrial membrane 40 homologue gene (TOMM40). The highly variant ‘523’ poly-T repeat is associated with age-related cognitive decline and age of onset in Alzheimer’s disease, but whether it plays a role in modifying the risk or clinical course of PD it yet to be elucidated. The TOMM40 ‘523’ allele length was determined in 634 people with PD and 422 healthy controls from an Australian cohort and the Parkinson’s Progression Markers Initiative (PPMI) cohort, using polymerase chain reaction or whole genome sequencing analysis. Genotype and allele frequencies of TOMM40 ‘523’ and APOE ε did not differ significantly between the cohorts. Analyses revealed TOMM40 ‘523’ allele groups were not associated with disease risk, while considering APOE ε genotype. Regression analyses revealed the TOMM40 S/S genotype was associated with a significantly later age of symptom onset in the PPMI PD cohort, but not after correction for covariates, or in the Australian cohort. Whilst variation in the TOMM40 ‘523’ polymorphism was not associated with PD risk, the possibility that it may be a modifying factor for age of symptom onset warrants further investigation in other PD populations.

The Impact of Electrical Stimulation of the Brain and Spinal Cord on Iron and Calcium-Phosphate Metabolism

Background: Deep-brain stimulation (DBS) electrically modulates the subcortical brain regions. Under conditions of monopolar cerebral stimulation, electrical current flows between electrode’s contacts and an implantable pulse generator, placed in the subclavicular area. Spinal cord stimulation (SCS) delivers an electrical current to the spinal cord. Epidural electrical stimulation is associated with the leakage of current, which can cause a generalized reaction. The aim of our study was to investigate whether the electrical stimulation of the cerebrum and spinal cord could have generalized effects on biochemical parameters. Materials and methods: A total of 25 patients with Parkinson’s disease (PD, n = 21) and dystonia (n = 4), who underwent DBS implantation, and 12 patients with chronic pain, who had SCS, received electrical stimulation. The blood levels of selected biochemical parameters were measured before and after overnight stimulation. Results: After DBS, the mean ± interquartile range (IQR) values for iron (off 15.6 ± 13.53 µmol/L; on: 7.65 ± 10.8 µmol/L; p < 0.001), transferrin (off: 2.42 ± 0.88 g/L; on: 1.99 ± 0.59 g/L; p < 0.001), transferrin saturation (off: 23.20 ± 14.50%; on: 10.70 ± 11.35%; p = 0.001), phosphate (off: 1.04 ± 0.2 mmol/L; on: 0.83 ± 0.2 mmol/L; p = 0.007), and total calcium (off: 2.39 ± 0.29 mmol/L; on: 2.27 ± 0.19 mmol/L; p = 0.016) were significantly reduced, whereas ferritin (off: 112.00 ± 89.00 ng/mL; on: 150.00 ± 89.00 ng/mL; p = 0.003) and C-reactive protein (off: 0.90 ± 19.39 mg/L; on: 60.35 ± 35.91 mg/L; p = 0.002) were significantly increased. Among patients with SCS, significant differences were observed for ferritin (off: 35 ± 63 ng/mL; on: 56 ± 62 ng/mL; p = 0.013), transferrin (off: 2.70 ± 0.74 g/L; on: 2.49 ± 0.69 g/L; p = 0.048), and C-reactive protein (off: 31.00 ± 36.40 mg/L; on: 36.60 ± 62.030 mg/L; p = 0.018) before and after electrical stimulation. No significant changes in the examined parameters were observed among patients after thalamotomy and pallidotomy. Conclusions: Leaking electric current delivered to the subcortical nuclei of the brain and the dorsal column of the spinal cord exposes the rest of the body to a negative charge. The generalized reaction is associated with an inflammatory response and altered iron and calcium-phosphate metabolism. Alterations in iron metabolism due to electrical stimulation may impact the course of PD. Future research should investigate the influence of electric current and electromagnetic field induced by neurostimulators on human metabolism.

Psychosomatic and gender aspects of studying functional gastrointestinal disorders

The cross—sectional study included 194 senior students of a medical university, of which 156 were women and 38 were men. To judge the frequency and severity of the course of PD and IBS, the 7x7 questionnaire was used. A set of psychodiagnostic questionnaires included: an integrative anxiety test; a scale for psychological express—diagnostics of the level of neurotization; the methodology of the Strategy of coping behavior.The psychological characteristics of the examined men with PD and IBS were characterized by a predominance of subscales of personal anxiety (“emotional discomfort”, “asthenic component”, “phobic component”, “anxious assessment of perspective”). In the repertoire of strategies coping with stress, coping “acceptance of responsibility” and, on the contrary, less often “planning of solving a problem” was much more common.The women with the presence of PD and IBS, along with exceeding the general level of personal anxiety often have subscales such as “emotional discomfort”, “phobic component”, “anxious assessment of perspective”. Among the prevailing coping strategies noted “distance”, “the search for social support”, “acceptance of responsibility”, “fl ight—avoidance”. In addition, the female “cohort” with PD and IBS, in contrast to the male, was characterized by a significantly high level of neuroticism.

Addressing knowledge gaps in Parkinson\u2019s disease: a report on the Movement Disorder Society\u2019s Centre-to-Centre initiative to improve Parkinson\u2019s disease services in Lao People\u2019s Democratic Republic

BackgroundLao People’s Democratic Republic (Lao PDR) has only nine neurologists for seven million people; none have formal training in Parkinson’s disease (PD). Medical specialists require sufficient PD knowledge to provide high-quality care.MethodsThis study outlines a Centre-to-Centre programme for developing PD expertise in underserved regions through a tailored two-year educational enterprise between an established movement disorder mentor centre at Chulalongkorn University in Thailand and mentee centres in Lao PDR. Background knowledge of 80 Laotian physicians was assessed using a validated PD knowledge questionnaire containing 26 questions divided into 3 sections (diagnosis, therapeutic options, disease course) before and immediately after one-day kick-start training. Responses were compared across physicians’ demographic groups.ResultsOf 80 respondents, 50 (62.5%) were board-certified physicians, of which 27 (54%) specialised in internal medicine. Apparent knowledge gaps were shown by a 51.2% correct response rate for total score, 52.8% for diagnosis, 50.6% for therapeutic options, and 48.2% for disease course. No significant differences in total score or any domain sub-scores between neurologists and other specialties were found. Many did not know which non-motor symptoms could occur as prodromal symptoms or late in course of PD. Incorrect responses mainly reflected a lack of knowledge of the impact of medication on disease. Total and domain sub-scores significantly improved after the course (p < 0.05, each). The size of difference of the means was significant for the total score (d = 0.82), therapeutic option (d = 0.56), and disease course (d = 0.68) sub-scores.ConclusionsSignificant improvement of PD knowledge amongst Laotian physicians is demonstrated after a training course, focusing on practical management of PD. Our findings highlight the importance of continued medical education, especially PD-specific training.

The outcome for surgical fixation of distal radial fractures in patients with idiopathic Parkinson\u2019s disease: a cohort study

IntroductionIdiopathic Parkinson’s disease (PD) is a progressive neurologic disorder causing postural instability and unsteady gait. These patients are at increased risk for fractures and have inferior outcomes after treatment. Several studies have evaluated the incidence and outcome of PD patients after hip fractures. However, there are limited studies assessing the outcome of upper extremity fractures in these patients. In this study, we evaluated the outcome of PD patients that received surgical intervention for distal radial fractures (DRF). We hypothesize that these patients have an inferior outcome after surgery in comparison with non-PD patients.MethodsBetween May 2005 and May 2017, we retrospectively reviewed all of the patients with DRF and subsequently underwent open reduction and internal fixation (ORIF) at a level 1 trauma center. All of the surgeries were performed by fellowship-trained orthopedic surgeons. The inclusion criteria include patients with a definitive diagnosis of PD, non-pathological DRF, and a minimum follow-up of 1 year or up until the time of treatment failure was noted. Each PD patient was matched for age and gender to 3 non-PD patients. The primary objective was to determine the failure rate after surgical fixation for DRF. The secondary outcomes include time to treatment failure, reoperation rate, readmission rate, length of hospital stay, and postoperative complications.ResultsA total of 88 patients were included in this study (23 PD, 65 non-PD patients). All underwent ORIF and received standard postoperative follow-ups. The overall treatment failure rate in PD was 39.1% vs. 4.6% in the non-PD group (p < 0.05). The time to treatment failure were 9.11 ± 3.86 weeks and 14.67 ± 5.8 weeks for PD and non-PD, respectively (p < 0.05). PD patients had a significantly higher rate of failure when k-wires and ESF were used (p < 0.05%), while loss of reduction was the most common mode of failure in PD (44.4%). The length of hospital stay for PD was 5.3 ± 4.69 days compared with 3.78 ± 0.96 days for non-PD (p = 0.01). There were 3 PD patients readmitted within 30 days after surgery, and 1 patient had pneumonia after the surgery.ConclusionThis study revealed that patients with PD have a high treatment failure rate despite surgical intervention for DRF. PD patients had a longer hospital stay and had a shorter time to treatment failure. In treating PD patients complicated with DRF, the surgeon must take into consideration the complex disease course of PD and the associated comorbidities such as osteoporosis, frail status, and frequent falls. Rehabilitation and disposition plans should be discussed in advance and longer hospital stays should be expected.Level of evidenceLevel IV, retrospective cohort study

Combinatorial optimality of functional groups, process parameters, and Pd(II) adsorption-desorption characteristics for commercial anion exchange resins-synthetic electroless plating systems.

Considering combinatorial optimality of functional group analysis, speciation, solution chemistry complexity, Pd(II) adsorption-desorption characteristics, this article addresses the competence and efficacy of anion exchange resins namely Amberlite IRA958, Dowex Marathon MSA, Lewatit TP214, and Amberlyst A21 commercial resins. Based on preliminary batch adsorption experiments conducted in the range of 2-10 pH, 0.2-2 g L-1 adsorbent dosage, and 5-1080-min contact time, the optimal adsorption process parameters refer to 4 pH, 1.6, and 1.4 g L-1 adsorbent dosage, and 840- and 720-min contact time for Amberlite IRA958 and Dowex Marathon MSA resins, respectively. Among alternate models, the best-fit models refer to the Freundlich isotherm and pseudo-second-order kinetic models to represent Pd(II) adsorption data obtained for both Dowex Marathon MSA and Amberlite IRA958 resins. Based on the Langmuir isotherm, the maximum monolayer adsorption capacity was evaluated to be 185.16 and 166.67 mg g-1 for Dowex Marathon MSA and Amberlite IRA958 resins, respectively. For model electroless plating solutions as adsorbate system possessing desired solution chemistry complexity and resin cost, nitrogen- and oxygen-containing Amberlyst A21 resin is concluded to be optimal resin. This is not in agreement with the generalized rule of thumb that considers sulfur-nitrogen functional group containing commercial resins to be effective than resins with nitrogen-oxygen functional groups. Due to functional group interactions with the noble metal, no other by-products or exchanged chemicals have been produced in due course of Pd(II) adsorption process, which can be also regarded as an added advantage of the process. Graphical abstract.

The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson's disease.

MR-guided focused ultrasound is a novel, minimally invasive surgical procedure for symptomatic treatment of PD. With this technology, the ventral intermediate nucleus, STN, and internal globus pallidus have been targeted for therapeutic cerebral ablation, while also minimizing the risk of hemorrhage and infection from more invasive neurosurgical procedures. In a double-blinded, prospective, sham-controlled randomized controlled trial of MR-guided focused ultrasound thalamotomy for treatment of tremor-dominant PD, 62% of treated patients demonstrated improvement in tremor scores from baseline to 3 months postoperatively, as compared to 22% in the sham group. There has been only one open-label trial of MR-guided focused ultrasound subthalamotomy for patients with PD, demonstrating improvements of 71% for rigidity, 36% for akinesia, and 77% for tremor 6 months after treatment. Among the two open-label trials of MR-guided focused ultrasound pallidotomy for patients with PD, dyskinesia and overall motor scores improved up to 52% and 45% at 6 months postoperatively. Although MR-guided focused ultrasound thalamotomy is now approved by the U.S. Food and Drug Administration for treatment of parkinsonian tremor, additional high-quality randomized controlled trials are warranted and are underway to determine the safety and efficacy of MR-guided focused ultrasound subthalamotomy and pallidotomy for treatment of the cardinal features of PD. These studies will be paramount to aid clinicians to determine the ideal ablative target for individual patients. Additional work will be required to assess the durability of MR-guided focused ultrasound lesions, ideal timing of MR-guided focused ultrasound ablation in the course of PD, and the safety of performing bilateral lesions. © 2019 International Parkinson and Movement Disorder Society.

Determining the risk of dementia in Parkinson's disease: possibilities and perspectives

Dementia in Parkinson's disease (D-PD) worsens the course of PD, and it is associated with a decrease in the quality of life of patients and caregivers, as well as with elevated costs for patient care, and, as a consequence, leads to a significant cost increase in the health management. Early detection of the risk of dementia in patients with PD is one of the challenges of modern clinical neurology. Various methods for the detection of morphologic and functional changes associated with D-PD risk (prognostic biomarkers) were suggested. The aim of this article is a brief review of current achievements in the search for and evaluation of the effectiveness of such biomarkers. The review included the following methods: clinical examination, neuroimaging, examination of biological fluids, genetic analysis, neurophysiological methods and combined methods. Biomarkers of D-PD can contribute to optimization of the selection of pharmacological or non-pharmacological methods of preventing cognitive impairment at early stages of PD, and, therefore, to potential improvement of the overall clinical outcomes.

Computational thinking in elementary classrooms: measuring teacher understanding of computational ideas for teaching science

ABSTRACTA number of efforts have focused on preparing teachers to integrate CT within secondary disciplinary subject areas; however, there is little research on how CT ideas could be embedded within elementary subjects. We designed a professional development activity for elementary teachers to embed CT within science and examined how their understanding of CT emerged over the course of PD. This paper reports results from qualitative analysis of teacher responses to vignettes and open-ended questions, which presented teaching scenarios related to CT. We found that the vignettes allow us to see shift in teachers’ thinking about CT from broad and generalized ideas to more elaborate versions of those ideas. We discuss that while vignettes provided a good method to portray changes in teacher views about CT, we need additional mechanisms to monitor how teachers conceptualize and come to integrate computational thinking into elementary schools.