[Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]. / Biomarqueurs des pathologies neurodégénératives dans le diagnostic des troubles cognitifs - Revue et recommandations de Swiss Memory Clinics.

Established cerebrospinal fluid (CSF) biomarkers allow for earlier and more accurate etiological diagnosis of cognitive impairment. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published consensus recommendations. The results must be interpreted in the context of the other available history information and assessments. Blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice soon. Consequently, a broader usage of biomarkers is expected and may accelerate the development of individually tailored prevention and treatment approaches. This article provides the recommendations of the Swiss Memory Clinics for the use of biomarkers in clinical practice.

Les marqueurs du liquide céphalorachidien établis permettent un diagnostic des troubles cognitifs plus précoce et précis. Il est nécessaire de conseiller les patients avant et après un examen des biomarqueurs. Les procédures de la ponction lombaire et de traitement préanalytique des échantillons doivent suivre des recommandations publiées. L'interprétation des résultats prendra en compte les antécédents médicaux et les autres résultats d'examen disponibles. Des marqueurs sanguins pourraient être disponibles dans un avenir proche. Cela pourrait conduire à une utilisation plus large des biomarqueurs et accélérer le développement d'approches personnalisées de prévention et de traitement. Cet article présente les recommandations de Swiss Memory Clinics concernant l'utilisation des biomarqueurs en pratique clinique.

Surgical preferences for lateral canthoplasty and canthopexy.

PURPOSE OF REVIEW: To describe the currently used techniques of lateral canthal tightening and their indications. RECENT FINDINGS: The treatment of involutional ectropion involves horizontal tightening of the lower eyelid via a lateral canthal resuspension procedure, which can be either a canthopexy or a canthoplasty. The lateral tarsal strip, one of the most common canthoplasty procedures performed today, is a powerful technique, very useful in cases of profound eyelid laxity or ectropion in which horizontal eyelid shortening is necessary to achieve adequate eyelid tightening.For less-severe eyelid laxity, a canthopexy can be performed through either an upper or a lower eyelid incision, in which the suture is passed through the eyelid incision without externalization at the lateral canthal angle. We recently described the lateral canthal resuspension sine canthotomy technique that was slightly more effective than the lateral tarsal strip at decreasing the MRD-2 and lengthened the horizontal palpebral aperture without significantly changing the lateral canthal height. SUMMARY: Although the lateral canthal resuspension sine canthotomy technique has advantages for tightening loose lower eyelids in both cosmetic and functional cases, the lateral tarsal strip remains the procedure of choice for severe lid laxity or ectropion.

Effects of Micro- and Nanosilica on the Mechanical and Microstructural Characteristics of Some Special Mortars Made with Recycled Concrete Aggregates.

In this paper, we study the influence of densified microsilica and colloidal nanosilica admixtures on the mechanical strength and the microstructural characteristics of special mortars used for immobilizing radioactive concrete waste. The experimental program focused on the replacement of cement with micro- and/or nanosilica, in different proportions, in the basic composition of a mortar made with recycled aggregates. The technical criteria imposed for such cementitious systems, used for the encapsulation of low-level radioactive waste, imply high fluidity, increased mechanical strength and lack of segregation and of bleeding. We aimed to increase the structural compactness of the mortars by adding micro- and nanosilica, all the while maintaining the technical criteria imposed, to obtain a cement matrix with high durability and increased capacity for immobilizing radionuclides. The samples from all the compositions obtained were analyzed from the point of view of mechanical strength. Also, micro- and nanosilica as well as samples of the optimal mortar compositions were analyzed physically and microstructurally. Experimental data showed that the mortar samples present maximum compressive strength for a content between 6 and 7.5% wt. of microsilica, respectively, for a content of 2.25% wt. nanosilica. The obtained results suggest a synergistic effect of micro- and nanosilica when they are used simultaneously in cementitious compositions. Thus, among the analyzed compositional variants, the mortar composition with 3% wt. microsilica and 2.25% wt. nanosilica showed the best performance, with an increase in compressive strength of 23.5% compared to the control sample (without micro- and nanosilica). Brunauer-Emmett-Teller (BET) analysis and scanning electron microscopy (SEM) images highlighted the decrease in pore diameter and the increase in structural compactness, especially for mortar samples with nanosilica content or a mixture of micro- and nanosilica. This study is useful in the field of recycling radioactive concrete resulting from the decommissioning of nuclear research or nuclear power reactors.

[Recommendations for the diagnostic and therapy of behavioural and psychological symptoms of dementia (BPSD)].

INTRODUCTION: The «Recommendations for the Diagnosis and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)¼ were developed in parallel with the Swiss National Dementia Strategy 2014-2019 under the auspices of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP) and mark the beginning of a series of recommendations for geriatric psychiatric disorders. They depict the evidence-based state of knowledge about diagnostics and therapy, based on the clinical experience of the experts, and are designed for interprofessional and interdisciplinary use. The non-pharmacological intervention options and pharmacotherapy are discussed in detail. This paper is the revised version of the 2014 publication and compiles the development in this area for everyday clinical practice.

[Quality development in Consultation and Liaison Psychiatry and Psychosomatics].

INTRODUCTION: Quality or quality development and the corresponding regulations are becoming increasingly important in the Swiss healthcare system, in particular due to the link with aspects of permission for the provision of services and financing. In doing so, the focus is directed to varying degrees on structural, processual or outcome criteria. Specific quality aspects of the specialist area consultation-liaison psychiatry and psychosomatics (CLPP) are compiled and the indicators derived from them are grouped according to the quality criteria mentioned. There are numerous requirements, the implementation of which requires considerable efforts from the service providers, not least because of the shortage of specialists and limited financial resources. The requirements listed should be continuously evaluated and developed as well as sensibly anchored in regulation. Linking quality requirements with corresponding financial aspects within the framework of national tanning structures as well as national and cantonal permission regulations should be sought.

[Measures restricting freedom in the geriatric psychiatry].

INTRODUCTION: Measures restricting freedom include physical restraints restricting movement and treatment without consent according to the Swiss Civil Code. Patients incapable of consenting to treatments and other measures of care and who are somatically multimorbid in addition to their mental illness are frequently encountered in the geriatric psychiatry inpatient setting. In this group of patients, physical restraints are repeatedly used to prevent falling and to quarantine patients due to infectious diseases. Frequently, treatment is conducted with the apparent agreement of the patient but which are to be recorded as measures restricting freedom due to the inability to give informed consent. The National Association for Quality Development in Hospitals and Clinics (ANQ) has introduced geriatric psychiatry as a separate department category; this differentiation should also be seen as an opportunity and invitation to take a differentiated look at measures restricting freedom in geriatric psychiatry.

[Qualitätsstandards in der Alterspsychiatrie]. / Standards de qualité en psychiatrie de la personne âgée.

Quality Standards in Old Age Psychiatry Abstract: Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

Résumé: Les normes et réglementations en matière de qualité prennent de plus en plus d'importance et sont encouragées dans le cadre de l'approbation des thérapeutiques, de la facturation et des incitations financières. Dans ce contexte, ces réglementations mettent l'accent, à des degrés divers, sur des critères de structure, de processus ou de résultats. Au nom de la Société Suisse de Psychiatrie et Psychothérapie de la Personne Âgée (SPPA) nous résumons dans ce document les éléments de qualité et regroupons les exigences qui en découlent en fonction du setting (ambulatoire, intermédiaire, stationnaire) et des critères de qualité structurelle (clé de répartition du personnel, infrastructure). Il existe une vaste matrice d'exigences dont la mise en œuvre requiert des efforts considérables, entre autres en raison de la pénurie de personnel qualifié et des ressources financières limitées des institutions et des cabinets médicaux. Les critères définis dans la matrice d'exigences devraient être développés et ancrés dans une «formation continue en psychiatrie de la personne âgée basée sur les compétences¼.

[Quality Standards in Old Age Psychiatry]. / Qualitätsstandards in der Alterspsychiatrie.

Quality Standards in Old Age Psychiatry Abstract. Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements, matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

[Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics]. / Biomarker in der Diagnostik kognitiver Störungen ­ Empfehlungen der Swiss Memory Clinics.

Biomarkers for the diagnosis of cognitive impairment - Recommendations from the Swiss Memory Clinics Abstract. Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice.

Ways of Coping with Stress among Patients with Depressive Disorders.

BACKGROUND: Experiencing stressful life events and ways of coping with them can predispose to the onset of depressive mood disorders, while depression itself can be responsible for severe stress and can weaken resilience to stressors. Thus, variables relevant to the onset of depressive episodes and the course of depression have significant relationships with coping strategies to stressors. The aim of this research was to evaluate the most commonly used stress-coping strategies in patients treated for depression compared to patients with anxiety disorders and to healthy subjects. METHODS: The multidimensional coping inventory (COPE Inventory) by C. S. Carver, M. F. Scheier, and J. K. Weintraub, covering 15 stress response strategies included in more general and overarching coping styles, was used in the study. RESULTS: Patients with depression differed from the healthy subjects in a statistically significant way. Statistical analysis showed that people with depression are less likely than healthy subjects to use Active Coping, Planning, Seeking of Instrumental and Emotional Social Support, Suppression of Competing Activities, and Positive Reinterpretation. In contrast, they are more likely to use Denial, Mental Disengagement, and Behavioral Disengagement compared to those not treated for mental disorders. The patients with depressive disorders, compared to the group of patients with anxiety disorders, scored significantly differently on stress coping strategies in only two types of actions taken in stressful situations. CONCLUSION: The patients with depression differed from the healthy subjects in terms of the highest number of the stress coping strategies assessed. Compared to the healthy individuals, a tendency toward an avoidant behavior style was prevalent among the depressed patients. There was no statistically significant difference between the patients with the first episode of the disease and recurrent depressive disorders in terms of stress coping strategies.

Local gene knockdown in the brain using viral-mediated RNA interference.

Conditional mutant techniques that allow spatial and temporal control over gene expression can be used to create mice with restricted genetic modifications. These mice serve as powerful disease models in which gene function in adult tissues can be specifically dissected. Current strategies for conditional genetic manipulation are inefficient, however, and often lack sufficient spatial control. Here we use viral-mediated RNA interference (RNAi) to generate a specific knockdown of Th, the gene encoding the dopamine synthesis enzyme tyrosine hydroxylase, within midbrain neurons of adult mice. This localized gene knockdown resulted in behavioral changes, including a motor performance deficit and reduced response to a psychostimulant. These results underscore the potential of using viral-mediated RNAi for the rapid production and testing of new genetic disease models. Similar strategies may be used in other model species, and may ultimately find applications in human gene therapy.

Lateral canthal resuspension sine canthotomy.

PURPOSE: The purpose of this study is to describe a novel canthopexy technique-the lateral canthal resuspension sine canthotomy (LCR-SC)-performed via an upper-eyelid incision and to compare it with the lateral tarsal strip procedure (LTS). METHODS: This is a retrospective study in which the pre- and postoperative photographs of 20 patients per group who had LCR-SC, LCR-SC + midface lift (LCR-SC+ML), or LTS were analyzed by using the Image-J 1.40 software. Parameters measured were as follows: the horizontal palpebral aperture margin-reflex distance 2 (MRD-2) and the height of lateral canthus. LCR-SC was performed through an upper-eyelid incision, by using a 4.0 Prolene suture. For the LCR-SC+ML, a large myocutaneous flap was created first and anchored to the orbital-rim periosteum. The surgical technique is described. Two-way ANOVA was used for analysis. RESULTS: The horizontal palpebral aperture was significantly increased by LCR-SC and LCR-SC+ML when compared with LTS (1.61 ± 0.22 mm and 1.56 ± 0.14 vs. 0.04 ± 0.12 mm; p < 0.01). LCR-SC and LCR-SC+ML decreased the MRD-2 more than the LTS (1.06 ± 0.26 and 1.50 ± 0.23 mm vs. 0.86 ± 0.1 mm; p < 0.01). All 3 procedures increased the lateral canthal height by less than 0.5 mm. CONCLUSIONS: LCR-SC is a safe and effective procedure for tightening the lower eyelids. It tightens both the upper and the lower cruri of the lateral canthal tendon, avoiding imbrication of the eyelids. LCR-SC obviates the need for a lateral canthal incision and widens the horizontal palpebral aperture. LCR-SC is more effective than LTS at decreasing the MRD-2. Concomitant midface elevation (LCR-SC+ML) further decreases MRD-2.

Orbital augmentation with injectable calcium hydroxylapatite for correction of postenucleation/evisceration socket syndrome.

PURPOSE: To demonstrate the utility of injectable calcium hydroxylapatite (Radiesse) for orbital volume augmentation to correct postenucleation/evisceration socket syndrome (PESS). METHODS: A retrospective chart review of all consecutive patients in our practice who received injectable calcium hydroxylapatite placed in the extraconal space to augment orbital volume was conducted. Patients with at least 6 months follow-up were included in the study. RESULTS: Among 26 patients with PESS who received injectable calcium hydroxylapatite for orbital volume augmentation, 15 individuals were identified with adequate follow-up. The mean amount of preoperative relative enophthalmos measured by Hertel exophthalmometry was 4 mm (range 0.5-7 mm). An average reduction of 2.4 mm of enophthalmos per syringe of filler was achieved. The mean follow-up obtained was 46 weeks (range 24-78 weeks). Most patients demonstrated clinical and aesthetic improvement that was observed to continue up to 1.5 years. Complications observed included anterior migration of filler, a peribulbar hemorrhage, and orbital discomfort. Two patients demonstrated little response to filler. CONCLUSIONS: Injectable calcium hydroxylapatite provides a novel, safe, simple, cost-effective technique to treat volume deficiency in the anophthalmic orbit. Augmentation achieved with this semipermanent filler has demonstrated a lasting effect in the orbit with little volume loss. Volume replacement can be titrated to the socket requirements. Correction of PESS using this technique may be limited in orbits that demonstrate significant fibrosis as a result of multiple surgeries, severe trauma, or radiation treatment.

Enduragen patch grafts for exposed orbital implants.

PURPOSE: To present a new technique using the recently introduced Enduragen(®) material (Tissue Science Laboratories) as a patch graft for exposed ocular implants. METHODS: A retrospective, interventional, non-comparative case series of 3 patients who had Enduragen patch grafts for the closure of Tenon's capsule and conjunctiva over exposed ocular implants. Medical records were reviewed and the following parameters were collected: age, gender, indication for surgery, type of surgery, laterality, type of orbital implant, complications after repair and length of follow-up. RESULTS: Three patients were identified, 2 males and 1 female. One patient had a secondary quad-motility implant with supertemporal exposure. The second patient had a secondary implant with a fistula at the lateral aspect of the socket. The third patient had a centrally exposed primary hydroxyapatite implant. All patients received Enduragen patch grafts to cover the implant. Follow up ranged from 40 to 43 months (mean, 41.3 months; SD, ± 1.5). None of the 3 patients had any signs of implant re-exposure at the time of the last post-operative visit. There were no intra-operative or early complications observed. CONCLUSIONS: This consecutive case series suggests that Enduragen could be used as a safe and effective patch graft for exposed ocular implants. However, a larger prospective study with longer follow-up would be useful in further defining the indications and limitations of the Enduragen patch graft for the treatment of exposed orbital implants.

Appropriate use criteria for dementia amyloid imaging in Switzerland - mini-review and statement on behalf of the Swiss Society of Nuclear Medicine and the Swiss Memory Clinics.

While FDG-PET imaging of the brain for the differential diagnosis of dementia has been covered by the compulsory health insurance in Switzerland for more than a decade, beta-amyloid-PET just recently has been added to the catalogue of procedures that have been cleared for routine use, provided that a set of appropriate use criteria (AUC) be followed. To provide guidance to dementia care practitioners, the Swiss Society of Nuclear Medicine and the Swiss Memory Clinics jointly report a mini-review on beta-amyloid-PET and discuss the AUC set into effect by the Swiss Federal Office of Public Health, as well as their application and limitations.

Leptin receptor signaling in midbrain dopamine neurons regulates feeding.

The leptin hormone is critical for normal food intake and metabolism. While leptin receptor (Lepr) function has been well studied in the hypothalamus, the functional relevance of Lepr expression in the ventral tegmental area (VTA) has not been investigated. The VTA contains dopamine neurons that are important in modulating motivated behavior, addiction, and reward. Here, we show that VTA dopamine neurons express Lepr mRNA and respond to leptin with activation of an intracellular JAK-STAT pathway and a reduction in firing rate. Direct administration of leptin to the VTA caused decreased food intake while long-term RNAi-mediated knockdown of Lepr in the VTA led to increased food intake, locomotor activity, and sensitivity to highly palatable food. These data support a critical role for VTA Lepr in regulating feeding behavior and provide functional evidence for direct action of a peripheral metabolic signal on VTA dopamine neurons.

Evisceration with equatorial sclerotomy for phthisis bulbi and microphthalmos.

PURPOSE: To describe a new technique for ocular volume augmentation at the time of evisceration in patients with phthisis bulbi and microphthalmos. METHODS: A retrospective, interventional, noncomparative case series of all patients with phthisis bulbi and microphthalmos who underwent successful evisceration with equatorial sclerotomy. The medical records were reviewed for patient history, surgical method, and postoperative course. RESULTS: Eighteen patients (16 with phthisis bulbi and 2 with microphthalmos) underwent evisceration with equatorial sclerotomy and placement of an orbital implant of 20 mm in 11 patients (61%), 18 mm in 6 patients (33%) and 16 mm in 1 patient. Complications encountered were implant exposure in one patient, fornix shortening and symblepharon in one patient, and enophthalmos in another. CONCLUSION: Equatorial sclerotomy could be a useful adjuvant technique for placement of a larger orbital implant at the time of evisceration in patients with phthisis bulbi and microphthalmos.

Brow ptosis correction: a comparison of five techniques.

This study evaluates the effectiveness of five surgical techniques for brow ptosis repair including internal brow release (IBR), internal brow release with brow pexy (IBR + BP), internal brow release with corrugator and depressor supercilii removal (IBR + CDR), direct brow-lift (DB), and endoscopic brow-lift (EB). This is a retrospective study of 120 patients in which the preoperative and postoperative position of the medial, central, and lateral brow on both sides was measured. The brow was elevated 1.16 +/- 0.05 mm by IBR, 1.74 +/- 0.05 mm by IBR + BP, and 2.52 +/- 0.06 mm by IBR + CDR. IBR + BP was more effective than IBR in elevating the lateral brow ( P < 0.05). Removal of the medial brow depressors resulted in greater elevation of the medial and central brow than could be achieved with IBR or IBR + BP alone ( P < 0.01). EB resulted in the greatest amplitude of brow elevation (3.44 +/- 0.06 mm). Eyebrow-lifting surgery performed via the upper eyelid blepharoplasty incision prevents the lowering of brow position caused by blepharoplasty surgery alone. Brow pexy sutures are useful in enhancing elevation of the lateral brow, and removal of the medial brow depressors is useful in raising the medial and central brow.

[Recognition of Psychiatric Symptoms in Inpatient Long-Term Care]. / Erkennung psychiatrischer Symptome in der stationären Langzeitpflege.

Recognition of Psychiatric Symptoms in Inpatient Long-Term Care Abstract. As part of the Swiss national strategy on dementia, we investigated to which extent the needs assessment instruments RAI and BESA can early detect symptoms of depression, delirium, and behavioral and psychological symptoms of dementia (BPSD) in long-term care facilities. While we decided that the RAI sufficiently detected depressive symptoms, we suggest to add the two-questions-test and the geriatric depression scale to the BESA assessment. The BESA evaluation had more targeted focused assessments, allowing for better identification of delirium. Neither RAI or BESA cover the whole spectrum of behavioral and psychological symptoms of dementia. We consider the continuous application of these assessment instruments an important step towards interdisciplinary exchange and a better treatment of residents with psychiatric symptoms.