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Measuring the Permeability of the Blood-Brain Barrier in Alzheimer's Disease Using Dynamic Contrast Enhanced MRI
- Beth McCausland, Nathan Huneke, Aravinthan Varatharaj, Claire Gee, Amy Kunicki, Angela Darekar, Jessica Teeling, Henrik Zetterberg, Clive Holmes, Ian Galea, Jay Amin
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S61-S62
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- Article
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Aims
1) To compare blood brain barrier (BBB) permeability between AD and controls. 2) To examine the relationship between BBB permeability and cognitive decline in AD. 3) To examine the relationship between BBB permeability and peripheral markers of inflammation.
MethodsThis pilot study combines the use whole brain DCE-MRI, with measures of peripheral inflammation in serum and urine. This is a clinical cohort study with longitudinal and cross-sectional arms, involving n = 15 AD and n = 17 age and gender matched controls. BBB permeability is measured using DCE-MRI and inflammation is measured by comparing serum cytokine and urine neopterin concentrations. AD participants attend three study visits over 12 months; control participants attend two over one week. Urinary neopterin analysis is being conducted in February 2023.The 12 month follow up visits complete in May 2023. Both neopterin and longitudinal cognitive assessment data will be included in the poster presentation in July.
ResultsAD and control groups were well matched with no significant differences in demographics and multi-morbidity. We measured blood cytokine profiles for IL-6, IL-8, IL-2, IL-4, IL-1b, IL-10, IL13, IL-12p70-, TNF-alpha and INF-gamma. Only INF-Gamma was significantly different; higher in AD vs Controls (mean ± SD; 28.758 ± 90.226 AD, 3.773 ± 2.256 Control, P = 0.03). There were no significant differences in markers of neurodegeneration NfL and pTau-181, or vascular markers VCAM1, ICAM1, CRP and SAA between the groups. Ki is being calculated for overall whole brain, white matter, grey matter and hippocampus regions; an interim analysis showed no significant differences between the tissue categories, but analysis is ongoing.
ConclusionThere are currently no prognostic biomarkers that accurately predict decline in AD. We believe this pilot study will add to the literature about the utility and feasibility of DCE-MRI to measure BBB permeability. We hope that combining DCE-MRI with blood and urine biomarkers will further our knowledge of the pathophysiology of AD and help to develop minimally invasive biomarkers for identifying patients with AD, including those who are at risk of faster progression.
How Are Special Interest Sessions Used by Higher Psychiatry Trainees in Wessex Deanery?
- Claire Gee
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S23
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Aims
The aim of this survey was to establish how higher psychiatry trainees are using special interest sessions. Special interest sessions provide trainees with the opportunity to gain additional experience and are defined as ‘a clinical or clinically related area of service which cannot be provided within the training post but which is of direct relevance to the prospective career pathway of the trainee.’ The Curriculum for Specialist Training in Psychiatry states that two sessions every week must be devoted during each year of Specialty training for such personal development, which may be taken in research or to pursue special clinical interests.
MethodsAll higher psychiatry trainees working within Health Education England (HEE) Wessex Deanery were invited to complete a survey using Google Forms between 1st March 2021 and 1st April 2021. The survey included multiple choice and open questions relating to the accessibility, use and content of special interest sessions. Participants were asked to comment on their experiences. Quantitative data were analysed using Excel and qualitative data were collated and reviewed.
Results20 of the total 42 higher psychiatry trainees responded with the highest response rates from trainees in Old Age Psychiatry and dual training posts. 25% were using all their entitled special interest sessions. The remaining trainees were not able to use them consistently due to clinical service demands and 10% were not using any due to being unaware of opportunities available.
The majority of trainees were using special interest sessions for research, followed by postgraduate qualifications and psychotherapy. Other special interests included medical education, management experience and psychiatric liaison. 70% found their special interest sessions straightforward to arrange and supervisors were highlighted as a useful support.
Most trainees did not have a good awareness of special interest opportunities available within their specialty. 90% would like to be better informed of opportunities for special interest sessions.
ConclusionThe survey indicated that the majority of higher psychiatry trainees are having difficulty accessing special interest sessions due to clinical service demands and a lack of awareness of opportunities available. In order to meet Curriculum requirements, it is important that trainees are supported by supervisors and trusts to access special interest sessions. Specialty training job descriptions should allow for special interest time with appropriate cover arrangements. To improve awareness of special interest sessions, I have developed an information booklet listing opportunities available for higher psychiatry trainees in HEE Wessex Deanery.