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Background Young plasma infusions have emerged as a potential treatment for neurodegenerative disease, and convalescent plasma therapy has been used safely in the management of viral pandemics. However, the effect of plasma therapy in Parkinson's disease (PD) is unknown. Objectives The objective of this study was to determine the safety, tolerability, and feasibility of plasma infusions in people with PD. Methods A total of 15 people with clinically established PD, at least 1 cognitive complaint, and on stable therapy received 1 unit of young fresh frozen plasma twice a week for 4 weeks. Assessments and adverse effects were performed/reported on and off therapy at baseline, immediately after, and 4 weeks after the infusions ended. Adverse effects were also assessed during infusions. The primary outcomes were safety, tolerability, and feasibility. Exploratory outcomes included Unified Parkinson's Disease Rating Scale Part III off medication, neuropsychological battery, Parkinson's Disease Questionnaire‐39, inflammatory markers (tumor necrosis factor‐α, interleukin‐6), uric acid, and quantitative kinematics. Results Adherence rate was 100% with no serious adverse effects. There was evidence of improvement in phonemic fluency (P = 0.002) and in the Parkinson's Disease Questionnaire‐39 stigma subscore (P = 0.013) that were maintained at the delayed evaluation. Elevated baseline tumor necrosis factor‐α levels decreased 4 weeks after the infusions ended. Conclusions Young fresh frozen plasma was safe, feasible, and well tolerated in people with PD, without serious adverse effects and with preliminary evidence for improvements in phonemic fluency and stigma. The results of this study warrant further therapeutic investigations in PD and provide safety and feasibility data for plasma therapy in people with PD who may be at higher risk for severe complications of COVID‐19. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC. on behalf of International Parkinson and Movement Disorder Society.

BackgroundResting state beta band (13 – 30 Hz) oscillations represent pathological neural activity in Parkinson’s disease (PD). It is unknown how the peak frequency or dynamics of beta oscillations may change among fine, limb and axial movements and different disease phenotypes. This will be critical for the development of personalized closed loop deep brain stimulation (DBS) algorithms during different activity states.MethodsSubthalamic (STN) local field potentials (LFPs) were recorded from a sensing neurostimulator (Activa® PC+S, Medtronic PLC.,) in fourteen PD participants (six tremor-dominant, 8 akinetic-rigid) off medication/off STN DBS during thirty seconds of repetitive alternating finger tapping, wrist-flexion extension, stepping in place, and free walking. Beta power peaks and beta burst dynamics were identified by custom algorithms and were compared among movement tasks and between tremor-dominant and akinetic-rigid groups.ResultsBeta power peaks were evident during fine, limb, and axial movements in 98% of movement trials; the peak frequencies were similar during each type of movement. Burst power and duration were significantly larger in the high beta band, but not in the low beta band, in the akinetic-rigid group compared to the tremor-dominant group.ConclusionsThe conservation of beta peak frequency during different activity states supports the feasibility of patient-specific closed loop DBS algorithms driven by the dynamics of the same beta band during different activities. Akinetic-rigid participants had greater power and longer burst durations in the high beta band than tremor-dominant participants during movement, which may relate to the difference in underlying pathophysiology between phenotypes.

Objective. To investigate the progression of neural and motor features of Parkinson's disease in a longitudinal study, after washout of medication and bilateral subthalamic nucleus deep brain stimulation (STN DBS). Methods. Participants with clinically established Parkinson's disease underwent bilateral implantation of DBS leads (18 participants, 13 male) within the STN using standard functional frameless stereotactic technique and multi-pass microelectrode recording. Both DBS leads were connected to an implanted investigative sensing neurostimulator (Activa™ PC + S, Medtronic, PLC). Resting state STN local field potentials (LFPs) were recorded and motor disability, (the Movement Disorder Society-Unified Parkinson's Disease Rating Scale – motor subscale, MDS-UPDRS III) was assessed off therapy at initial programming, and after 6 months, 1 year, and yearly out to 5 years of treatment. The primary endpoint was measured at 3 years. At each visit, medication had been held for over 12/24 h and DBS was turned off for at least 60 min, by which time LFP spectra reached a steady state. Results. After 3 years of chronic DBS, there were no increases in STN beta band dynamics (p = 0.98) but there were increases in alpha band dynamics (p = 0.0027, 25 STNs). Similar results were observed in a smaller cohort out to 5 years. There was no increase in the MDS-UPDRS III score. Interpretation. These findings provide evidence that the beta oscillopathy does not substantially progress following combined STN DBS plus medication in moderate to advanced Parkinson's disease.

Freezing of gait (FOG), a devastating symptom of Parkinson’s disease (PD), can be refractory to current treatments such as medication and open-loop deep brain stimulation (olDBS). Recent evidence suggests that closed-loop DBS (clDBS), using beta local field potential power from the subthalamic nucleus (STN) as the control variable, can improve tremor and bradykinesia; however, no study has investigated the use of clDBS for the treatment of FOG. In this study, we provide preliminary evidence that clDBS was superior to olDBS in reducing percent time freezing and in reducing freezing behavior (gait arrhythmicity) in a person with PD and FOG. These findings warrant further investigation into the use of clDBS to treat FOG while also minimizing the total energy delivered to maintain a therapeutic effect.

Freezing of gait (FOG), a devastating symptom of Parkinson’s disease (PD), can be refractory to current treatments such as medication and open-loop deep brain stimulation (olDBS). Recent evidence suggests that closed-loop DBS (clDBS), using beta local field potential power from the subthalamic nucleus (STN) as the control variable, can improve tremor and bradykinesia; however, no study has investigated the use of clDBS for the treatment of FOG. In this study, we provide preliminary evidence that clDBS was superior to olDBS in reducing percent time freezing and in reducing freezing behavior (gait arrhythmicity) in a person with PD and FOG. These findings warrant further investigation into the use of clDBS to treat FOG while also minimizing the total energy delivered to maintain a therapeutic effect.

Resume L'omeprazole est indique chez l'enfant de plus d'un an presentant une œsophagite par reflux gastro-œsophagien objectivee par une endoscopie. L'efficacite clinique de l'omeprazole dans le traitement des œsophagites a ete mise en evidence dans plusieurs etudes pediatriques tant sur les symptomes digestifs ou extradigestifs (manifestations ORL ou respiratoires) que sur les donnees endoscopiques. Sa tolerance demontree chez l'adulte a court comme a long terme est egalement constatee au cours d'etudes pediatriques moins nombreuses a court terme (8 semaines), mais egalement pour des durees de traitement superieures. Le traitement antisecretoire de l'œsophagite ulceree chez l'enfant consiste en la prise quotidienne de 10 mg d'omeprazole(poids inferieur a 20 kg) ou 20 mg (poids superieur a 20 kg) pendant 8 semaines. Un controle endoscopique peut etre realisea la fin du traitement. Les gelules peuvent etre ouvertes et les microgranules melangees a une boisson ou un aliment legerement acide, mais ne doivent pas etre ecrasees, pilees.

Resume Introduction L’erytheme margine rhumatismal fait partie de criteres majeurs de Jones pour le diagnostic du rhumatisme aigu poststreptococcique. Devenu peu frequent dans les pays industrialises, son diagnostic est rarement evoque chez l’adulte. Observation Nous rapportons le cas d’une femme de 30 ans qui a eu deux episodes d’une eruption annulaire du visage, associee a une fievre et a des polyarthralgies. Cette eruption est survenue chaque fois quelques jours apres une angine streptococcique. Discussion Cette observation souligne que le rhumatisme poststreptococcique n’a pas completement disparu des pays developpes. Les dermatologues ne doivent pas en meconnaitre les manifestations cutanees et doivent rester vigilants quant a ses possibles complications cardiaques.

We report the successful control of an outbreak caused by imipenem-resistant VIM-1-producing Klebsiella pneumoniae (IR-Kp) in France. This outbreak occurred in a care centre for abdominal surgery that includes a 15-bed liver intensive care unit and performs more than 130 liver transplantations per year. The index case was a patient with acute liver failure transferred from a hospital in Greece for urgent liver transplantation who was carrying IR-Kp at admission as revealed by routine culture of a rectal swab. Infection control measures were undertaken and included contact isolation and promotion of hand hygiene with alcohol-based hand rub solution. Nevertheless, secondary IR-Kp cases were identified during the six following months from 3 December 2003 to 2 June 2004. From 2 June to 21 October, extended infection control measures were set up, such as cohorting IR-Kp carriers, contact patients and new patients in distinct sections with dedicated staff, limiting ward admission, and strict control of patient transfer. They led to a rapid control of the outbreak. The global attack rate of the IR-Kp outbreak was 2.5%, 13% in liver transplant patients and 0.4% in the other patients in the care centre (p

Pneumocystis jiroveci pneumonia (PCP) has become a rare opportunistic infection due to the efficacy of prophylactic regimens. We conducted a 6-year retrospective study at our institution. A total of 13 cases of PCP were diagnosed among 519 patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) (2.5%). In three patients, PCP occurred within the first 5 months following HSCT. These severely immunocompromised patients were receiving prophylaxis and had concomitant aspergillosis that caused rapid death in two of them. In 10 other patients, PCP occurred a median of 14.5 months after HSCT. In all these patients, PCP prophylaxis had been discontinued, mainly because of the suspected bone-marrow toxicity of the prophylactic regimen. Median CD4+ T cell count was 131/microl at diagnosis. Seven of these 10 patients were receiving immunosuppressive therapy for chronic graft versus host disease and three had a relapse of their hematological malignancy. One patient died from PCP despite high doses of cotrimoxazole. We conclude that PCP is still occurring after allogeneic HSCT, mainly as a late complication in patients in whom PCP prophylaxis had been prematurely discontinued. Long-term PCP prophylaxis should be maintained in patients receiving immunosuppressive drugs, and in those with low CD4+ T cell counts or a relapse of their hematological malignancy.

The aim of this study was to evaluate the safety and efficacy of intravenous iron saccharate administration in iron-deficient anemic children, under long-term parenteral nutrition, who are unable to tolerate oral iron supplementation or are unresponsive to oral supplementation because of gastrointestinal dysfunction or iron malabsorption. Methods: Twenty-two infants and children aged 5 months–17 years (median: 38 months) receiving long-term parenteral nutrition and presenting with iron deficiency anemia were included. Total iron to be infused was determined by the formula: total iron (mg) = 0.6× W (100 − Hb×100/12) ( W : weight, Hb: hemoglobin). Intravenous iron saccharate was given at the hospital. Each patient received a test dose of 25 mg of iron saccharate prior to the initiation of the infusion. Hemoglobin values, reticulocytes count, serum iron, and serum ferritin were determined before iron administration (day 1), as well as 15 and 45 days after iron administration. Results: Tolerance of intravenous iron saccharate was good except in one patient who developed transient exanthema and hypotension after completion of the last iron saccharate infusion. Intravenous iron led to a significative increase in hemoglobin concentration of 2.2 g/dl within 45 days (range: 0.4–4.3 g/dl). Conculsion: Intravenous iron supplementation with iron saccharate is an efficient procedure, replenishing iron body stores and significantly increasing the hemoglobin concentration. The possible occurrence of allergic reactions emphasizes the need for close medical supervision.