The utility of an RDoC motor domain to understand psychomotor symptoms in depression.

Despite the clinical impact of motor symptoms such as agitation or retardation on the course of depression, these symptoms are poorly understood. Novel developments in the field of instrumentation and mobile devices allow for dimensional and continuous recording of motor behavior in various settings, particularly outside the laboratory. Likewise, the use of novel assessments enables to combine multimodal neuroimaging with behavioral measures in order to investigate the neural correlates of motor dysfunction in depression. The research domain criteria (RDoC) framework will soon include a motor domain that will provide a framework for studying motor dysfunction in mood disorders. In addition, new studies within this framework will allow investigators to study motor symptoms across different stages of depression as well as other psychiatric diagnoses. Finally, the introduction of the RDoC motor domain will help test how motor symptoms integrate with the original five RDoC domains (negative valence, positive valence, cognitive, social processes, and arousal/regulation).

Updating the research domain criteria: the utility of a motor dimension.

Within the NIMH Research Domain Criteria (RDoC) framework, dimensions of behavior are investigated across diagnoses with the goal of developing a better understanding of their underlying neural substrates. Currently, this framework includes five domains: cognitive, social, arousal/regulatory, negative, and positive valence systems. We argue that the inclusion of a motor systems domain is sorely needed as well. Independent of medication, distinct areas of motor dysfunction (e.g. motor planning/inhibition/learning/coordination, involuntary movements) commonly appear across a number of mental disorders (e.g. schizophrenia, bipolar disorder, autism, attention deficit hyperactivity disorder, Alzheimer's disease, depression) as well as neurological disorders accompanied by significant psychological symptoms (e.g. Parkinson's disease). In addition, motor systems are amenable to study across multiple levels of analysis from the cellular molecular level focusing on cytoarchitechtonics and neurotransmitter systems, to networks and circuits measured using neuroimaging, and finally at the level of overt behavioral performance. Critically, the neural systems associated with motor performance have been relatively well defined, and different circuits have been linked to distinct aspects of motor behavior. As such, they may also be differentially associated with symptoms and motor dysfunction across diagnoses, and be uniquely informative about underlying etiology. Importantly, motor signs can change across stages of illness; they are also often present in the prodromal phases of disease and closely linked with course, suggesting that these behaviors represent a core feature reflective of pathogenic processes. The inclusion of a motor domain would allow researchers to better understand psychopathology more broadly, and may also reveal important contributions to disease processes across diagnoses.

[Professional practice evaluation in glaucoma]. / Evaluation des pratiques professionnelles (EPP) dans le glaucome.

Professional practice evaluation (PPE) and continuous medical education (CME) have been compulsory in France since July 2005. The objectives of PPE and CME are to increase the quality of care and to improve medical practice. Relatively easy to obtain, PPE is a self-evaluation of daily practice.

Alpha3 integrin receptors contribute to the consolidation of long-term potentiation.

Several lines of evidence suggest that integrin receptors play a pivotal role in consolidation of long-term potentiation (LTP), but which of the many integrin dimers are involved remains to be discovered. The present study used an LTP reversal paradigm to test if alpha3 integrins make an important contribution. Function blocking alpha3 monoclonal antibodies or vehicle were locally infused into recording sites in field CA1 of rat hippocampal slices and LTP induced with theta burst stimulation. Low frequency trains of pulses were applied 30 min after the theta bursts. Previous work indicates that low frequency stimulation reverses LTP when applied immediately after induction but is largely ineffective after 30-45-min delays. If the antibodies were to block consolidation, then they should extend the period over which potentiation is vulnerable to disruption. There was no detectable difference between the two groups in the initial degree of LTP or within slice decay of potentiation 1-10 min after induction; a small but reliable decay occurred from 10 to 30 min with antibody treatment (P<0.01) but not in control slices. Percent potentiation was not statistically different for vehicle (55 +/- 19%, mean +/- S.D.) and anti-alpha3 (43 +/- 21%) slices at 30 min post-theta bursts. Five-Hz stimulation ("theta pulse" stimulation) 30 min after induction caused a reduction of LTP. The percent loss of potentiation after the 1-min trains was greater in the antibody-treated slices than in controls (98 +/- 4% vs. 62 +/- 28%, P<0.01, U-test) and correlated (r=0.84, alpha3 slices) with the percent LTP present prior to low frequency stimulation, as expected if the stimulation reversed potentiation. Recovery occurred in both groups but percent LTP was significantly smaller in experimental slices at 10 min post-theta pulses (5 +/- 11% vs. 36 +/- 15%, P<0.01). Recovery continued for 20 min after theta pulses and, in accordance with earlier work, was nearly complete for the control slices (50 +/- 19% vs 55 +/- 15%, 40 min post- vs. immediately pre-theta pulses). LTP remained depressed after 40 min of recovery in the anti-alpha3 slices (23 +/- 19% vs. 43 +/- 21%) at which point it was substantially less than that found in controls (P<0.01). Western blots with anti-alpha3 antibodies identified a polypeptide with the molecular mass (155 kDa) expected for the alpha3 subunit and further showed that it is broadly distributed in brain. Subcellular fractionation experiments demonstrated that alpha3 is concentrated in synaptic membranes over homogenates to about the same degree as the GluR1 subunit of the alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionate-type glutamate receptor. From these results we suggest that alpha3-containing integrins are localized to synapses and are needed to stabilize a slowly decaying form of LTP. The findings also show that vulnerability to reversal can be used in place of extended recording sessions in studying consolidation.

[Retinal lesion due to an obstetrical traumatism: a case report]. / Lésion du fond d'oeil séquellaire d'un traumatisme obstétrical: à propos d'un cas.

The authors report a case of unilateral, stable, localized, and well-circumscribed choriocapillaris atrophy associated with retinal pigment epithelium dispersion and atrophy. The anterior segment was normal. Facial examination revealed a homolateral malar hypoplasia. The other eye was normal. The electrophysiologic study did not confirm pigmentary degeneration of the retina. The patient's history included a difficult delivery using obstetrical forceps. The authors review the main ocular lesions secondary to birth trauma. In this case, they favored a traumatic chorioretinal lesion secondary to an obstetrical traumatism. In this context, progressive facial hemiatrophy is the main differential diagnosis.

[Excessive tearing in infants and young children. Questions? Answers]. / Le larmoiement du petit enfant. Questions? Réponses...

Tearing in infants and young children is a subject of controversy. A logical succession of questions and answers is helpful in developing a consensual attitude.

[Endonasal dacryocystorhinostomy (DCR) with protected drill]. / Forage osseux protégé lors des dacryocystorhinostomies (DCR) par voie endo-nasale.

PURPOSE: To analyze the interest of protected drills to perform endoscopic endonasal DCR. MATERIAL AND METHODS: [corrected] Fifty patients suffering from chronic epiphora were operated successively. None of those patients had had prior nasal surgery. The same surgeons (BF and ER) did the surgical procedure for all the cases. The technical steps were: endoscopic visualization of the middle meatus and evaluation of the anatomic variations of the nose; identification of the lacrymal bag with a 1 mm light in the canaliculus; unciformectomy; the maxillary bone was drilled with a 3.2 mm bit (straightshot Xomed), protected and irrigated; the lacrymal bag was opened by cissors and the flap was pushed in the ethmoid and coagulated. RESULTS: The suction-irrigation system was efficient to clean the surgical site, with a good endoscopic control. The protected bit didn't damage the 4-mm optics and the septal wall mucosa, even in narrow noses. The staightshot bit (Xomed) was tough enough to drill the maxillary bone in only 68 % of the surgical cases. In 28 % the drilling was unsatisfactory and in 4 % it was inefficient. The functional results at 6 month were good in 85 %. There was no difference between normal and narrow noses. CONCLUSION: The concept of protected bits perfectly matches the endoscopic endonasal DCR. The visual comfort and security of the surgical procedure are increased. Short term results are equivalent to external DCR, but are rather inefficient and expensive.

Grid photocoagulation for focal diabetic macular edema with focal leaks and hard exsudates involving the peri-foveolar area.

This study was conducted to determine whether indirect grid laser therapy is effective in reducing focal diabetic macular edema characterised by focal leaks and hard exsudates involving the para-foveal area (less than 300 microns from the center of the fovea). Since focal coagulation of microaneurysms in such a critical location can be deleterious, indirect grid pattern laser treatment may be used in such cases.

[Eyelid and lacrimal abscesses]. / Abcès palpébraux et lacrymaux.

Nonspecific eyelid abscesses are rare, whereas periorbital infections occur more frequently. Localisation of a maximum number of inflammatory signs is essential for diagnosis. A superior external localisation suggest dacryoadenitis or infection of a dermal cyst and the end of the eyebrow. An internal canthal localisation would reflect lacrimal disorder. In the adult, the main cause of infection is acute dacryocystitis. After antibiotic and anti-inflammatory drug treatment, dacryocystorhinotomy is necessary to preclude recurrence. In the newborn, bilateral forms of dilatation of the lacrimal sacs can lead to respiratory distress. The treatment of choice is resection of the endonasal pouches.

[Hard exudates in diabetic retinopathy]. / Les exsudats secs au cours de la rétinopathie diabétique.

In diabetic retinopathy the hard exudates are often arranged in a halo and correspond to a focal oedema. Their number may increase after correctly performed photocoagulation, and may decrease after a certain period. The central (macular) hard exudate may be subretinal and are a poor prognosis, leading to a fibrotic scar. When those exudates are more superficial, filling the cystoid spaces, they are of better prognosis.

[Internal transient palpebral inclusion following dacryocystorhinostomy]. / Inocclusion palpébrale interne transitoire après dacryocystorhinostomie.

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacrycystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases. Lagophthalmos was observed on the operated side on the first postoperative day. Normal lid occlusion was present on the contralateral side. Impairement of palpebral occlusion was predominant in the nasal portion of the lid fissure. Upon voluntary and reflex blinking, a reduction in the downward movement of the superior lid was observed. This reduction was not as apparent when the patients were asked to produce a forced blink. Lagophthalmos disappeared progressively over 3 postoperative months in both cases. Neither epiphora nor any corneal complications were observed. Lagophthalmos following DCR via an inferior approach is a previously unreported complication and may be related to the disinsertion of the nasal portion of the orbicularis muscle and periosteum at the time of periosteal cleavage. Recovery of normal lid function may be due to reattachment of the periosteum.

[Transient internal palpebral inocclusion after dacryocystorhinostomy]. / Inocclusion palpébrale interne transitoire après dacryocystorhinostomie.

The authors report two cases of postoperative lagophthalmos immediately following ab externo dacryocystorhinostomy (DCR). Two female patients, aged 67 and 62 years, underwent under general analgesia for chronic dacryocystitis with mucocele. An inferior surgical approach, sparing the inner canthal ligament was chosen in both cases.

[Choroid rupture, macular hole and subretinal neovessels following contusions]. / Rupture choroïdienne, trou maculaire et néovaisseaux sous-rétiniens postcontusifs. Observation commentée.

We present a case of choroidal rupture of the fovea, progressing to a macular hole and sub retinal new vessels. Blunt trauma of the eye ball and the posterior pole can progress years after the initial trauma.

[Canalicular stenoses complicating the insertion of lacrimal plugs. Incidence and mechanisms]. / Sténoses canaliculaires compliquant la pose de bouchons lacrymaux. Incidence et mécanismes.

Changes in canalicular permeability following the insertion of punctum plugs was studied. This occlusive method was used to treat dry eye syndrome in 43 patients over a period of 32 months. All had normal canalicular patency, confirmed on the day of implantation. One hundred and five large plugs were used (2.4 plugs per patient). Twenty seven (25.7%) impassable acquired canalicular stenoses were seen in 15 patients. The canalicular site of the 27 stenoses was the same: junction between the vertical and horizontal portions. Among the 27 stenoses: 4 plugs had disappeared at an unknown time, with follow-up probing taking place after a mean interval of 7.5 (months range: 1 to 15 months); 17 plugs had been expelled after being in place for an average of 5 months (range: 1 to 12 months; standard deviation 3.47), with follow-up examination taking place on average 12 months after insertion (range: 6 to 17 months; standard deviation 3.4); and 6 plugs were still in place after a mean of 7 months (range: 2 to 15 months; standard deviation 4.73) and the stenosis was discovered when they were removed. They were intact. These 6 Cases eliminate any possibility of intra-canalicular migration of the prosthesis--of all or part--of the prosthesis. Stenoses appeared to develop rapidly: 45% of cases were discovered during the first 3 months. 16/27 (59%) of stenoses were investigated a second time, 6 months later on average (range: 2 to 12 months): these 16 canaliculi all remained impassable.