Background In 2009, we reported a novel form of delayed anaphylaxis to red meat that is related to serum IgE antibodies to the oligosaccharide galactose-α-1,3-galactose (alpha-gal). Most of these ...patients had tolerated meat for many years previously. The implication is that some exposure in adult life had stimulated the production of these IgE antibodies. Objectives We sought to investigate possible causes of this IgE antibody response, focusing on evidence related to tick bites, which are common in the region where these reactions occur. Methods Serum assays were carried out with biotinylated proteins and extracts bound to a streptavidin ImmunoCAP. Results Prospective studies on IgE antibodies in 3 subjects after tick bites showed an increase in levels of IgE to alpha-gal of 20-fold or greater. Other evidence included (1) a strong correlation between histories of tick bites and levels of IgE to alpha-gal (χ2 = 26.8, P < .001), (2) evidence that these IgE antibodies are common in areas where the tick Amblyomma americanum is common, and (3) a significant correlation between IgE antibodies to alpha-gal and IgE antibodies to proteins derived from A americanum ( rs = 0.75, P < .001). Conclusion The results presented here provide evidence that tick bites are a cause, possibly the only cause, of IgE specific for alpha-gal in this area of the United States. Both the number of subjects becoming sensitized and the titer of IgE antibodies to alpha-gal are striking. Here we report the first example of a response to an ectoparasite giving rise to an important form of food allergy.
The Parkinson Study Group (PSG) gathered North American experts in Parkinson disease during the 9th Annual Symposium on “Shaping the Management of Parkinson Disease: Debating Current ...Controversies”. Debaters were tasked with agree or disagree positions to a particular prompt. This is the first in three-part series of “Hype vs. Hope” debates involving current trends and advances in Parkinson disease. With the prompt of “Spreading alpha-synuclein explains cognitive deficits in Parkinson disease,” Dr. Kelly Mills, MD, MHS was tasked with the “agree” stance and Dr. Abhimanyu Mahajan, MD, MHS was tasked with the “disagree” stance. The following point-of-view article is an adaptation of this debate
Probing the happy place Mills, Kelly A
The Journal of clinical investigation,
03/2019, Letnik:
129, Številka:
3
Journal Article
Recenzirano
Odprti dostop
A variety of neurological procedures, including deep brain stimulation and craniotomies that require tissue removal near elegant cortices, require patients to remain awake and responsive in order to ...monitor function. Such procedures can produce anxiety and are poorly tolerated in some subjects. In this issue of the JCI, Bijanki and colleagues demonstrate that electrical stimulation of the left dorsal anterior cingulum bundle promoted a positive (mirthful) effect and reduced anxiety, without sedation, in three patients with epilepsy undergoing intracranial electrode monitoring. The results of this study highlight the need for further evaluation of anterior cingulum stimulation to reduce anxiety during awake surgery and as a possible approach for treating anxiety disorders.
Objective
To systematically review and analyze the efficacy and tolerability of different antidepressant pharmacologic treatments for depressive symptoms in Parkinson's disease (PD)
Methods
We ...searched PubMed, EMBASE, Cochrane database (CENTRAL), clinicaltrials.gov, and bibliographies for randomized controlled trials investigating the efficacy of antidepressant medications versus a non‐treatment, placebo, or active treatment groups for depressive symptoms in PD. Twenty of 3191 retrieved studies (1893 patients) were included, but not all could be meta‐analyzed. We used a random‐effects model meta‐analysis to compare depression scores between an active drug and placebo or control group then used a network meta‐analysis to compare the effectiveness of different antidepressant classes. The primary outcome was the efficacy of different classes of antidepressant medications in PD patients with depressive symptoms, measured by standardized mean difference (SMD) in depression score from baseline compared with control.
Results
Pairwise meta‐analysis suggested that type B‐selective monoamine oxidase inhibitors (SMD = −1.28, CI = −1.68, −0.88), selective serotonin reuptake inhibitors (SMD = −0.49, CI = −0.93, −0.05), and tricyclics (SMD = −0.83, CI = −1.53, −0.13) are effective antidepressants in PD. Network meta‐analysis showed that monoamine oxidase inhibitors had the largest effect on depression in PD (SMD (vs selective serotonin reuptake inhibitors) = −0.78, CI = −1.55, −0.01), but these might not be considered traditional antidepressants given their type B selectivity.
Conclusions
Although limited by few data, this review suggests that multiple antidepressant classes are potentially efficacious in the treatment of depression in PD, but that further comparative efficacy and tolerability research is needed.
Abstract
By older adulthood, nearly all older adults will have been exposed to at least one potentially traumatic event, and the majority (93%) of older veterans report exposure to at least one ...event. Some may have developed posttraumatic stress disorder (PTSD) during their lifetimes; however, most do not, as the prevalence of PTSD in later adulthood is low. Nevertheless, the long-lasting psychological effects of trauma may manifest in later life, exacerbated by the normative experiences of aging (e.g., medical illness, loss of loved ones, and retirement) and encounters with medical settings. Receiving care in skilled nursing settings may trigger traumatic memories or may aggravate PTSD of symptoms. As the population ages, more individuals will receive care in long-term care environments, leading to increased risk of worsening PTSD. Staff and facilities may not have skills or knowledge needed to address symptoms or reduce retraumatization. Implementing trauma-informed care practices can mitigate these effects and is mandated in skilled nursing facilities; however, no models of trauma-informed care practice in long-term care exist. This article reviews the effects of trauma and PTSD in later life, the effects of medical settings on PTSD, and provides a framework for implementing trauma-informed care in long-term care settings.
Phase-amplitude coupling (PAC) in which the amplitude of a faster field potential oscillation is coupled to the phase of a slower rhythm, is one of the most well-studied interactions between ...oscillations at different frequency bands. In a healthy brain, PAC accompanies cognitive functions such as learning and memory, and changes in PAC have been associated with neurological diseases including Parkinson's disease (PD), schizophrenia, obsessive-compulsive disorder, Alzheimer's disease, and epilepsy.
/Hypothesis: In PD, normalization of PAC in the motor cortex has been reported in the context of effective treatments such as dopamine replacement therapy and deep brain stimulation (DBS), but the possibility of normalizing PAC through intervention at the cortex has not been shown in humans. Phase-targeted stimulation (PDS) has a strong potential to modulate PAC levels and potentially normalize it.
We applied stimulation pulses triggered by specific phases of the beta oscillations, the low frequency oscillations that define phase of gamma amplitude in beta-gamma PAC, to the motor cortex of seven PD patients at rest during DBS lead placement surgery We measured the effect on PAC modulation in the motor cortex relative to stimulation-free periods.
We describe a system for phase-targeted stimulation locked to specific phases of a continuously updated slow local field potential oscillation (in this case, beta band oscillations) prediction. Stimulation locked to the phase of the peak of beta oscillations increased beta-gamma coupling both during and after stimulation in the motor cortex, and the opposite phase (trough) stimulation reduced the magnitude of coupling after stimulation.
These results demonstrate the capacity of cortical phase-targeted stimulation to modulate PAC without evoking motor activation, which could allow applications in the treatment of neurological disorders associated with abnormal PAC, such as PD.
•Phase-amplitude coupling (PAC) has been implicated as a mechanism for coordination of neural signals across brain regions.•Abnormalities in PAC have been associated with neurological diseases.•In Parkinson's disease (PD), motor symptoms are correlated with exaggerated PAC in the motor cortex and basal ganglia. .•Phase-dependent stimulation (PDS) of the motor cortex in PD patients could modulate the magnitude of PAC.•PSD has the potential to provide a closed-loop neuromodulation technique for neurological disorders.
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