Severe PD Research Articles

Functional outcomes after total joint arthroplasty are related to the severity of Parkinson\u2019s disease: a mid-term follow-up

BackgroundPerforming total joint arthroplasty (TJA) in Parkinson’s disease (PD) patients may encounter a higher complication rate or worse functional outcomes compared with common patients. The relationship between PD and clinical outcomes after TJA is not fully understood.MethodsRetrospectively, we used manual charts to investigate the clinical outcomes in 41 patients including 24 total hip arthroplasty (THA) patients (28 hips) and 18 total knee arthroplasty (TKA) patients (22 knees) with a diagnosis of PD from 2009 to 2016. The stage of PD was confirmed by Hoehn and Yahr scale. Prosthesis survivorship was estimated with revision for any reason as the endpoint.ResultAll the clinical outcomes improved significantly (p < 0.05). Subgroup analysis revealed worse functional outcomes in mid- or end-stage PD patients. Sixteen short-term mild to moderate complications were noted. Two revisions were conducted for hip periprosthetic osteolysis and postoperative knee pain. The prosthesis survivorship at 60 months for TJA, total hip arthroplasty (THA), or total knee arthroplasty (TKA) was 91.6%, 94.1%, and 87.5%, respectively.ConclusionPatients with PD who underwent TJA would result in excellent pain relief and gain of function. However, patients at late-stage PD may suffer from functional loss. The effectiveness of TJA in patients with severe PD remains a concern. Physician should help delay the progression of PD which may optimize and stabilize the functional outcomes of TJA.

Subthalamic Nucleus (STN) Deep-Brain Stimulation (DBS) in the Management of Idiopathic Parkinson's Disease: Results of our First 20 Cases

AbstractBackground: Idiopathic Parkinson's Disease (iPD) is one of the most disabling chronic neurologic diseases and leads to a significant loss of quality of life. Interest in surgical therapy for PD was renewed in the early 1990s. The most common functional stereotactic procedures that are performed worldwide for PD are lesioning and Deep-Brain Stimulation (DBS).Aim of Study: Is to review and evaluate the results of STN-DBS in management of iPD in our first 20 patients.Patients and Methods: This study was conducted in Department of Neurosurgery, Tanta University from January 2007 to March 2014. It included 20 patients with iPD, they must had positive L-dopa challenge test with at least a 33% decrease in the UPDRS III score. All patients were assessed by UPDRS in off and on phases. Stereotactic STN-DBS was done. The total off UPDRS III score was considered the primary outcome measurement.Results: We had 14 males and 6 females with a mean age at PD onset of 46.5 years, a mean age at implant of 54.5 years with mean duration of symptoms of 10 years. 14 patients had moderate PD while 6 patients had severe PD. The post-operative OFF and ON UPDRS III score improved by 45.5%, and 63.9% respectively. The post-operative OFF and ON bradykinesia score improved by 55.5%, and 62.9% respec-tively. The post-operative OFF and ON tremor score was improved by 68.01% and 76.5% respectively. The post-operative OFF and ON rigidity score was improved by 71.81% and 78.8%. The post-operative OFF and ON postural instability and gait score was improved by 45.42% and 61.9% respec-tively. 60% of patients had good outcome and 40% had fair outcome. We reported one transient post-operative confusion, one infection, one lead displacement, and one lead fracture. Dyskinesia occurred in two patients, speech problems in two patients and emotional lability in one patient.Conclusion: Bilateral STN-DBS provides significant symptom relief for the majority of well-screened patients with iPD.

Unusually large ephedrine-induced blood pressure increases due to cardiac sympathetic denervation supersensitivity in a patient with Parkinson\u2019s disease

BackgroundParkinson’s disease (PD) patients often suffer from cardiac sympathetic denervation, a hallmark of which is orthostatic hypotension. Denervation supersensitivity to sympathomimetic drugs is also seen in such patients, and this phenomenon is important and can be sometimes dangerous.Case presentationA 65-year-old male underwent gastrojejunostomy. The patient had severe PD and did not exhibit metaiodobenzylguanidine (MIBG) accumulation in his heart, which was indicative of cardiac sympathetic nerve denervation. When 8 mg of ephedrine was administered intravenously, an unexpectedly large increase in blood pressure was observed. The phenomenon recurred when 4 mg of ephedrine was administered again, and nicardipine was required to suppress the patient’s blood pressure.ConclusionsDenervation supersensitivity is not as well recognized as other complications seen in PD patients, but anesthesiologists should be aware of it because sympathomimetic drugs can have excessively strong effects in patients with the condition.

MP67-17 PLICATION FOR SEVERE PEYRONIE'S DEFORMITIES HAS SIMILAR OUTCOMES TO MILD CASES

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018MP67-17 PLICATION FOR SEVERE PEYRONIE'S DEFORMITIES HAS SIMILAR OUTCOMES TO MILD CASES Rohit Reddy, Maxim McKibben, Nabeel Shakir, Joceline Fuchs, Jeremy Scott, and Allen Morey Rohit ReddyRohit Reddy More articles by this author , Maxim McKibbenMaxim McKibben More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Joceline FuchsJoceline Fuchs More articles by this author , Jeremy ScottJeremy Scott More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although penile plication (PP) is an effective and common treatment for mild to moderate Peyronie′s Disease (PD), scant data exists on outcomes of PP for severe or complex deformities. We compared long-term PP outcomes among severe and mild PD patients in our large single surgeon experience. METHODS We performed a retrospective review of patients who underwent PP for PD between 2009-2017. All patients had multiple parallel tunical plication without degloving via a longitudinal penile incision regardless of curvature severity. Severe PD was defined as either ≥60°, biplanar curvature, or hourglass deformity. Patient demographics and surgical outcomes were analyzed. A modified Peyronie′s Disease Questionnaire (PDQ) and International Index of Erectile Function (IIEF-5) were administered by phone. Success was defined as improvement in sexual function. Additionally, 30 PP patients with mild to moderate curvature were contacted as a comparator group. RESULTS Of 379 PP patients, 225 (59‰) had severe/bidirectional curvature, 54 (24‰) of whom responded to phone survey at a median follow-up of 38 months. Mean preoperative curvature was 68.3°, which was corrected to a mean of 9.5°, using an average of 9.4 plication sutures (range 4-25). Comparing severe PD to the mild PD group (mean curve 40°), similar proportions of patients reported improvement of penile curvature (77.8‰ v 73.3‰, p=0.7), improvement in sexual function (50‰ v 46.7‰, p=0.9), and penile shortening (55.6‰ v 76.7‰, p=0.16), though only two severe patients (3.7‰) had decreased stretched penile length measured intraoperatively. IIEF-5 was similar between the groups preoperatively (19.5 v 18.7, p=0.5), and slightly decreased in the mild group postoperatively (19.7 v 16.0, p=0.015). PDQ metrics including difficulty inserting penis and pain with erections and intercourse were the same between severe and mild patients (p>0.1). On multivariate logistic regression, independent predictors of improved sexual function were younger age (OR 0.85, IQR 0.75-0.96, p=0.003), and greater angle of correction (OR 1.09, IQR 1.01-1.17, p=0.007). CONCLUSIONS PP for surgical correction of severe PD is effective, with similar PROs compared to patients with milder disease. Similarities in PDQ and IIEF between simple and complex groups suggests broader application of PP beyond mild cases. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e913-e914 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Rohit Reddy More articles by this author Maxim McKibben More articles by this author Nabeel Shakir More articles by this author Joceline Fuchs More articles by this author Jeremy Scott More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Palladium redispersion at high temperature within the Pd@SiO2 core@shell structure

Maintaining high dispersion of palladium is critical for Pd-based catalysts, which suffer from deactivation due to sintering at high temperatures (≥800 °C). Here, we report direct evidence that Pd nanoparticles (~4 nm) of a palladium silica core@shell (Pd@SiO2) catalyst can redisperse into nanoclusters (≤2 nm) after aging at 800 °C, where severe Pd sintering would be expected on supported Pd catalysts. The Pd redispersion was confirmed by in situ, as well as ex situ, high resolution transmission electron microscopy, and is manifested by a remarkably decreased light-off temperature for CO oxidation after aging.

The relationship between childhood adversity, psychiatric disorder and clinical severity: results from a multi-centre study

Although several studies have shown a clear association between childhood adversities and later development of a number of psychiatric disorders, a number of recent reports have cast doubts regarding the aetiological role played by abuse, neglect and loss, arguing that they are neither necessary nor sufficient to account for the development of subsequent psychopathology. In this study, we aimed to investigate the associations and predictive power of childhood adversities on later onset of Axis-I &-II psychiatric conditions and the impact on severity of psychiatric presentation in a large sample of patients. This cross-sectional multi-centre study evaluated patients (N = 1136) recruited in fourteen NHS psychotherapy departments in the UK. Patients were assessed using a number of rater-based questionnaires and self-rated measures. Multiple regression analyses showed that childhood experiences of loss and physical abuse were predictive of severe personality disorder and borderline personality disorder, but not of other less severe PD and Axis-I diagnoses. Sexual abuse predicted later onset of Post-traumatic Stress Disorder. In addition, we found that childhood abusive experiences were strongly associated with severity of psychiatric distress, interpersonal problems and global functioning. Having experienced two or more childhood adversities significantly increased severity of psychiatric distress, interpersonal malfunctioning and CORE scores.

PP274-MON: Outstanding abstract: Chromium, Magnesium, Zinc and Oxidative Stress Biomarker in Type 1 Diabetic Patients at Pre-Puberty, Puberty, and Young Adulthood Stages

Results: Lymphocyte VC levels were significantly lower in patients with severe PD (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.80 0.97; P < 0.01). Plasma VC levels tended to be lower in this group, although the difference was not significant (OR, 0.98; 95%CI, 0.96 1.00; P = 0.09). PD severity was not significantly associated with serum VA (P = 0.61), serum b-carotene (P = 0.17), or serum VE (P = 0.15) levels. Conclusion: Lymphocyte VC level is a potentially useful biomarker of PD progression, but before it can be applied to clinical practice, prospective cohort studies on the relationship between changes in lymphocyte VC level and the progression of PD are required.

A new Drosophila model to study the interaction between genetic and environmental factors in Parkinson׳s disease

The fruit fly Drosophila melanogaster has long been used as a model organism for human diseases, including Parkinson׳s disease (PD). Its short lifespan, simple maintenance, and the widespread availability of genetic tools allow researchers to study disease mechanisms as well as potential drug therapies. Many different PD models have already been developed, including ones utilizing mutated α-Syn and chronic exposure to rotenone. However, few animal models have been used to study interaction between the PD causing factors. In this study, we developed a new model of PD for use in the larval stage in order to study interaction between genetic and environmental factors. First, the 3rd instar larvae (90–94 hours after egg laying) expressing a mutated form of human α-Syn (A53T) in dopaminergic (DA) neurons were video-taped and quantified for locomotion (e.g. crawling pattern and speed) using ImageJ software. A53T mutant larvae showed locomotion deficits and also loss of DA neurons in age-dependent manner. Similarly, larvae chronically exposed to rotenone (10μM in food) showed age-dependent decline in locomotion accompanied by loss of DA neurons. We further show that combining the two models, by exposing A53T mutant larvae to rotenone, causes a much more severe PD phenotype (i.e. locomotor deficit). Our finding shows interaction between genetic and environmental factors underlying development of PD symptoms. This model can be used to further study mechanisms underlying the interaction between genes and different environmental PD factors, as well as to explore potential therapies for PD treatment.

A deficit in optimizing task solution but robust and well-retained speed and accuracy gains in complex skill acquisition in Parkinson׳s disease: Multi-session training on the Tower of Hanoi Puzzle

IntroductionThere are inconsistent results in the research literature relating to whether a procedural memory dysfunction exists as a core deficit in Parkinson׳s disease (PD). To address this issue, we examined the acquisition and long-term retention of a cognitive skill in patients with moderately severe PD. To this end, we used a computerized version of the Tower of Hanoi Puzzle. MethodsSixteen patients with PD (11 males, age 60.9±10.26 years, education 13.8±3.5 years, disease duration 8.6±4.7 years, UPDRS III “On” score 16±5.3) were compared with 20 healthy individuals matched for age, gender, education and MMSE scores. The patients were assessed while taking their anti-Parkinsonian medication. All participants underwent three consecutive practice sessions, 24–48h apart, and a retention-test session six months later. A computerized version of the Tower of Hanoi Puzzle, with four disks, was used for training. Participants completed the task 18 times in each session. Number of moves (Nom) to solution, and time per move (Tpm), were used as measures of acquisition and retention of the learned skill. ResultsRobust learning, a significant reduction in Nom and a concurrent decrease in Tpm, were found across all three training sessions, in both groups. Moreover, both patients and controls showed significant savings for both measures at six months post-training. However, while their Tpm was no slower than that of controls, patients with PD required more Nom (in 3rd and 4th sessions) and tended to stabilize on less-than-optimal solutions. ConclusionsThe results do not support the notion of a core deficit in gaining speed (fluency) or generating procedural memory in PD. However, PD patients settled on less-than-optimal solutions of the task, i.e., less efficient task solving process. The results are consistent with animal studies of the effects of dopamine depletion on task exploration. Thus, patients with PD may have a problem in exploring for optimal task solution rather than in skill acquisition and retention per se.

Platinum-group elements in the Eastern Deccan volcanic province and a comparison with platinum metals of the western Deccan

This study is the first detailed investigation of the platinum-group elements (PGE) at the eastern margin of the Deccan volcanic province of India. One of the PGE, osmium, is not included largely because of analytical problems. The study is focused on mafic volcanics and dykes from four areas including Amarkantak, Umaria, Shahdol and Chirimiri. The first two localities represent two lava piles of about 170 and 400 m thickness respectively. In Umaria, 16 flows have been demarcated based on petrography and field studies. The Shahdol samples are basal lava formations overlying Gondwana sediments (Carboniferous) and the Chirimiri samples are dykes. In this study, the western Deccan province is defined as the Western Ghats plus Kutch. On average, the PGE are ~20% higher in Amarkantak than Umaria and the flows are ~13% higher in PGE than the dykes. A Zr vs. Pd scattergram found a strong positive correlation for these two elements except for one Umaria sample which indicated severe Pd loss. A comparison of west and east parts of the Deccan volcanic province using primitive mantle normalization showed that higher values prevailed in the western province suite in the Ni-Ir-Ru-Pt region. In contrast, eastern province values dominated in the Pd-Au-Cu region at the ‘Cu’ end of the profiles. A strong dominance of Pd in the eastern Deccan was also of interest. A number of factors, for example, percentage partial melting of the source rock and the temperature and pressure of partial melting strongly influence the character of these profiles. The observed PGE profile characteristics probably result in part from a long distance of subsurface transport of Deccan magma from the western to eastern regions.

Induction chemotherapy (IC) with docetaxel/cisplatin/5-fluorouracil (TPF) followed by cisplatin-containing concomitant chemoradiotherapy (CRT) in fit patients with locally advanced head and neck cancer (LAHNC): The CONDOR study—A study of the Dutch Head and Neck Society.

6057 Background: Standard treatment for patients (pts) with LAHNC is concomitant CRT containing cisplatin. In general 70% of the pts receive all planned cisplatin cycles. TPF IC is associated with survival benefit, but has never been studied in combination with standard CRT. We aimed to determine if TPF followed by cisplatin-containing CRT, in 2 different schedules, was feasible. Methods: In this multicenter randomized phase II trial LAHNC pts, PS 0-1, were treated with maximal 4 TPF courses (T 75 mg/m2, P 75mg/m2 and F 750 mg/m2 day 1-5) and thereafter randomized between P 100 mg/m2 on days 1, 22, 43 combined with conventional RT (arm A) or P 40 mg/m2weekly, maximally 6, combined with accelerated RT (arm B). Primary endpoint was feasibility, defined as receiving ≥ 90% of the planned total radiation dose. Based on power analysis 70 pts were needed. Results: Following an interim-analysis, the study was early terminated after inclusion of 65 pts because only 32% of pts could be treated with the full cisplatin dose during CRT after TPF. 81,5% of pts was male, median age was 56 yrs and PS was 0 in 79% and 1 in 21%, primary site: oral cavity (23%), oropharynx (57%), hypopharynx (12%), larynx (8%). 3 pts did not start TPF; 6/62 pts were not randomized after TPF, due to death (1), toxicity (3) or severe PD (2). RR after TPF was CR 4%, PR 64% and SD 28% in the randomized pts. 27 pts were randomized in arm A and 29 in arm B. 97% of the pts received at least 90% of the planned total radiation dose. However, in arm A only 6 of the 27 pts (22%) and in arm B 12 of the 29 pts (41%) received the total planned chemotherapy part of the CRT. Most common grade 3-4 toxicity during TPF was febrile neutropenia (18%),and during CRT arm A vs arm B dehydration (26% vs 14% ), dysphagia (26% vs 24%), mucositis (22% vs 57%) and creatinin increase (19% vs 3%). After a median follow-up of 21 (7-42) months 66% of the pts was still alive. Conclusions: After TPF IC cisplatin-containing concomitant CRT is not feasible in LAHNC, because the total planned dose of cisplatin could only be administered in 32% of the pts due to severe toxicity. Clinical trial information: NCT00774319.

1692 FAVORABLE PATIENT REPORTED OUTCOMES FOLLOWING PENILE PLICATION FOR CORRECTION OF SIMPLE AND COMPLEX PEYRONIE'S DISEASE DEFORMITIES

TGFb1, and 9 weeks in the combined group. Functional and histological analysis was performed in all groups. RESULTS: Histological plaques were identified in all groups. Gross curvature and palpable plaque was noted at 3 and 6 weeks in the TS alone group. The combined group demonstrated gross curvature and palpable scar at 9 weeks. The TGF-b1 group did not demonstrate detriments in penile pressures or gross curvature. Detriments were seen in the TS alone and combined groups, trending towards worse maximal penile pressures in the combined group. CONCLUSIONS: Combination TS with TGFb1 appears to be a superior model for severe PD in the rat as we observed gross deviations and deleterious effects on penile pressures which have not been previously reported. Durability has been demonstrated up to 9 weeks whereas previous models have been shown to resolve spontaneously. We present an animal model of severe PD which better emulates the human condition as compared to previous animal models.

Carbon nanotube‐supported bimetallic palladium–gold electrocatalysts for electro‐oxidation of formic acid

AbstractIt is known that palladium‐based catalysts are initially very active in direct formic acid oxidation but they suffer from fast deactivation caused by a strongly adsorbed CO intermediate. Reactivation of the catalysts involving application of anodic potential may cause palladium dissolution. The aim of the present study is to increase the stability and performance of palladium‐based catalysts in direct formic acid fuel cells (DFAFCs). Preparation and characterization of palladium/multiwalled carbon nanotubes (Pd/MWCNTs) and towards formic acid oxidation via different treatments are described. The catalysts were characterized by thermogravimetric analysis (TGA), X‐ray diffraction (XRD), transmission electron microscopy (TEM) and cyclic voltammetry (CV). It was shown that the Pd and Pd–Au MWCNTs supported catalysts after reduction in H2–Ar at 200 °C (R200 treatment) were highly active in formic acid electro‐oxidation, whereas the catalysts after heating in argon at 250 °C (C250 treatment) were inactive. The catalysts after hydrogen treatment have smaller metal particles and better contact with MWCNTs support. CV, simulating reactivation of the catalysts, showed that the Pd catalyst suffers from severe Pd dissolution, whereas for the Pd–Au selective leaching of Pd is considerably slower.

Abnormal mannose-6-phosphate receptor trafficking impairs recombinant alpha-glucosidase uptake in Pompe disease fibroblasts

BackgroundPompe disease (PD) is a metabolic myopathy caused by α-glucosidase (GAA) deficiency and characterized by generalized glycogen storage. Heterogeneous GAA gene mutations result in wide phenotypic variability, ranging from the severe classic infantile presentation to the milder intermediate and late-onset forms. Enzyme replacement therapy (ERT) with recombinant human GAA (rhGAA), the only treatment available for PD, intriguingly shows variable efficacy in different PD patients. To investigate the mechanisms underlying the variable response to ERT, we studied cell morphology of PD fibroblasts, the distribution and trafficking of the cation-independent mannose-6-phosphate receptor (CI-MPR) that mediates rhGAA uptake, and rhGAA uptake itself.ResultsWe observed abnormalities of cell morphology in PD cells. Electron microscopy analysis showed accumulation of multivesicular bodies and expansion of the Golgi apparatus, and immunolocalization and western blot analysis of LC3 showed activation of autophagy. Immunofluorescence analysis showed abnormal intracellular distribution of CI-MPR in PD fibroblasts, increased co-localization with LC3 and reduced availability of the receptor at the plasma membrane. The recycling of CI-MPR from the plasma membrane to the trans-Golgi network was also impaired. All these abnormalities were more prominent in severe and intermediate PD fibroblasts, correlating with disease severity. In severe and intermediate PD cells rhGAA uptake and processing were less efficient and correction of GAA activity was reduced.ConclusionThese results indicate a role for disrupted CI-MPR trafficking in the variable response to ERT in PD and have implications for ERT efficacy and optimization of treatment protocols.

Surgical Correction of Peyronie's Disease via Tunica Albuginea Plication or Partial Plaque Excision with Pericardial Graft: Long Term Follow‐Up: An Editorial Comment

This is an excellent article on two surgical techniques to straighten the penis in Peyronie’s disease. As with other series it is evident that grafting, be it autologous or extracellular matrix grafts, is associated with a significant risk of erectile dysfunction (ED) and a risk of some penile shortening [1,2]. In this article, 32% had worsening erections and 21% new onset of ED after a grafting procedure. There was an objective loss of length in 33% in the grafting group with 22% wishing that they had not had the operation. It is clear, however, that patients who request a grafting technique usually have more severe PD with a more significant curvature and are more concerned about length loss. It is, therefore, not surprising that satisfaction is less than in the plication group. As patients with PD have significant risk factors for “de novo” ED at presentation, there is a significant risk that this may get worse when a grafting technique is performed [3]. The article highlights that in advanced and severe disease it may therefore be better to insert a penile prosthesis that straightens the penis and corrects any ED while minimizing loss of length. Informed consent is therefore imperative so that patients can have real expectations and then hopefully satisfaction improved.

Recurrent Flares of Pancreatitis Predict Development of Exocrine Insufficiency in Chronic Pancreatitis

The natural history of specific morphologic stages of chronic pancreatitis (CP) is not well defined. The aim of this study was to determine if worsening morphologic stages of CP are associated with poorer clinical outcomes. A retrospective analysis of 159 subjects with CP was performed. The baseline stage of CP was categorized according to the Cambridge classification. Pain was categorized as type A (intermittent acute), B (continuous), or combined. Exocrine failure was defined by steatorrhea; endocrine failure was characterized as diabetes mellitus. Complications were defined clinically. Pancreatic duct (PD) morphology was equivocal in 37.1%, minimal in 12.6%, moderate in 7.5%, and severe in 42.8% of the patients. Over a median follow-up period of 3.7 years, the risk of developing exocrine insufficiency and diabetes was 28% and 19%, respectively. Recurrent acute flares of pancreatitis predicted the development of exocrine insufficiency (P = .004). Severe PD morphology predicted the likelihood of having persistent pain (P = .008). Patients with concurrent type A and B pain and older age at diagnosis had a greater likelihood of having persistent pain (P = .021). The risk of developing bile duct stricture was higher in the advanced morphologic stages of CP (P = .005). Recurrent flares of pancreatitis predispose to the development of exocrine insufficiency in CP. Patients with complex-type pain, older age at diagnosis, and advanced morphologic stage are more likely to have persistent pain. PD morphology does not correlate with the risk of developing exocrine failure and/or diabetes. Pain does not necessarily decrease or disappear with the onset of exocrine insufficiency and diabetes.

Predictors of effective bilateral subthalamic nucleus stimulation for PD.

To identify factors predictive of effective bilateral subthalamic nucleus (STN) stimulation for PD with severe motor complications, pre- and postoperative Unified PD Rating Scale (UPDRS) scores were analyzed in a series of 54 patients who received bilateral STN stimulation. Younger age and levodopa responsiveness predict a favorable response to bilateral STN stimulation. For individual PD symptoms, those that improve with a suprathreshold dose levodopa challenge are likely to improve with stimulation.

The long-term safety and efficacy of pramipexole in advanced Parkinson's disease

Objective: To assess the long-term safety and efficacy of pramipexole in advanced Parkinson's disease over a four year time period. Methods: This study is an open-label extension trial of pramipexole for Parkinson's disease open to patients completing a double-blind placebo controlled safety and efficacy trial of this drug. Three hundred and six patients entered the trial. These patients had moderate to severe PD (stage II–IV Hoehn and Yahr during off time) and were experiencing motor fluctuations. Patients were titrated over a six week period and then entered a maintenance phase which lasted up to 50 months. Patients were evaluated every 3 months using the Unified Parkinson's Disease Rating Scale (UPDRS II, III and IV) and modified Schwab and England scale (S/E). Results: Sixty-four percent (197) of the 306 patients who entered this study completed it. Patients showed steady improvement over the 6 week ascending dose interval when pramipexole was reintroduced into the trial as the open-label study medication. Over the duration of the trial patients slowly returned to their baseline levels. This was true for all measures evaluated except for the UPDRS part IV. On UPDRS part IV patients remained below their baseline score which indicated an improvement for the duration of the study. Patterns similar to the overall scores were seen when the individual components of the UPDRS scale part II for “on” and “off” periods and part III were evaluated. However tremor during “on” periods showed improvement over baseline for the duration of the trial. The most common adverse events secondary to pramipexole occurring in greater than 10% of patients included dyskinesias, asymptomatic orthostatic hypotension, dizziness, insomnia, and hallucinations. Conclusion: Pramipexole was well tolerated for up to 4 years. Pramipexole treatment appeared to show continued efficacy in the treatment of Parkinson's disease for 3 years in this open-label descriptive study. After 3 years there was a gradual return to baseline motor states perhaps suggesting progression of Parkinson's disease.

Seasonal Plant Water Relationships in Acacia berlandieri

In order to assess how plant water potential is related to soil water availability and evaporative demand, determinations of diurnal and seasonal plant water potentials between 23 April 1997, and 22 September 1998, were studied in Acacia berlandieri Benth., a native shrub of the northeastern region of Mexico. Average plant water potentials during the wettest period ranged from-0.37 MPa (predawn, PD) to -2.79 MPa (midday, MD )whereas, during the long, hot, and severe drought period PD and MD water potentials measurements diminished down to -5.9 and -6.8 MPa, respectively. Average diurnal depression of plant water potential (calculated as the difference between midday and predawn water potentials) during the wettest and driest season varied from -2.28 - 0.50 MPa to -0.86 - 0.46 MPa, respectively. An exponential function was found between PD water potential with average soil water content and vapor pressure deficit (VPD). Both variables supported about 85% and 66%, respectively, of the variability in PD water potential. PD water potential values were high and relatively constant above soil water content of 0.17 kg kg-¹; below this threshold value the PD water potential declined. Highest positive (r = 0.870) and negative (r = -0.706) correlation coefficients of PD water potential data were observed with soil moisture content at the 20-30cm soil layer and VPD, respectively. MD water potential, VPD, and air temperature explained about 83% of the variation in PD water potential. Soil water content at the 20-30cm soil layer, PD water potential, andrelative humidity described about 82% of the variation in MD water potential. It was concluded A. berlandieri can endure substantial drydown periods and its water relations are strongly associated with soil water content and atmospheric evaporative demand components.

EVALUATION OF SMALL INTESTINE FUNCTION IN INFANTS WITH PERSISTENT DIARRHEA (PD) USING MONOCLONAL ANTIBODIES (MAbs)

MAbs against enzymes of the brush border provide a new approach to evaluate intestinal lesions in severe PD. The 10 patients with PD in whom a small bowel biopsy was performed during 1992 were evaluated by means of MAbs for lactese (L), sucrase (S), maltsse (M) and aminopeptidase (A); results were compared with those of light mi croscopy, histochemistry lor lactase, disacchandase activities (Dalqvist) and clinical history. Diagnosis was DP and severe malnutrition (MN) in 4 cases, congenital sucrose intolerance (CSI) 1, cow's milk protein intolerance (CMI) 2, celiac disease (CD) 1, sIgA deficiency 1 and cryptosporidias is (Crypt) 1. The latter was the only child with a positive ethiologic study. MAP ofr sucrase detected more enzyme than Dalqvist, which may be interpreted as tht MAP binds non-functional molecules. In patient with CSI, MAP for sucase detedted less enzyme than Dalqvist, which is in agreement with the production of a defective molecule.