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Ginkgo biloba extract (EGb761) has been used for many years to treat age-related cognitive disorders. Recent studies also indicate a therapeutic potential of EGb761 in Alzheimer disease (AD). Bolstered evidence indicates that mitochondrial abnormalities might be part of the spectrum of chronic oxidative stress occurring in aging and AD finally contributing to synaptic failure and neuronal degeneration.
We investigated the protective effects of EGb761 on mitochondrial function and ATP production.
As cellular models, PC12 cells and acutely dissociated brain cells from young and aged mice were investigated under a variety of conditions, e.g. oxidative and nitrosative stress, associated with impaired mitochondrial function and decreased membrane potential.
EGb761 alleviated mitochondrial functions in vitro at concentrations as low as 0.01mg/ml. The effect of EGb761 was specific, since protective effects were mainly seen after specifically impairing respiratory chain complexes II, IV, and V. Comparable findings were made with dissociated brain cells from young and aged mice where usually aged brain cells were more sensitive for the protective effects of EGb761. In addition, PC12 cells bearing an AD-related mutation in the amyloid precursor protein, that leads to enhanced beta-amyloid production, showed a greater benefit from treatment with EGb761 than control cells.
Taking together, our finding clearly show stabilization and protection of mitochondrial function as a specific and very sensitive property of EGb761 at rather low concentrations. This mechanism can explain many of the until now rather unrelated observations of EGb761 in brain aging and neurodegeneration.
To review our experience of managing patients with a dual diagnosis of metastatic cutaneous squamous cell carcinoma in the head and neck region and low-grade non-Hodgkin lymphoma. The secondary aim was to evaluate the utility of 18F-fluorodeoxyglucose positron emission tomography during diagnosis.
Patients diagnosed with metastatic cutaneous squamous cell carcinoma of the head and neck and low-grade non-Hodgkin lymphoma, in a five-year period, were identified. Patient, tumour and treatment characteristics were identified. 18F-fluorodeoxyglucose positron emission tomography imaging was reviewed and correlated with histopathology findings.
Eight patients were identified. There was a delay in diagnosis of metastatic squamous cell carcinoma in two patients. 18F-fluorodeoxyglucose positron emission tomography differentiated metastatic squamous cell carcinoma from low-grade non-Hodgkin lymphoma with a sensitivity of 88.2 per cent and a specificity of 94.7 per cent. In 38 per cent of patients, compromises in management had to be made.
The management of metastatic squamous cell carcinoma can be challenging in patients with low-grade non-Hodgkin lymphoma. 18F-fluorodeoxyglucose positron emission tomography can be useful in the diagnosis of metastatic squamous cell carcinoma in patients with low-grade non-Hodgkin lymphoma.
The aim was to reduce non-attendance for first-time consultations at psychiatric out-patient clinics.
The study was a pragmatic randomized controlled trial; the setting was seven inner-city UK out-patient clinics in Leeds. The participants were 764 subjects of working age with an appointment to attend a psychiatric out-patient clinic for the first time. The intervention was an ‘orientation statement’ letter delivered 24–48 h before the first appointment compared with standard care. The primary outcome measure was attendance at the first appointment; secondary outcomes included hospitalization, transfer of care, continuing attendance, discharge, presentation at accident and emergency and death by 1 year.
Follow-up was for 763 out of 764 subjects (>99%) for primary and for 755 out of 764 subjects (98.8%) of secondary outcome data. The orientation statement significantly reduced the numbers of people failing to attend [79 out of 388 v. 101 out of 376 subjects, relative risk 0.76, 95% confidence interval (CI) 0.59–0.98, number needed to treat 16, 95% CI 10–187].
Prompting people to go to psychiatric out-patient clinics for the first time encourages them to attend. Pragmatic trials within a busy working environment are possible and informative.
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