Prevalence of Dyskinesia and OFF by 30-Minute Intervals Through the Day and Assessment of Daily Episodes of Dyskinesia and OFF: Novel Analyses of Diary Data from Gocovri Pivotal Trials.

BACKGROUND: Parkinson\u27s disease (PD) patients using levodopa commonly develop dyskinesia and OFF episodes that reduce quality of life. OBJECTIVE: Evaluate prevalence of troublesome dyskinesia and OFF through the day, assessed by 30-minute intervals, as well as the mean number and duration of troublesome dyskinesia and OFF episodes, transitions between PD states, and effects of Gocovri® (amantadine) extended release capsules on these episodes. METHODS: Evaluate diary data from pooled Gocovri phase 3, placebo-controlled trials-analyzed for 17 hours following wake-up-at baseline and week 12. RESULTS: Diaries were evaluable for 162 patients. At baseline, 67% of patients woke up OFF, with prevalence decreasing to 13% at 2 hours and then remaining relatively steady at ∼12% (range, 6-17%) across half-hour intervals thereafter. Troublesome dyskinesia prevalence rose steadily from 5% to 24% over the first 2 hours, then fluctuated between 20% and 44% through the rest of the waking day. At baseline, patients experienced a mean of 3.0 daily episodes of troublesome dyskinesia (average duration 2.0 hours each), and 2.2 daily episodes of OFF (average duration 1.1 hour each). At week 12, Gocovri-treated patients showed greater reductions than placebo in troublesome dyskinesia and OFF episodes per day (treatment difference: -1.0 episodes and -0.4 episodes, respectively) and average episode duration (treatment difference: -0.6 hours and -0.3 hours, respectively). Mean duration of individual episodes of ON without troublesome dyskinesia (Good ON) increased by 5.0 hours for Gocovri, compared with 2.0 hours for placebo. Patients taking Gocovri experienced 2.2 fewer transitions between states than patients taking placebo. CONCLUSIONS: Troublesome dyskinesia and OFF occurred in the morning and throughout the waking day. Gocovri-treated patients experienced fewer, shorter episodes of both troublesome dyskinesia and OFF, thereby increasing the duration of continuous Good ON episodes and reducing the frequency of transitions between motor states

A2A Receptor Antagonism and Dyskinesia in Parkinson's Disease

Dyskinesia, a major complication of treatment of Parkinson's disease (PD), involves two phases: induction, which is responsible for dyskinesia onset, and expression, which underlies its clinical manifestation. The unique cellular and regional distribution of adenosine A2A receptors in basal ganglia areas that are richly innervated by dopamine, and their antagonistic role towards dopamine receptor stimulation, have positioned A2A receptor antagonists as an attractive nondopaminergic target to improve the motor deficits that characterize PD. In this paper, we describe the biochemical characteristics of A2A receptors and the effects of adenosine A2A antagonists in rodent and primate models of PD on L-DOPA-induced dyskinesia, together with relevant biomarker studies. We also review clinical trials of A2A antagonists as adjuncts to L-DOPA in PD patients with motor fluctuations. These studies have generally demonstrated that the addition of an A2A antagonist to a stable L-DOPA regimen reduces OFF time and mildly increases dyskinesia. However, limited clinical data suggest that the addition of an A2A antagonist along with a reduction of L-DOPA might maintain anti-Parkinsonian benefit and reduce dyskinesia. Whether A2A antagonists might reduce the development of dyskinesia has not yet been tested clinically

Levodopa/carbidopa/entacapone 200/50/200 mg (Stalevo® 200) in the treatment of Parkinson’s disease: a case series

Levodopa continues to be the most efficacious and widely used treatment for Parkinson’s disease. Levodopa dosing is understood to be critical for the optimal control of symptoms, and increasing the levodopa dose is a common method to treat advancing disease. Escalating levodopa dosages coupled with disease progression is associated with increasing likelihood of developing levodopa-induced dyskinesia. Moreover, frequent and complicated dosing schemes, combined with limited dose availability, leads to increasing pill burden and its associated impairment of patient adherence issues. Levodopa/carbidopa/entacapone has been shown to improve the pharmacokinetic profile of levodopa and provide superior symptomatic control compared with conventional levodopa/dopa decarboxylase inhibitor therapy. We report four case histories describing clinical experience of using levodopa/carbidopa/entacapone 200/50/200 mg, one of the latest doses of this formulation, in a range of patients with Parkinson’s disease. These cases illustrate that levodopa/carbidopa/entacapone 200/50/200 mg provides improvements in symptomatic control and convenience, and that switching to this dose was not associated with safety concerns

Criminal Justice Decision Making as a Stratification Process: The Role of Race and Stratification Resources in Pretrial Release

Our purpose is to bridge the criminal justice and stratification research literatures and to pursue the argument that homologous structural principles stratify allocation processes across central institutions of American society. The principle observed here in the making of bail decisions, as in earlier studies of the allocation of earnings, is that stratification resources operate to the greater advantage of whites than blacks. The operation of this principle is established through the estimation of covariance structure models of pretrial release decisions affecting 5660 defendants in 10 federal courts. Education and income are treated in this study as observed components of a composite construct, stratification resources, which works to the greater advantage of whites. Prior record is also found to operate to the greater advantage of whites. Two further variables, dangerousness and community ties, increase bail severity among blacks and whites. While the effect of community ties has been legally legitimized since the Bail Reform Act of 1966, the effect of dangerousness was not so legitimized until the Bail Reform Act of 1984. However, because our data precede the latter act, they confirm that this act simply reinstitutionalized earlier practice. Meanwhile, our race-specific findings may explain why although this and earlier studies find negligible main effects of race on criminal justice outcomes, black Americans nonetheless perceive more criminal injustice than do whites. In the criminal justice system, as in other spheres of American society, whites receive a better return on their resources, but our findings that the statutory severity of the offense and dangerousness work to the relative disadvantage of white defendants’ challenges conflict and labeling theory\u27s one-dimensional characterization of black defendant disadvantage

ABERRANT TESTA SHAPE encodes a KANADI family member, linking polarity determination to separation and growth of Arabidopsis ovule integuments

The Arabidopsis aberrant testa shape (ats) mutant produces a single integument instead of the two integuments seen in wild-type ovules. Cellular anatomy and patterns of marker gene expression indicate that the single integument results from congenital fusion of the two integuments of the wild type. Isolation of the ATS locus showed it to encode a member of the KANADI (KAN) family of putative transcription factors, previously referred to as KAN4. ATS was expressed at the border between the two integuments at the time of their initiation, with expression later confined to the abaxial layer of the inner integument. In an inner no outer (ino) mutant background, where an outer integument does not form, the ats mutation led to amorphous inner integument growth. The kan1 kan2 double mutant exhibits a similar amorphous growth of the outer integument without affecting inner integument growth. We hypothesize that ATS and KAN1/KAN2 play similar roles in the specification of polarity in the inner and outer integuments, respectively, that parallel the known roles of KAN proteins in promoting abaxial identity during leaf development. INO and other members of the YABBY gene family have been hypothesized to have similar parallel roles in outer integument and leaf development. Together, these two hypotheses lead us to propose a model for normal integument growth that also explains the described mutant phenotypes

Serum PCB levels and congener profiles among US construction workers

Abstract Background The presence of PCB in caulking (sealant) material found in masonry buildings has been well-documented in several countries. A recent investigation of 24 buildings in the greater Boston area found that 8 buildings had high PCB levels in caulking materials used around window frames and in joints between masonry blocks. Workers removing caulking material have been shown to have elevated serum PCB levels. Methods This project compared serum PCB levels among male workers who installed and/or removed PCB-containing caulking material from buildings in the greater Boston area with reference serum PCB levels from 358 men from the same area. Serum PCB levels were measured in the same laboratory by liquid-liquid extraction, column chromatography clean-up and dual capillary column GC/microECD analysis. Results When the congener profiles were compared between the reference population and the construction workers, the serum levels of the more volatile, lighter PCBs (di-, tri-and tetrachloro, sum of IUPAC# 6–74) were substantially higher among the construction workers. One of the youngest workers had the lowest total serum PCB levels (sum of 57 congeners) of all 6 workers, but the contribution of more volatile (less chlorinated) PCB congeners (#16, 26,28,33,74,66, and 60) was markedly higher than in other 5 workers and reference men. Only this worker was working on a job that involved removing PCB caulking at the time of the blood sampling. Conclusion While the results of this pilot study are based upon small numbers (6 construction workers who handled PCB caulking), the serum PCB levels among the construction workers exceed the referents. Comparison of the congener profiles suggests that there are substantial differences between the construction workers and the general population samples. These differences, and the similarities of profiles among the construction workers strongly suggest that occupational contact with caulking material can be a major source of PCB exposure for construction workers.http://deepblue.lib.umich.edu/bitstream/2027.42/117256/1/12940_2007_Article_124.pd

Reading Others’ Emotions: The Role of Intuitive Judgments in Predicting Marital Satisfaction, Quality and Stability

This study examined links between emotion expression in couple interactions and marital quality and stability. Core aspects of emotion expression in marital interactions were identified using naïve observational coding by multiple raters. Judges rated 47 marital discussions using 15 emotion descriptors. Coders’ pooled ratings yielded good reliability on four types of emotion expression: hostility, distress, empathy, and affection. These four types were linked with concurrent marital satisfaction and interviewer ratings of marital adjustment, as well as with marital stability at 5-year follow-up. The study also examined the extent to which naïve judges’ ratings of emotion expression correspond to “expert” ratings using the Specific Affect Coding System (SPAFF). The unique advantages of naïve coding of emotion expression in marital interaction are discussed

Abbreviated MDS-UPDRS for Remote Monitoring in PD Identified Using Exhaustive Computational Search

Background. The Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) comprises 50 items, consisting of historical questions and motor ratings, typically taking around 30 minutes to complete. We sought to identify an abbreviated version that could facilitate use in clinical practice or used remotely via telemedicine. Methods. To create an 8-item version we conducted an “exhaustive search” of all possible subsets. We measured explained variance in comparison to the 50-item version using linear regression, with the “optimal” subset maximising this while also meeting remote assessment practicality constraints. The subset was identified using a dataset collected by the Parkinson’s Progression Markers Initiative and validated using an MDS Non-Motor Symptoms Scale validation study dataset. Results. The optimal remote version comprised items from all parts of the MDS-UPDRS and was found to act as an unbiased estimator of the total 50-item score. This version had an explained variance score of 0.844 and was highly correlated with the total MDS-UPDRS score (Pearson’s r = 0.919, p -value <0.0001). Another subset that maximised explained variance score without adhering to remote assessment practicality constraints provided similar results. Conclusion. This result demonstrates that the total scores of an abbreviated form identified by computational statistics had high agreement with the MDS-UPDRS total score. Whilst it cannot capture the richness of information of the full MDS-UPDRS, it can be used to create a total score where practicality limits the application of the full MDS-UPDRS, such as remote monitoring. Further validation will be required, including in specific subgroups and advanced disease stages, and full validation of clinimetric properties

Stability, delivery and functions of human sperm RNAs at fertilization

Increasing attention has focused on the significance of RNA in sperm, in light of its contribution to the birth and long-term health of a child, role in sperm function and diagnostic potential. As the composition of sperm RNA is in flux, assigning specific roles to individual RNAs presents a significant challenge. For the first time RNA-seq was used to characterize the population of coding and non-coding transcripts in human sperm. Examining RNA representation as a function of multiple methods of library preparation revealed unique features indicative of very specific and stage-dependent maturation and regulation of sperm RNA, illuminating their various transitional roles. Correlation of sperm transcript abundance with epigenetic marks suggested roles for these elements in the pre- and post-fertilization genome. Several classes of non-coding RNAs including lncRNAs, CARs, pri-miRNAs, novel elements and mRNAs have been identified which, based on factors including relative abundance, integrity in sperm, available knockout data of embryonic effect and presence or absence in the unfertilized human oocyte, are likely to be essential male factors critical to early post-fertilization development. The diverse and unique attributes of sperm transcripts that were revealed provides the first detailed analysis of the biology and anticipated clinical significance of spermatozoal RNAs