The APPLE Tree programme: Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce-randomised controlled trial.

BACKGROUND: Large-scale trials of multidomain interventions show that modifying lifestyle and psychological risk factors can slow cognitive decline. We aim to determine if a lower intensity, personally tailored secondary dementia prevention programme for older people with subjective or mild objective memory decline, informed by behaviour change theory, reduces cognitive decline over 2 years. METHODS: A multi-site, single-blind randomised controlled trial recruiting 704 older adults at high dementia risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD). Participants are randomised using 1:1 allocation ratio to the APPLE Tree intervention versus control arm (dementia prevention information), stratified by site. The intervention explores and implements strategies to promote healthy lifestyle, increase pleasurable activities and social connections and improve long-term condition self-management. Two facilitators trained and supervised by a clinical psychologist deliver ten, 1-h group video call sessions over 6 months (approximately every fortnight), video-call 'tea breaks' (less structured, facilitated social sessions) in intervening weeks and individual goal-setting phone calls every 2 weeks. From 6 to 12 months, participants meet monthly for 'tea breaks', with those not attending receiving monthly goal-setting phone calls. Participants receive a food delivery, pedometer and website access to cognitive training and information about lifestyle modification. Follow-ups for all outcome measures are at 12 and 24 months. The primary outcome is cognition (Neuropsychological Test Battery (NTB) score) at 24 months. Secondary outcomes are quality of life, cost per quality-adjusted life year (QALY) and wellbeing and lifestyle factors the intervention targets (diet, vascular risk, body weight, activity, sleep, anxiety, depression, social networks and loneliness, alcohol intake and smoking). Participants from purposively selected sites participate in qualitative process evaluation interviews, which will be analysed using thematic analytic methods. DISCUSSION: If effective, the intervention design, involving remote delivery and non-clinical facilitators, would facilitate intervention roll-out to older people with memory concerns. TRIAL REGISTRATION: ISRCTN17325135 . Registration date 27 November 2019.

[Anesthetist facing ethylic patient : management and precaution]. / L'anesthésiste face à un patient éthylique : gestion et précautions.

The anesthetic management of the patient with unhealthy alcohol use is challenging. Chronic alcohol intake results in numerous co-morbid diseases, physiologic changes and pharmacologic alterations leading to increased perioperative morbidity and mortality. Hence anesthesiologists should search for chronic and acute effects of alcohol abuse when managing such patients. Also, the anesthetic approach of these patients must be adapted to prevent perioperative complications, including withdrawal symptoms. Last, the preoperative period is on opportunity to initiate alcohol withdrawal, with patient's agreement and collaboration.

La gestion anesthésique du patient ayant une consommation d'alcool pathologique est difficile. La consommation chronique d'alcool entraîne de nombreuses pathologies, des modifications physiologiques et des changements pharmacologiques, entraînant une augmentation de la morbidité et de la mortalité périopératoires. Par conséquent, les anesthésistes doivent rechercher les effets chroniques et aigus de l'abus d'alcool lors de la prise en charge de tels patients. En outre, l'approche anesthésique de ces patients doit être adaptée pour prévenir les complications périopératoires, y compris les symptômes de sevrage. Enfin, la période préopératoire est l'occasion de commencer le sevrage alcoolique, avec l'accord et la collaboration du patient.

Ultradian rhythmicity of plasma cortisol is necessary for normal emotional and cognitive responses in man.

Glucocorticoids (GCs) are secreted in an ultradian, pulsatile pattern that emerges from delays in the feedforward-feedback interaction between the anterior pituitary and adrenal glands. Dynamic oscillations of GCs are critical for normal cognitive and metabolic function in the rat and have been shown to modulate the pattern of GC-sensitive gene expression, modify synaptic activity, and maintain stress responsiveness. In man, current cortisol replacement therapy does not reproduce physiological hormone pulses and is associated with psychopathological symptoms, especially apathy and attenuated motivation in engaging with daily activities. In this work, we tested the hypothesis that the pattern of GC dynamics in the brain is of crucial importance for regulating cognitive and behavioral processes. We provide evidence that exactly the same dose of cortisol administered in different patterns alters the neural processing underlying the response to emotional stimulation, the accuracy in recognition and attentional bias toward/away from emotional faces, the quality of sleep, and the working memory performance of healthy male volunteers. These data indicate that the pattern of the GC rhythm differentially impacts human cognition and behavior under physiological, nonstressful conditions and has major implications for the improvement of cortisol replacement therapy.

Plasma REST: a novel candidate biomarker of Alzheimer's disease is modified by psychological intervention in an at-risk population.

The repressor element 1-silencing transcription (REST) factor is a key regulator of the aging brain's stress response. It is reduced in conditions of stress and Alzheimer's disease (AD), which suggests that increasing REST may be neuroprotective. REST can be measured peripherally in blood plasma. Our study aimed to (1) examine plasma REST levels in relation to clinical and biological markers of neurodegeneration and (2) alter plasma REST levels through a stress-reduction intervention-mindfulness training. In study 1, REST levels were compared across the following four well-characterized groups: healthy elderly (n=65), mild cognitive impairment who remained stable (stable MCI, n=36), MCI who later converted to dementia (converter MCI, n=29) and AD (n=65) from the AddNeuroMed cohort. REST levels declined with increasing severity of risk and impairment (healthy elderly>stable MCI>converter MCI>AD, F=6.35, P<0.001). REST levels were also positively associated with magnetic resonance imaging-based hippocampal and entorhinal atrophy and other putative blood-based biomarkers of AD (Ps<0.05). In study 2, REST was measured in 81 older adults with psychiatric risk factors for AD before and after a mindfulness-based stress reduction intervention or an education-based placebo intervention. Mindfulness-based training caused an increase in REST compared with the placebo intervention (F=8.57, P=0.006), and increased REST was associated with a reduction in psychiatric symptoms associated with stress and AD risk (Ps<0.02). Our data confirm plasma REST associations with clinical severity and neurodegeneration, and originally, that REST is modifiable by a psychological intervention with clinical benefit.

Vortices and vortex lattices in quantum ferrofluids.

The experimental realization of quantum-degenerate Bose gases made of atoms with sizeable magnetic dipole moments has created a new type of fluid, known as a quantum ferrofluid, which combines the extraordinary properties of superfluidity and ferrofluidity. A hallmark of superfluids is that they are constrained to rotate through vortices with quantized circulation. In quantum ferrofluids the long-range dipolar interactions add new ingredients by inducing magnetostriction and instabilities, and also affect the structural properties of vortices and vortex lattices. Here we give a review of the theory of vortices in dipolar Bose-Einstein condensates, exploring the interplay of magnetism with vorticity and contrasting this with the established behaviour in non-dipolar condensates. We cover single vortex solutions, including structure, energy and stability, vortex pairs, including interactions and dynamics, and also vortex lattices. Our discussion is founded on the mean-field theory provided by the dipolar Gross-Pitaevskii equation, ranging from analytic treatments based on the Thomas-Fermi (hydrodynamic) and variational approaches to full numerical simulations. Routes for generating vortices in dipolar condensates are discussed, with particular attention paid to rotating condensates, where surface instabilities drive the nucleation of vortices, and lead to the emergence of rich and varied vortex lattice structures. We also present an outlook, including potential extensions to degenerate Fermi gases, quantum Hall physics, toroidal systems and the Berezinskii-Kosterlitz-Thouless transition.

[Ketamine revisited]. / Regain d'intérêt pour la kétamine.

Synthesized as anesthetic agent about fifty years ago, ketamine (Ketalar) has been supplanted by more attractive anesthetic agents with less adverse effects. Nevertheless, the potential of this drug, although often unknown by many practitioners, remains significant. Nowadays, ketamine is more and more used in the treatment and prevention of hyperalgesia and chronicisation of postoperative pain. Indeed, ketamine interacts with NMDA-receptors involved in spinal neuroplasticity and hyperexcitability responsible for these phenomena. Moreover, its efficacy to treat acute pain resistant to classic analgesics makes ketamine a very interesting and clinically-relevant drug for all practitioners facing this type of pain. This article reviews the clinical benefits of ketamine which has sometimes suffered from a negative reputation, but which possesses recently reconsidered wonderful pharmacological properties.

Positive effects of nicotine on cognition: the deployment of attention for prospective memory.

RATIONALE: Human and animal studies over the last two decades report that nicotine can improve cognitive performance. Prospective memory (PM), the retrieval and implementation of a previously encoded intention, is also improved by pre-administration of nicotine. As with other nicotine effects, however, predicting precisely how and when nicotine improves the processes engaged by PM has proved less straightforward. OBJECTIVE: We present two studies that explore the source of nicotine's enhancement of PM. Experiment 1 tests for effects of nicotine on preparatory attention (PA) for PM target detection. Experiment 2 asks whether nicotine enhances processing of the perceptual attributes of the PM targets. MATERIALS AND METHODS: Young adult non-smokers matched on baseline performance measures received either 1 mg nicotine or matched placebo via nasal spray. Volunteers completed novel PM tasks at 15 min post-administration. RESULTS: Experiment 1 confirmed that pre-administration of nicotine to non-smokers improved detection rate for prospective memory targets presented during an attention-demanding ongoing task. There was no relationship between PM performance and measures of preparatory attention. In experiment 2, salient targets were more likely to be detected than non-salient targets, but nicotine did not confer any additional advantage to salient targets. CONCLUSION: The present study suggests that nicotinic stimulation does not work to enhance perceptual salience of target stimuli (experiment 2), nor does it work through better deployment of preparatory working attention (experiment 1). An alternative explanation that nicotine promotes PM detection by facilitating disengagement from the ongoing task is suggested as a future line of investigation.

The cost-effectiveness of doxazosin for the treatment of hypertension in type II diabetic patients in the UK and Italy.

The objective of this analysis was to assess the cost-effectiveness of achieving 'tight control' versus 'less tight control' of blood pressure, as defined in the UK Prospective Diabetics Study 38, in type II diabetic patients in the UK and Italy. The effect of including doxazosin in a 'tight control' combination therapy was analysed. Given doxazosin's positive impact on lipid levels in addition to its antihypertensive effect, it is hypothesised that treatment including doxazosin will reduce the incidence of macrovascular complications. For each country, a Markov model was constructed to simulate macrovascular outcomes of patients on various drug combinations. Transitional probabilities were based on the risk rates presented in UKPDS 38. Risk rates were adjusted for the ageing of the cohort and the lipid-lowering properties of doxazosin using Framingham risk equations. Incremental cost-effectiveness ratios ranged from 2224 Pounds to 4867 Pounds (US$3225-7057) per life-year saved for the UK and from L1.8-9.3 million (US$818-4159) per life-year saved for Italy. Doxazosin is a cost-effective agent when included in a combination therapy in the treatment of hypertension in the diabetic populations of the UK and Italy.

Xenobiotic metabolism in rat, dog, and human precision-cut liver slices, freshly isolated hepatocytes, and vitrified precision-cut liver slices.

Human, rat, and dog phase I and phase II xenobiotic metabolism in precision-cut liver slices and freshly isolated hepatocytes was compared using a range of substrates. Carbamazepine (50 microM) and styrene (2 mM) were used as probes to study the maintenance of cytochrome P450 and epoxide hydrolase-mediated metabolism in male Sprague-Dawley rat, precision-cut liver slices and hepatocytes. Carbamazepine metabolism in both models resulted in the formation of the bioactive 10,11-epoxide (KM = 766 microM and Vmax = 2.5 pmol/min/mg protein in precision-cut slices). Epoxide formation was higher (2.4-fold) in hepatocytes than slices. Styrene was deactivated to styrene diol at a higher rate in hepatocytes (9.7-fold) than slices. The lower rate of metabolism in slices compared with hepatocytes confirms our previous observations using testosterone, 7-ethoxycoumarin, 1-chloro-2,4-dinitrobenzene and 2-(5'-chloro-2'-phosphoryloxyphenyl)-6-chloro-4-(3H)-quinazolinone in the rat. Testosterone 6 beta-hydroxylation in human liver slices was similar to cultured hepatocytes, but lower than in freshly isolated hepatocytes. 7-Ethoxycoumarin O-deethylation was higher in freshly isolated human hepatocytes, as was the ratio of glucuronide to 7-hydroxycoumarin. Testosterone hydroxylations, 7-ethoxycoumarin O-deethylation, and 1-chloro-2,4-dinitrobenzene conjugation were also lower in male beagle dog slices, compared with freshly isolated hepatocytes. Attempts at long-term preservation of dog liver slices using vitrification and storage for up to 9 days at -196 degrees C resulted in the retention of phase I and phase II metabolism, although conjugation was lower than in freshly prepared slices. Xenobiotic metabolism in short-term incubations is consistently lower in dog and rat precision-cut slices than in freshly isolated hepatocytes; whereas, in humans, this quantitative difference is partly hidden by the large interindividual variation.

Quantitative differences in phase I and II metabolism between rat precision-cut liver slices and isolated hepatocytes.

Testosterone (250 microM), 7-ethoxycoumarin (25 microM), and 1-chloro-2,4-dinitrobenzene (CDNB, 50 microM) were used as substrates to compare phase I and II metabolism in rat precision-cut liver slices and rat hepatocytes. Overall clearance to metabolites was significantly greater in hepatocytes for testosterone (1.9- to 16.9-fold), 7-ethoxycoumarin (O-deethylation, 14.8-fold; glucuronidation, 3.1-fold), and CDNB (8.7-fold). The same metabolites for each of the substrates were detected in slices and hepatocytes. However, the ratio of sulfate to glucuronide conjugation was higher in slices, in line with the markedly slower rate of formation of 7-hydroxycoumarin. The slower rate of CDNB conjugation could not be explained by differences in the intracellular concentration of glutathione. These data suggest that metabolism in precision-cut slices is limited by diffusion of the substrate. This was illustrated by the use of 2-(5'-chloro-2'-phosphoryloxyphenyl)-6-chloro-4-(3H)-quinazolinone as a fluorescent probe to investigate diffusion in slices and hepatocytes.

Comparative biodisposition and metabolism of 14C-(+/-)-fenfluramine in mouse, rat, dog and man.

1. The comparative metabolism of fenfluramine was investigated in mouse, rat, dog and man following a single oral dose of 14C-(+/-)-fenfluramine hydrochloride (1 mg/kg), and also in rat after eight consecutive 12-h subcutaneous doses (24 mg/kg). 2. Main route of excretion of radioactivity in all species and at all doses was into urine (> 80%), with only minor amounts of radioactivity found in faeces. 3. From all species examined a total of 11 metabolites were observed in urine and plasma by t.l.c. and h.p.l.c. analysis and no metabolite was present in the plasma which was not present in urine. 4. All species dealkylate fenfluramine to the active metabolite norfenfluramine, to a relative greater or lesser extent, with plasma metabolic ratios (norfenfluramine/fenfluramine) showing inter-animal variation (rat >> dog >> mouse = man). 5. These differences are due to the efficient deamination of both compounds to polar inactive metabolites in man, with less dealkylation and lower plasma levels of norfenfluramine compared with the other species studied. 6. In conclusion, major species differences in the metabolism of (+/-)-fenfluramine, both qualitative and quantitative were observed, and no one species had a similar metabolic profile to that found in man.

Disposition, pharmacokinetics, and metabolism of 14C-fotemustine in cancer patients.

The pharmacokinetics and metabolism of intravenously infused 14C-fotemustine (about 100 mg/m2) were examined in 2 cancer patients. Plasma levels of radioactivity increased to a maximum of 4.1 and 5.5 micrograms equivalents per g when the infusion stopped then declined triexponentially with mean half-lives of about 1/2, 10 and 80 h for the initial, mid and terminal phases, respectively. Plasma levels of intact drug were lower, with maximum levels of 1.1 and 2.8 micrograms/ml, and declined monophasically with a half-life of about 24 min. Plasma clearance was high (1426 and 764 ml/min) with the volume of distribution based on areas of 47.7 and 26.4 l. Most of the radioactivity was eliminated in urine (50.1 and 61.3%) over 7 days with smaller amounts in the feces (6.8 and 0.3%) and only minimal quantities (under 0.1%) as expired carbon dioxide. Metabolites of fotemustine were identified as chloroethanol and N-nitroso-1-imidazolone-ethyl-diethylphosphonate in plasma and as 1-hydantoin-ethyl-diethyl-phosphonate and acetic acid in urine.

[Psychodrama in psychotic patients]. / Psicodrama en psicóticos.

This experience was carried out over the years 1979/81 and 1983/4 at the Magnan ward of the Braulio Moyano Women's Neuropsychiatric Hospital in Buenos Aires, Argentina. Theory and the techniques of Psychodrama were applied to different groups of chronic psychotics, one of those groups being in a deep state of deterioration. Objects and therapeutic aims were to achieving changes in the patients' behavior, improving their socialization level as well as their communication links with their inmates and both their doctors and nurses. By means of both role playing and the nucleus of both the Ego and Scheme of Roles as a frame of reference it was aimed at recovering patients' integrative activity, thus increasing their re-adaptability to the familiar group an the society structure as well.

Psicodrama en psicóticos. / [Psychodrama in psychotic patients]

This experience was carried out over the years 1979/81 and 1983/4 at the Magnan ward of the Braulio Moyano Womens Neuropsychiatric Hospital in Buenos Aires, Argentina. Theory and the techniques of Psychodrama were applied to different groups of chronic psychotics, one of those groups being in a deep state of deterioration. Objects and therapeutic aims were to achieving changes in the patients behavior, improving their socialization level as well as their communication links with their inmates and both their doctors and nurses. By means of both role playing and the nucleus of both the Ego and Scheme of Roles as a frame of reference it was aimed at recovering patients integrative activity, thus increasing their re-adaptability to the familiar group an the society structure as well.

[Evaluation of the efficacy of haloperidol decanoate in the treatment of chronic psychotic hospital patients]. / Evaluación de la eficacia del haloperidol decanoato en el tratamiento de pacientes psicóticas crónicas hospitalizadas.

The purpose of our experience was to determine the efficacy of haloperidol decanoate during the treatment of chronic psychotic in-patients. So we included, in an open study, 30 patients hospitalized in the Esquirol and Magnan Departments of the National Hospital of Mental Health "Dr. Braulio A. Moyano". As a result of this study, we have observed that to the already known properties of this drug, it may be added, because of its new depot formulation, the following advantages: a) it replaces effectively the daily intake of neuroleptics; b) it allows the reduction of the dose of oral neuroleptics as well as the number of drugs combination; c) it diminishes the incidence of extrapyramidal symptoms, allowing the reduction of the dose or the interruption of antiparkinsonian drugs; d) it facilitates the nurse's labor; e) it allows the physician to be sure of the fulfillment of his prescription.

Evaluación de la eficacia del haloperidol decanoato en el tratamiento de pacientes psicóticas crónicas hospitalizadas. / [Evaluation of the efficacy of haloperidol decanoate in the treatment of chronic psychotic hospital patients]

The purpose of our experience was to determine the efficacy of haloperidol decanoate during the treatment of chronic psychotic in-patients. So we included, in an open study, 30 patients hospitalized in the Esquirol and Magnan Departments of the National Hospital of Mental Health [quot ]Dr. Braulio A. Moyano[quot ]. As a result of this study, we have observed that to the already known properties of this drug, it may be added, because of its new depot formulation, the following advantages: a) it replaces effectively the daily intake of neuroleptics; b) it allows the reduction of the dose of oral neuroleptics as well as the number of drugs combination; c) it diminishes the incidence of extrapyramidal symptoms, allowing the reduction of the dose or the interruption of antiparkinsonian drugs; d) it facilitates the nurses labor; e) it allows the physician to be sure of the fulfillment of his prescription.