Increased medial thalamic creatine-phosphocreatine found by proton magnetic resonance spectroscopy in children with obsessive-compulsive disorder versus major depression and healthy controls.

Altered brain creatine-phosphocreatine levels might reflect changes in brain energy use and have been implicated in the pathogenesis of obsessive-compulsive disorder and major depressive disorder. We used proton magnetic resonance spectroscopy to measure absolute concentrations of creatine-phosphocreatine in the right and left medial thalami in 18 pediatric patients with major depressive disorder 9 to 17 years of age, 18 case-matched healthy controls, and 27 patients with obsessive-compulsive disorder 7 to 16 years old. The two patient groups were psychotropic drug naive and were not comorbid for the diagnosis of the comparison group. We found significantly increased left and right medial thalamic creatine-phosphocreatine concentrations in patients with obsessive-compulsive disorder compared with both healthy controls and patients with major depression. Creatine-phosphocreatine concentrations did not differ significantly between patients with major depression and healthy controls. Our data suggest that increased medial thalamic creatine-phosphocreatine concentrations in patients with untreated obsessive-compulsive disorder reflect altered energy use in the medial thalamus and might differentiate patients with obsessive-compulsive disorder from healthy controls and patients with major depression. Although these results must be considered preliminary, further study of the diagnostic specificity of creatine-phosphocreatine in obsessive-compulsive disorder is indicated.

Healthcare librarians and learner support: a review of competences and methods.

OBJECTIVES: London Health Libraries (LHL) are undertaking a project in order to develop the role of their library and knowledge services staff in supporting learners within the NHS in the London area (LHL Learner Support Project). This paper reports on the first phase of the project. METHODOLOGY: A literature analysis was carried out to provide guidance on the skills and competences needed for library and knowledge staff to perform this function. RESULTS: A variety of competences are identified, and structured in a model incorporating both training skills and general professional competencies. Library and knowledge staff will themselves need to have a high-level of information literacy and to be active lifelong learners. CONCLUSIONS: A 'blended learning' approach, involving e-learning together with other methods, is identified as the most appropriate way for skills to be acquired.

Reduced anterior cingulate glutamate in pediatric major depression: a magnetic resonance spectroscopy study.

BACKGROUND: Anterior cingulate cortex has been implicated in the pathogenesis of major depressive disorder (MDD). With single voxel proton magnetic resonance spectroscopy, we reported reductions in anterior cingulate glutamatergic concentrations (grouped value of glutamate and glutamine) in 14 pediatric MDD patients versus 14 case-matched healthy control subjects. These changes might reflect a change in glutamate, glutamine, or their combination. METHODS: Fitting to individually quantify anterior cingulate glutamate and glutamine was performed in these subjects with a new basis set created from data acquired on a 1.5 Tesla General Electric Signa (GE Healthcare, Waukesha, Wisconsin) magnetic resonance imaging scanner with LCModel (Version 6.1-0; Max-Planck-Institute, Gottingen, Germany). RESULTS: Reduced anterior cingulate glutamate was observed in MDD patients versus control subjects (8.79 +/- 1.68 vs. 11.46 +/- 1.55, respectively, p = .0002; 23% decrease). Anterior cingulate glutamine did not differ significantly between patients with MDD and control subjects. CONCLUSIONS: These findings provide confirmatory evidence of anterior cingulate glutamate alterations in pediatric MDD.

Role of troponin I in active infective endocarditis.

Infective endocarditis (IE) remains a disease associated with high morbidity and mortality rates. In this pilot study, the role of troponin I in IE was assessed. Myocardial involvement distal to the site of infection in IE has been previously described. Elevated troponin was demonstrated in 11 of 15 patients diagnosed with the condition. Patients diagnosed with staphylococcal endocarditis were more likely to have elevated troponin (3 of 3 patients). Patients with elevated troponin I were not more likely to need valve replacement. Troponin I levels did not predict perivalvular extension. It is hypothesized that elevated troponin I is a reflection of myocardial involvement.

Reduced anterior cingulate glutamatergic concentrations in childhood OCD and major depression versus healthy controls.

OBJECTIVE: To examine in vivo glutamatergic neurochemical alterations in the anterior cingulate cortex of pediatric patients with obsessive-compulsive disorder (OCD) without major depressive disorder (MDD) versus pediatric patients with MDD without OCD and healthy controls. METHOD: Single-voxel proton magnetic resonance spectroscopic examinations of the anterior cingulate cortex were conducted in 14 psychotropic-naïve children and adolescents with MDD without OCD, 10 to 19 years of age, 14 case-matched healthy controls, and 20 nondepressed, psychotropic-naïve pediatric patients with OCD 7 to 19 years of age. RESULTS: Anterior cingulate glutamatergic concentrations were significantly reduced in both patients with OCD (15.1% decrease) and patients with MDD (18.7% decrease) compared with controls. Anterior cingulate glutamatergic concentrations did not differ significantly between patients with OCD and those with MDD. CONCLUSIONS: Altered anterior cingulate glutamatergic neurotransmission may be involved in the pathogenesis of OCD and MDD. These preliminary findings further suggest that reduced anterior cingulate glutamate does not differentiate pediatric patients with OCD from pediatric patients with MDD.