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Objective: The aim was to elaborately describe individual pharmacokinetic-pharmacodynamic profiles in patients with difficult-to-treat dyskinesias treated with levodopa/carbidopa intestinal gel infusion., Methods: A nonrandomized, partly blinded, investigator-initiated trial was conducted in 5 patients with idiopathic Parkinson disease who were difficult to keep in "on" state without dyskinesia. Levodopa/carbidopa intestinal gel (Duodopa) doses of 80% to 120% of individually and clinically optimized dosage were infused during five 4-hour periods. Pharmacokinetic profiling, blinded assessment of video recordings, and objective movement analysis were applied every 20 to 30 minutes., Results: Individual correlations between plasma levodopa concentrations and corresponding motor scores 20 to 30 minutes after the sampling time were significant in all patients (P < 0.05 and P < 0.001). Motor scores were generally stable during the 4-hour periods. The objective test revealed that motor performance was faster the more dyskinetic the patients were. Mean individual Treatment Response Scale scores were positive in 24 of the 25 steady-state periods. Dystonia was always combined with choreic dyskinesias., Conclusions: Motor response from different doses of levodopa/carbidopa intestinal gel is in a broad sense predictable even in dyskinetic patients although major interindividual differences in dose requirement, plasma levels, and motor response are found. That motor performance was faster the more dyskinetic the patients were implies that motor performance may be better with moderate dyskinesia than with mild dyskinesia. This may explain why patients with persistent dyskinesias choose to keep their doses above the dyskinesia threshold. There is no ideal therapeutic window in such patients, but levodopa infusion offers stable motor response.

Background: Knee injuries end many careers among female soccer players. The number of injuries can be anticipated to increase because of the increasing popularity of the sport worldwide and the higher incidence of knee injuries among young females compared with males., Methods: In a community-based intervention trial performed from February 1 through October 31, 2007, we sought to reduce the number of knee injuries among female soccer players aged 13 to 19 years (N = 1506), representing 97 teams from 2 Swedish counties. A physical exercise program designed exclusively for female soccer players was combined with education of athletes, parents, and coaches to increase awareness of injury risk. The training program aimed to improve motor skills, body control, and muscle activation. New acute knee injuries, diagnosed by the physician, were the main outcome measure., Results: Three knee injuries occurred in the intervention group and 13 occurred in the control group, corresponding to incidence rates of 0.04 and 0.20, respectively, per 1000 player hours. The preventive program was associated with a 77% reduction in knee injury incidence (crude rate ratio, 0.23; 95% confidence interval, 0.04-0.83). The noncontact knee injury incidence rate was 90% lower in the intervention group (crude rate ratio, 0.10; 95% confidence interval, 0.00-0.70). Adjustment for potential confounders strengthened the estimates. Forty-five of the 48 intervention teams (94%) reported a high adherence of at least 75%., Conclusion: The incidence of knee injuries among young female soccer players can be reduced by implementation of a multifaceted, soccer-specific physical exercise program including education of individual players.

The incidence of fragility fractures has increased epidemically. Especially patients with senile dementia (including Alzheimer's disease) have a greatly increased risk of fragility fractures. Aluminum inhibits bone mineralization; the greater the aluminium exposure, the higher the risk of an early fracture. Aluminium is neurotoxic and may, in addition to genetic factors, play a role in the development of Alzheimer's disease by contributing to the formation of the characteristic beta-amyloid and neurofibrillary tangles. Thus, a common denominator between Alzheimer's disease and bone fragility may be a chronic low-grade aluminum intoxication. The epidemic of fragility fractures may be caused by increased aluminium exposure--due to the use of aluminum cooking pots or the pollution acidification of our environment. In our pilot study of 26 hip-fracture patients (13 patients with Alzheimer's disease and 13 individually age- and gender-matched non-demented patients), the aluminum content, determined mass-spectro-metrically, was higher in trabecular bone biopsies from the patients with Alzheimer's disease than from the non-demented patients (p = 0.005). The aluminum content was also higher in the younger of the 26 patients (p = 0.02). Our findings agree with the hypothesis that aluminum plays a role in the development of Alzheimer's disease and bone fragility.