Background: Adverse effects and risks associated with glucocorticoid (GC) treatment are frequently encountered in immune-mediated neuromuscular disorders. However, significant variability exists in the management of these complications. Our aim was to establish international consensus guidance on the management of GC-related complications in neuromuscular disorders. Methods: An international task force of 15 experts was assembled to develop clinical recommendations for managing GC-related complications in neuromuscular patients. The RAND/UCLA Appropriateness Method (RAM) was employed to formulate consensus guidance statements. Initial statements were drafted following a comprehensive literature review and were refined based on anonymous expert feedback, with up to three rounds of email voting to achieve consensus. Results: Consensus was reached on statements addressing general patient care, monitoring during GC therapy, osteoporosis prevention, vaccinations, infection screening, and prophylaxis for Pneumocystis jiroveci pneumonia. A multidisciplinary approach to managing GC-related complications was highlighted as a key recommendation. Conclusions: This represents the first consensus guidance in the neurological literature on GC complications, and offer clinicians structured guidance on mitigating and managing common adverse effects associated with both short- and long-term GC use. They also provide a foundation for future debate, quality improvement, research work in this area.

Since the discovery of a significant depletion of acetylcholine in discrete areas of the brain of patients affected by Alzheimer's disease, attempts at symptomatic therapy have concentrated on acetylcholine supplementation, an approach that is based upon the efficacy of dopaminergic supplementation therapy for Parkinson's disease. Choline, then lecithin, used orally, failed to improve symptoms but the hypothesis that long-term choline supplementation might stabilize the course of Alzheimer's disease remains to be tested. Nerve growth factor may also offer that possibility. Bethanechol administered intracerebroventricularly did not help when a fixed dose was used but individual titration of more selective muscarinic agonists may prove more effective. In this article we report that tetrahydroaminoacridine (THA), given together with highly concentrated lecithin, appears to bring improvement in cognition and in functional autonomy using the Mini Mental State and the Rapid Disability Rating Scale-2 respectively, without change in behavior as reflected by the Behave-AD. Double-blind cross-over studies are in progress to establish its efficacy. Improvement in study design and means of assessment of cognition, functional autonomy and behavior have been made possible by these drug trials.

Monte Carlo simulation, in conjunction with the embedded atom method, has been used to model the composition and structure of a semicoherent (001) interphase boundary separating coexisting Cu-rich and Ag-rich phases in a binary Cu-Ag alloy. The results are compared with earlier simulations of the same boundary in a Cu-Ag-Au alloy, in which Au was found to segregate to the interface, and the boundary was found to be unstable with respect to break-up into {111} facets. The boundary in the binary system is also unstable to faceting, but displays both {100} as well as {111} facets. It is concluded that Au segregation in the ternary alloy plays an important role in stabilizing the {111} facets. The interplay between the misfit dislocations present at the interface, and the compositional features of the boundary are also discussed.

Based on the characterization of 12 clay and 5 fly ash samples, samples were selected for the following laboratory scale experiments: preparation of raw mixes, determination of the correlation between water content and plasticity, rate-controlled sintering in a laser-dilatometer, DTA-TGA-analyses, preparation, firing and testing of bars. Laboratory experiments have shown that it is necessary to bind the soluble sulphates as barium sulphate under acidic conditions and bind the free lime as phosphate when wet production methods are to be used. A full scale experiment has been carried out, resulting in the production of 16,000 red bricks containing 33% fly ash by volume in the raw mix. These fly ash bricks look satisfactory and have 10% higher strength and 2% less density than the corresponding bricks without fly ash. The water extractable matter in the two kinds of bricks were compared. The bricks were used for constructing a wall with the purpose of investigating their weather resistance.