A computational model of neurodegeneration in Alzheimer's disease.

Disruption of mental functions in Alzheimer's disease (AD) and related disorders is accompanied by selective degeneration of brain regions. These regions comprise large-scale ensembles of cells organized into systems for mental functioning, however the relationship between clinical symptoms of dementia, patterns of neurodegeneration, and functional systems is not clear. Here we present a model of the association between dementia symptoms and degenerative brain anatomy using F18-fluorodeoxyglucose PET and dimensionality reduction techniques in two cohorts of patients with AD. This reflected a simple information processing-based functional description of macroscale brain anatomy which we link to AD physiology, functional networks, and mental abilities. We further apply the model to normal aging and seven degenerative diseases of mental functions. We propose a global information processing model for mental functions that links neuroanatomy, cognitive neuroscience and clinical neurology.

Changes in Ventricular and Cortical Volumes following Shunt Placement in Patients with Idiopathic Normal Pressure Hydrocephalus.

BACKGROUND AND PURPOSE: While changes in ventricular and extraventricular CSF spaces have been studied following shunt placement in patients with idiopathic normal pressure hydrocephalus, regional changes in cortical volumes have not. These changes are important to better inform disease pathophysiology and evaluation for copathology. The purpose of this work is to investigate changes in ventricular and cortical volumes in patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement. MATERIALS AND METHODS: This is a retrospective cohort study of patients with idiopathic normal pressure hydrocephalus who underwent 3D T1-weighted MR imaging before and after ventriculoperitoneal shunt placement. Images were analyzed using tensor-based morphometry with symmetric normalization to determine the percentage change in ventricular and regional cortical volumes. Ventricular volume changes were assessed using the Wilcoxon signed rank test, and cortical volume changes, using a linear mixed-effects model (P < .05). RESULTS: The study included 22 patients (5 women/17 men; mean age, 73 [SD, 6] years). Ventricular volume decreased after shunt placement with a mean change of -15.4% (P < .001). Measured cortical volume across all participants and cortical ROIs showed a mean percentage increase of 1.4% (P < .001). ROIs near the vertex showed the greatest percentage increase in volume after shunt placement, with smaller decreases in volume in the medial temporal lobes. CONCLUSIONS: Overall, cortical volumes mildly increased after shunt placement in patients with idiopathic normal pressure hydrocephalus with the greatest increases in regions near the vertex, indicating postshunt decompression of the cortex and sulci. Ventricular volumes showed an expected decrease after shunt placement.

Tau uptake in agrammatic primary progressive aphasia with and without apraxia of speech.

BACKGROUND AND PURPOSE: The non-fluent/agrammatic variant of primary progressive aphasia (agPPA) is a heterogeneous diagnosis wherein some individuals have apraxia of speech (AOS). When agPPA includes AOS, a tauopathy is the likely underlying pathology. Recently, [18F]AV-1451 was developed for the in-vivo assessment of tau. In this study, we compared patterns of tau tracer uptake in patients with agPPA with and without AOS. METHODS: Nine patients with agPPA (four without AOS) underwent tau positron emission tomography imaging with [18F]AV-1451. Uptake of [18F]AV-1451 was assessed as cortical to cerebellar crus ratio (standard uptake value ratio) in cortical regions of interest measured using the MCALT atlas and compared voxel-wise in SPM12. Each patient was age- and sex-matched to three controls. RESULTS: The agPPA without AOS showed uptake in the left frontal and temporal lobes, whereas agPPA with AOS showed uptake in the bilateral supplementary motor areas, frontal lobes, precuneus and precentral gyrus relative to controls. The left precentral gyrus had uptake in agPPA with AOS relative to those without AOS. CONCLUSIONS: This cross-sectional study suggests that [18F]AV-1451 uptake in the precentral gyrus is implicated in AOS in agPPA.

Suicide Cases Investigated at the State Mortuary in Bloemfontein; 2003-2007

Background: Up to 8 000 South Africans commit suicide annually. This study aimed to investigate the profile of suicide cases in Bloemfontein and the southern Free State province. Methods: A cross-sectional descriptive study was performed. Suicides in the Bloemfontein and southern Free State areas (Xhariep and Motheo districts) investigated at the state mortuary in Bloemfontein in 2003 to 2007 were included. Data were collected retrospectively by using a specially designed data-capturing form. Results: A total of 469 suicide cases were included in the study. The estimated suicide rate for this part of the Free State province was 10.9/100 000 of the population per year. The majority (82.1) of the victims were men. In total; 338 (72.1) of the victims were black; 122 (26.0) were white; five (1.1) were coloured and three (0.6) were Indian. The most common methods were hanging (262; 55.9); shooting (99; 21.1) and overdosing on pills (43; 9.2). Most cases (57.8) occurred in victims 21 to 40 years of age. Five (1.1) victims were children younger than 11 years of age; while 12 (2.6) were older than 65 years. More than half (267 cases; 56.9) of the suicide victims were unemployed. The majority (43.1) of suicides occurred in January to April of each year; with the highest incidence (67 cases; 14.3) in January. Conclusion: The rate of suicide and the profile of victims with regard to the variables investigated corresponded to findings reported from other studies. The information obtained could make a meaningful contribution to suicide-prevention programmes

Effects of a group rational-emotive behavior therapy program on the Type A behavior pattern.

A sample of 44 male Type A insurance representatives, selected by means of the Videotaped Structured Interview, were randomly assigned to a treatment (n = 22) and a delayed treatment control group (n = 22). The treatment group participated in 9 weekly sessions of group Rational-Emotive Behavior Therapy and were followed up after 10 weeks. After the control period, the delayed treatment control group received the same treatment program. Repeated measurements were obtained by means of the Videotaped Structured Interview, Jenkins Activity Survey, Cook-Medley Hostility Scale, and Type A Cognitive Questionnaire. Self and spouse/friend ratings of Type A behavior were obtained by means of the Bortner Rating Scale. Analysis indicated that, compared to the control condition, the therapy significantly reduced the intensity of Type A behavior and its time urgency component. These improvements were maintained at follow-up and were accompanied by self-reports of significant positive changes in Type A behavior and irrational beliefs.

Shear bond strength of a composite resin after delayed bonding to a polymerised dentine bonding system.

Polymerised adhesive may serve as a temporary sealant on prepared dentine surfaces and may be used as a precursor to the final bonding of a resin restoration. This procedure may, however, have an adverse effect on the strength of the final bond. This study was undertaken on 40 extracted human molar teeth to assess the effect of delayed bonding on the shear bond strength of a composite resin luted with a luting resin to abraded dentine treated with the Scotchbond Multi-Purpose (SMP) Bonding System (3M). No significant difference (p = 0.969) could be demonstrated between shear bond strengths achieved after immediate and delayed bonding to the polymerised Scotchbond Multi-Purpose adhesive.

Primary health care according to African requirements.

African conditions and circumstances present specific challenges to health service providers. These conditions have implications for primary health care (PHC), including problems of communication (geographical, educational and cultural), maldistribution of health manpower, political unrest and wars. Local PHC services must compete with the prestige of and faith in the hospitals. Manpower training should be stressed at all levels of education of all medical and paramedical personnel. The status of PHC in the Republic of South Africa is now well recognized, and provision of the required services has a high priority.

PIP: To promote and protect the health of individuals and communities in Africa at the primary health care (PHC) level, strategy must be translated into action. Discussion focuses on the assistance that possibly can be given to PHC through health and related systems. Health development councils and networks have been proposed and are being tried in several African countries as structures for attacking health problems at their roots. The Health Act of 1977 provides for community participation by creating a number of subcommittees on which the public can serve. Community involvement is cost effective. An involved public enables the transfer and management of certain patients from the hospital into the community. Care groups can be a viable link between communities and the authorities. Policy statements for PHC must be supported by appropriate plans. Voluntary involvement is not always sufficient. Certain forms of "gentle persuasion" must then be exerted. For example, health legislation should support education, and for many years immunization for tuberculosis, polio, and smallpox have been mandatory by law. Compulsory notification of diseases does not require sophisticated supervision, yet it is vital for the planning and evaluation of PHC. A variety of health responsibilities must be shared by different health authorities: teaching hospitals and PHC units; psychiatric hospitals and PHC units; employers and health authorities; and health authorities and private enterprise. In some African countries, a wide gap exists between PHC services and hospitals, and there is a discrepancy in the money allocated for hospitals and for extrainstitutional services. At this time patients in Africa must themselves take the initiative in order to obtain health care. This system should be replaced by active outreach programs that bring promotive, preventive, and curative health care to the entire population. In Africa, people are realizing that well situated community health centers (CHCs) reduce the need for hsopital beds. The day hospital and large CHCs are gaining more and more suppport as ideal facilities for delivering PHC, especially in urban areas. Traditional doctors and midwives continue to pay a significant role in Africa, even in urban areas, and they should be regarded as members of the extended health team. In most African nations the State remains the major funding source for PHC. More funding should come from the private sector within the country or from international sources.

The micromorphological development of the post partum corpus luteum in the ewe.

The morphological changes in the post partum corpus luteum was investigated by light microscopy on 16 ewes during the normal breeding season (March/April). The increase in luteal tissue results from hypertrophy and not from hyperplasia of the granulosa and thecal cells. Two types of lutein cells were found in the corpus luteum: a large light-staining cell and a small dark-staining cell. These might reflect the 2 extremes of a spectrum of cells in different functional states, or they might represent cell lines derived from the follicular granulosa and the thecal interna, respectively.

Community participation in cardiac rehabilitation.

Cardiac patients are not solely responsible for their own rehabilitation. The rehabilitative process is a prolonged one, and success lies in multidisciplinary management involving the patient, the immediate family and the community. The Health Act (Act No. 63 of 1977) has various implications for the future provision of rehabilitative services in South Africa. Each member of the health team and the community has a specific role to play, either within or outside the hospital setting, thus providing ongoing rehabilitative supervision of cardiac patients.

[Centuries-old community involvement of South African physicians]. / Eeue-oue gemeenskapsbetrokkenheid van Suid-Afrikaanse geneeshere.

Involvement in community affairs is an honoured tradition among South African medical practitioners. The so-called old doctor belonged to an era when dedication to the arts, botany, zoology and nature in general was often combined with the practice of medicine. They were colourful individuals and their names are worth remembering in this eventful year.

In search of a curriculum.

The curricular needs in the continuing education of general practitioners can be assessed by means of surveys which utilise practice profile data. In constructing the practice profile, we have made use of disease classification fata and factors involved in practice management. So far, the results of a survey in which 100 practitioners are participating indicate that the method will yield valuable results.

[South African family doctor's contribution to public health during the period 1900-1950]. / Die Suid-Afrikaanse huisarts se hydrae tot die openbare gesondheid gedurende die periode 1900-1950

During the period 1900-1950 the general or family practitioners made significant contributions to the health care in South Africa. The historical details of these contributions were not always documented and are difficult to trace. The Department of Family Medicine is anxious to preserve this part of South African medical history and a research project to further this effort was carried out. All possible sources of information were used. Chairs of medical history should be established in our medical faculties.