Effects of Helicobacter pylori on Levodopa Pharmacokinetics

Background: Infection with Helicobacter pylori seems overrepresented in Parkinson’s disease. Clinical observations suggest a suboptimal treatment effect of levodopa in Helicobacter positive patients. Objective: Describe and explain the connection between a Helicobacter pylori infection of the upper gut and changes in pharmacokinetics of oral levodopa treatment in Parkinson’s disease. Methods: PubMed, Google Scholar, and Cross Reference search was done using the key words and combined searches: Bioavailability, drug metabolism, dyskinesia, Helicobacter, L-dopa, levodopa, motor control, pharmacodynamics, pharmacokinetics, prevalence, unified Parkinson’s disease rating scale. Results: The prevalence of Helicobacter pylori in Parkinson’s disease patients is reported to be about 1.6-fold higher than in a control population in some studies. Helicobacter has therefore been assumed to be linked to Parkinson’s disease, but the mechanism is unclear. As regards symptoms and treatment, patients with Parkinson’s disease on levodopa therapy and with Helicobacter pylori infection display worse motor control than those without Helicobacter infection. Eradication of the infection improves levodopa response in Parkinson’s disease, likely as a consequence of an increased oral pre-systemic bioavailability of levodopa, likely to be explained by reduced Helicobacter-dependent levodopa consumption in the stomach. In addition, small intestinal bacterial overgrowth may also have an impact on the therapeutic setting for levodopa treatment but is less well established. Conclusion: Eradication of Helicobacter pylori improves levodopa bioavailability resulting in improved motor control. Eradication of Helicobacter should be considered in patients with poor symptomatic control and considerable motor fluctuations

Computational analysis of oligosaccharide conformations – methodological development, applied studies, and design of glycomimetics

Carbohydrates are the most abundant class of biomolecules. Besides their roles as structural elements and energy storage, they are involved in signaling and recognition processes. Their functions and activities depend on their preferred conformations. The software GLYGAL was developed to perform conformational studies of oligosaccharides using a genetic algorithm tailored for carbohydrates. The new method was applied to the highly branched exopolysaccharide of Burkholderia cepacia. The results show that its heptasaccharide repeating units assume a well defined conformation, stabilized by steric interactions between consecutive units. Furthermore, GLYGAL was used to calculate favorable conformations of histo-blood group antigens. The compounds were then fitted in the binding site of the surface protein of the norovirus VA387 strain and their binding affinity was estimated by molecular dynamics and Glide scoring, giving insights into the interaction patterns involved in norovirus infection. Finally, the mimetic properties of thioglycosidic and selenoglycosidic derivatives of the ABH antigens were studied by conformational and dockings studies, indicating potentially bioactive derivatives with increased resistance to hydrolysis. In conclusion, the computational methodologies developed during this study were successfully used, together with existing methods, for the investigation of natural carbohydrates and the rational design of glycomimetics

Detection of duplicate defect reports using natural language processing

Defect reports are generated from various testing and development activities in software engineering. Some-times two reports are submitted that describe the same problem, leading to duplicate reports. These reports are mostly written in structured natural language, and as such, it is hard to compare two reports for similarity with formal methods. In order to identify duplicates, we investigate using Natural Language Processing (NLP) techniques to support the identification. A prototype tool is developed and evaluated in a case study analyzing defect reports at Sony Ericsson Mobile Communications. The evaluation shows that about 2/3 of the duplicates can possibly be found using the NLP techniques. Different variants of the techniques provide only minor result differences, indicating a robust technology. User testing shows that the overall attitude towards the technique is positive and that it has a growth potential. © 2007 IEEE

Levodopa–Carbidopa Intestinal Gel in Patients with Parkinson’s Disease : A Systematic Review

Background: Levodopa–carbidopa intestinal gel (LCIG) is available in several countries for the treatment of advanced levodopa-responsive Parkinson’s disease (PD) with severe motor fluctuations and dyskinesia when other treatments have not given satisfactory results. Objective: Our objective was to summarize the present evidence base for LCIG therapy through a systematic review of the literature. Methods: Studies were identified from the PubMed and EMBASE databases up to 12 March 2016 using the following search terms: Parkinson disease, duodopa, levodopa/carbidopa intestinal gel, levodopa–carbidopa intestinal gel, LCIG, l-dopa infusion, levodopa infusion, duodenal l-dopa infusion, and duodenal levodopa infusion. Data extraction focused on whether LCIG therapy improves motor and non-motor outcomes as well as quality of life in PD patients compared with conventional therapy, apomorphine infusion, or deep brain stimulation. Randomized controlled trials (RCTs) and observational studies, with or without a control group, that included more than ten patients were included. The search was limited to peer-reviewed articles published in full in the English language and involving humans. Results: Infusion of LCIG reduced “off” time, increased “on” time without increasing troublesome dyskinesias, and improved quality of life in three RCTs (one double-blind). Open-label follow-ups confirm these findings. The data evaluating long-term efficacy and safety are still limited. Conclusions: The quality of evidence that LCIG is effective in reducing fluctuating motor symptoms and improving quality of life is moderate. Quality of evidence for reduction of non-motor symptoms is very low. Safety issues mainly relate to the intestinal infusion system. LCIG might be a useful treatment option in PD patients with severe motor fluctuations

Clinical outcome and prognostic factors in elderly traumatic brain injury patients receiving neurointensive care

Background: The probability of favorable outcome after traumatic brain injury (TBI) decreases with age. Elderly,≥60 years, are an increasing part of our population. Recent studies have shown an increase of favorable outcome in elderly over time. However,the optimal patient selection and neurointensive care (NIC) treatments may differ in the elderly and the young. The aims of this study were to examine outcome in a larger group of elderly TBI patients receiving NIC and to identify demographic and treatmentrelated prognostic factors. Methods: Patients with TBI≥60 years receiving NIC at our department between 2008 and 2014 were included. Demographics, co-morbidity, admission characteristics, and type of treatments were collected. Clinical outcome at around 6 months was assessed. Potential prognostic factors were included in univariate and multivariate regression analysis with favorable outcomeas dependent variable. Results: Two hundred twenty patients with mean age 70 years (median 69; range 60–87) were studied. Overall, favorable outcome was 46% (Extended Glasgow Outcome Scale (GOSE) 5–8), unfavorable outcome 27% (GOSE 2–4), and mortality 27% (GOSE 1). Significant independent negative prognostic variables were high age (p< 0.05), multiple injuries (p<0.05),GCSM≤3 on admission (p< 0.05), and mechanical ventilation (p<0.001). Conclusions: Overall, the elderly TBI patients> 60 years receiving modern NIC in this study had a fair chance of favorable outcome without large risks for severe deficits and vegetative state, also in patients over 75 years of age. High age, multiple injuries, GCS M≤3 on admission, and mechanical ventilation proved to be independent negative prognostic factors. The results underline that a selected group of elderly with TBI should have access to NI

Capturing of intracranial pressure treatment during neurointensive care in patients with acute brain injury using a novel tablet-based method

Critical care is complex and stressful. It is difficult to register in real time data not recorded by automatic systems. Time-specific knowledge of manual measures is important for understanding pathophysiology and for analyzing treatment and quality of care. Therefore, a novel iPad-based method for registration of manual measures was developed, which many can build themselves. Using a configuration for intracranial pressure (ICP) management, the methodology was validated, ICP treatment captured, and the quality of ICP management evaluated. Twenty-two patients with acute brain injuries were studied. The iPad-system was totally used for 2538 h. Thirteen-hundred-five manual measures were entered. Thirty-nine episodes of predefined ICP insults were identified. During 16/39 episodes, ICP treatments were registered. For 4/39 episodes treatments were registered within 90 s before or after the episode. For 3/39 episodes it was registered that treatment was intentionally refrained. In 15/16 episodes without registered treatment, the insult was mild or reasonable explanations were found when medical records and the Patient data management system were reviewed. In one situation without particular circumstances, morphine and clonidine were given to decrease ICP but not registered. No episodes of downtime or loss of data occurred. The developed methodology appears to be stable and robust as well as feasible and user-friendly. It was possible to capture the treatment of ICP insults with high temporal resolution, and to evaluate the quality of ICP management. An own developed novel tablet-based system like our system may be a promising potential tool useful in various future intensive care applications

Parkinsons sjukdom – heterogen och komplex i sitt kliniska uttryck - Individuella kombinationer av symtom som ändrar sig över tid kräver behandlingsjusteringar och anpassningar

Parkinson's disease is the second most common neurodegenerative disease. Lewy bodies with alpha-synuclein as the major component and loss of dopaminergic nerve cells in substantia nigra are neuropathological features. The diagnosis of Parkinson's disease is based on the occurrence of bradykinesia, rigidity and resting tremor. The disease is also associated with several non-motor symptoms. The therapy is mainly based on pharmacological treatment to increase dopamine signaling and neurosurgical deep brain stimulation. The symptoms and signs of the progressive disease change over time, requiring treatment adjustments. Patients should be followed by a physician, nurse and a multidisciplinary team with expertise in Parkinson's disease