MedicalResearch.com Interview with:Yvette I. Sheline, M.D.
Professor of Psychiatry, Radiology, Neurology
Director, Center for Neuromodulation in Depression and Stress (CNDS)
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA 19104
MedicalResearch: What are the main findings of this study?Prof. Sheline:The main findings were that in transgenic mice who are genetically altered to develop Alzheimer's amyloid plaques, citalopram dramatically slowed the growth of plaques but did not cause existing plaques to shrink. In normal young people, it decreased the production of amyloid.
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MedicalResearch Interview with: Patrick S. F. Bellgowan, PhD
Laureate Institute for Brain Research
Faculty of Community Medicine, The University of Tulsa,
Tulsa, Oklahoma
MedicalResearch: What are the main findings of the study?Dr. Bellgowan: These results demonstrate 14% and 24% smaller hippocampal volumes in collegiate football players with and without a history of concussion relative to education-, sex- and age-matched controls participants. Further, the number of years of tackle football experience was correlated with smaller hippocampi and slower baseline reaction times. The hippocampus plays a key role in memory and emotional regulation. Volumetrics of other medial temporal lobe structures (I.e. The amygdala) did NOT show differences among groups suggesting that this effect is localized to the hippocampus.
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MedicalResearch.com Interview with:Professor Jayashri Kulkarni MBBS, MPM, FRANZCP, PhD
Monash University
MedicalResearch.com: What are the main findings of the study?Professor Kulkarni: Persistent schizophrenia is difficult and unfortunately common, despite advances over the past years in antipsychotic drug development. New treatment approaches are urgently needed. Also, a specific focus for women with schizophrenia is still somewhat lacking and there is a need to consider the special issues facing women with schizophrenia.
Over many years, we have been conducting clinical trials to develop the role of adjunctive estradiol use to treat symptoms of schizophrenia. This study is the largest clinical trial in the world of this type and we found that in an 8 week, three arm, double blind, placebo-controlled, adjunctive trial of transdermal estradiol (200mcg v 100mcg v placebo) in 183 women with schizophrenia, that the women who received either 200mcg or 100mcg transdermal estradiol made a better recovery. The women who received 200mcg transdermal estradiol made a slightly better recovery than women receiving 100mcg transdermal estradiol. Both estradiol groups were significantly better than the group who received adjunctive transdermal placebo.
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MedicalResearch.com interview with:Dr Alexandra Pitman MBBS MRC Psych
MRC Clinical Research Fellow,
UCL Division of Psychiatry, UCL (University College London
MedicalResearch: What are the main findings of the study?Answer: We conducted a systematic review of all published research comparing the experience of suicide bereavement with bereavement due to other causes, in which we considered the evidence from 57 studies evaluating the effect of bereavement on death, mental health, and social functioning of family members, friends, and other close contacts of the deceased. These studies showed that parents and children bereaved by suicide were at higher risk of mental health problems after the loss than parents and children bereaved by other causes, and that spouses and mothers bereaved by suicide were at higher risk of suicide than spouses and mothers bereaved by other causes. We also found some evidence that people from a range of kinship groups bereaved by suicide report more rejection and shame than people bereaved by other violent deaths, and that feeling stigmatised by the death is commonly experienced after any violent bereavement. It seemed that people bereaved by violent deaths, for example due to accidental death, homicide, drug-related death, motor vehicle crash, undetermined death or suicide, shared a sense of feeling blamed for the death or tainted by their association with the deceased. (more…)
MedicalResearch.com Interview with: Meesha Ahuja, MD
Department of Psychiatry and Human Behavior of the
Warren Alpert Medical School of Brown University
Young Adult Behavioral Health Program at Rhode Island Hospital
Mentors: Laura Whiteley, MD and Larry Brown, MD
MedicalResearch: Why did you decided to study this topic?Dr. Ahuja: Severe mental illness is more common among college students than it was a decade ago, and the number of college students presenting for psychiatric care both on and off campus has dramatically increased. The rates of cannabis use have also been increasing among college students in the United States since the mid-1990s. The concomitant use of cannabis and other substances among general samples in psychiatric treatment has been linked to poorer clinical outcomes including increased hospitalizations, increased symptomatology, poorer treatment adherence, higher treatment resistance. However, before doing this study, there was no research that examined the effect of cannabis and other substance use disorders on the scholastic and general functioning of college students in psychiatric care.
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MedicalResearch.com Interview with: Marianna VirtanenPhD
Finnish Institute of Occupational Health
Helsinki, Finland
MedicalResearch: What are the main findings of the study?Dr. Virtanen: We examined whether psychological distress predicts incident type 2 diabetes and if the association differs between populations at higher or lower risk of type 2 diabetes. We used a clinical type 2 diabetes risk score to assess future diabetes risk and in addition, participants’ prediabetes status. We found that psychological distress did not predict future type 2 diabetes among participants who were normoglycemic and among those with prediabetes combined with a low diabetes risk score. However, psychological distress doubled the risk of type 2 diabetes among participants with prediabetes and a high diabetes risk score.
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MedicalResearch.com Interview with: Elizabeth Devore, ScD
Associate Epidemiologist
Brigham and Women’s Hospital
Instructor in Medicine, Harvard Medical School
MedicalResearch.com: What are the main findings of the study?Dr. Devore: In this study, we examined sleep duration and memory performance in a group of ~15,000 women participating in the Nurses’ Health Study. We found that women with sleep durations of 5 or fewer hours/day or 9 or more hours/day, either in midlife or later life, had worse memory at older ages than those sleeping 7 hours/day. In addition, women with sleep durations that changed by two or more hours/day from midlife to later life performed worse on memory tests compared to those whose sleep duration did not change during that time period.The magnitude of these memory differences was approximately equivalent to being 1-2 years older in age.
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MedicalResearch.com Interview with:Tara Lagu MD PhD
Assistant Professor of Medicine
Tufts University School of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Lagu:We found that use of mechanical ventilation in patients 65 and older is increasing rapidly. If current rates of increase continue, we expect that by 2020 there will be more than 600,000 hospitalizations per year that involve mechanical ventilation. This is a doubling in 20 years (2001-2020), and represents demand that could easily exceed the capacity of the US critical care system. We also found that increase in use among patients with dementia is 4 times faster than those without dementia. This is important because dementia is a terminal illness, and use of mechanical ventilation in patients with end-stage dementia is associated with poor 30-day and 1-year outcomes.
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MedicalResearch.com Interview with: Jane Topolovec-Vranic, PhD
Clinical Researcher, Trauma and Neurosurgery Program
Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto
Associate Member, Graduate Department of Rehabilitation Sciences, University of Toronto
MedicalResearch.com What are the main findings of the study?Answer: In our study we found that almost half of the men interviewed in a homeless shelter in Toronto had experienced a traumatic brain injury in their past, and that most of them had experienced their first brain injury prior to becoming homeless, usually in the early teenage years.
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MedicalResearch.com Interview with:Ziad Nasreddine MD FRCP(C)
Professeur adjoint
Université de Sherbrooke et McGill University
Neuro Rive-Sud/CEDRA: Centre Diagnostique et Recherche sur la Maladie d'Alzheimer Québec, Canada
MedicalResearch.com: What are the main findings of this study?Dr. Nasreddine: The Montreal Cognitive Assessment (MoCA) total score (MoCA-TS) and Memory Index Score (MoCA-MIS) are useful in predicting conversion to Alzheimer’s disease (AD) in individuals with mild cognitive impairment (MCI). Identifying individuals with MCI at high of conversion to Alzheimer’s disease is important clinically and for selecting appropriate subjects for therapeutic trials.
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MedicalResearch.com Interview withHelen C. Kales MD
Professor of Psychiatry
Director, Section of Geriatric Psychiatry and The Program for Positive Aging, University of Michigan
Research Scientist, VA Center for Clinical Management Research
and Geriatric Research Education and Clinical Center
VA Ann Arbor Healthcare System
Please note that this paper is the result of the deliberations of a multi-disciplinary national expert panel, not a specific study.MedicalResearch.com: What were the main findings of the expert panel?Dr. Kales: Often more than memory loss, behavioral symptoms of dementia are among the most difficult aspects of caring for people with dementia. These symptoms are experienced almost universally, across dementia stages and causes, and are often associated with poor outcomes including early nursing home placement, hospital stays, caregiver stress and depression, and reduced caregiver employment. Doctors often prescribe these patients psychiatric medications like antipsychotics, despite little hard evidence that they work well in this population and despite the risks they pose including hastening death. Meanwhile, studies show promise for non-medication behavioral and environmental approaches (such as providing caregiver education/support, creating meaningful activities and simplifying/enhancing the environment), but too few health providers are trained in their use. The method created by the national multidisciplinary group of experts (DICE which stands for Describe, Investigate, Create and Evaluate) represents a comprehensive approach to assessment and management of behavioral symptoms in dementia. For example, a new report of “agitation” from a caregiver, should be fully understood and described (e.g. who/what/when/where/risk/safety); underlying causes should be investigated (e.g. pain, changes in medications, medical conditions, poor sleep, fear); a treatment plan should be created (e.g. responding to physical problems, working collaboratively with the caregiver and other team members to institute non-pharmacologic interventions); and evaluating whether the interventions tried were effective.
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MedicalResearch.com Interview with:Li-Ching Lee, PhD, ScM
Associate Scientist,
Departments of Epidemiology and Mental Health
Johns Hopkins Bloomberg School of Public Health
Baltimore MD 21205
MedicalResearch.com: What are the main findings of the study?Dr. Li-Ching Lee: This population-based case-control study in young children provides evidence that prenatal selective serotonin reuptake inhibitor (SSRI) use may be a risk factor for autism and other developmental delays (DD). Among boys, prenatal SSRI exposure was nearly 3 times as likely in children with autism spectrum disorder (ASD) relative to children with typical development; the strongest association occurred with first-trimester exposure. Exposure was also elevated among boys with DD and was strongest in the third trimester.
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MedicalResearch.com Interview with:Dr. George Patton
Department of Paediatrics, University of Melbourne
Centre for Adolescent Health, Murdoch Children's Research Institute,
Royal Children's Hospital, Parkville, VIC, Australia
MedicalResearch.com: What are the main findings of the study?Dr. Patton: Although there has been wide acceptance that the teens are a time when emotional problems are common, views have been polarized about their significance. Some have viewed these problems are usual for this phase of life with little significance for later life mental health; others have argued that early psychiatric intervention was essential given the risks of ongoing disorders.
In this sample almost two thirds of girls and a third of boys had an episode of emotional troubles (anxiety and depression) at a level that would concern a family physician. For those where the episode were brief lasting weeks to months, recovery without further later life episodes was common. In contrast those with persistent (longer than 6 months) or recurrent emotional problems during the teens had a high likelihood of similar problems with depression and anxiety in their twenties. In general these emotional problems persisted more in females than in males.
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MedicalResearch.com Interview with:John I. Nurnberger, Jr., M.D., Ph.D.
Professor of Psychiatry
Joyce and Iver Small Professor of Psychiatry
Indiana University School of Medicine
MedicalResearch.com: What are the main findings of this study?Dr. Nurnberger: The main findings of the study are the biological pathways identified to be associated with bipolar disorder, including those involved in hormonal regulation, calcium channels, second messenger systems, and glutamate signaling. Gene expression studies implicated neuronal development pathways as well.
These findings highlight the role of certain neurobiological processes that have been considered in prior hypotheses of bipolar disorder. They underline a role for calcium signaling, which has only been clearly implicated in the genetics of bipolar disorder in recent years. They also feature hormonal processes such as the hypothalamic-pituitary-adrenal axis, which has been known to be involved in stress responses, but has not been prominent in many recent theories of the pathogenesis of bipolar disorder.
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MedicalResearch.com Interview with: Dr. Jeffery C. Huffman, M.D.
Harvard Medical School
Department of Psychiatry
Massachusetts General Hospital, Boston
MedicalResearch.com: What are the main findings of the study?Dr. Huffman: Depression and anxiety in cardiac patients are associated with adverse cardiac outcomes. We completed a very low-intensity care management intervention to identify depression and anxiety disorders during a cardiac admission and then to assist in the monitoring and management of the condition over the next 24 weeks. There have been other care management trials in cardiac patients, but ours was the first to co-manage depression and anxiety, the first to initiate treatment in the hospital, the first to take a broad population of cardiac patients rather than a single diagnosis, and the first to use such a low-resource strategy with only a single part-time social worker to coordinate care.
We found that the care management intervention was associated with significant improvements in mental health treatment, mental health related quality of life, depression, and function at 24 weeks compared to enhanced treatment as usual. We did not find differences in anxiety, adherence, or cardiac readmissions.
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MedicalResearch.com Interview with: Ioannis Tarnanas M.Sc
Senior Researcher
Gerontechnology and Rehabilitation Research Group,
ARTORG Centre for Biomedical Engineering,
University of Bern, 3010 Bern, Switzerland
MedicalResearch.com: What are the main findings of the study?Answer: We examined 75 healthy older people and 134 patients with mild cognitive impairment. Our aim was to collect neuropsychological, neurophysiological, neuroimaging and behavioural data by means of a virtual reality serious game, in order to model the profile of the patients who will progress to dementia within the next 2-4 years. We found that the prediction based on the performance at the virtual reality based computerized assessment instrument is comparable to that of more established and widely accepted biomarkers, such as ERP and MRI. This can be explained by the cognitive fidelity and richness of behavioural data collected with virtual reality based measures, which directly reflect neurocognitive processes affected at a very early stage.
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MedicalResearch.com Interview with: Michael B. Blank, PhD
Associate Professor of Psychology in Psychiatry
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA 19104-3309
MedicalResearch.com: What are the main findings of the study?Dr. Blank: We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US. We also found that severity of psychiatric symptoms increased the likelihood of infection.
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MedicalResearch.com Interview with: Prof. Dr. med. Piotr Lewczuk
Head,Lab for Clinical Neurochemistry
and Neurochemical Dementia Diagnostics,
Universitätsklinikum Erlangen,
Department of Psychiatry and Psychotherapy,
91054 Erlangen, Germany
MedicalResearch.com: What are the main findings of the study?Prof. Dr. med. Piotr Lewczuk: In our study, we investigated the concentrations of four isoforms of amyloid beta peptides in the blood of healthy young volunteers without memory complains. The participants were stratified into three groups according to their apolipoprotein E (APOE) genotype, which is the mostly investigated and generally accepted genetic risk factor for sporadic Alzheimer’s Disease (AD). It is known that the alterations of the amyloid beta metabolism are the earliest changes in the course of AD, occurring many years (or even decades) before the onset of the clinical symptoms, but it is actually not known how early these alterations start. Correspondingly, we wanted to investigate if healthy persons with genetic risk factor show changes in their amyloid beta metabolism already 30-40 years before the age when AD is usually diagnosed. We did not find any differences between the groups with and without APOE-driven risk, which might be carefully interpreted as no signs of Alzheimer’s Disease pathology in persons at risk at such an early life stage. Taken together, we think that the Alzheimer’s Disease pathology starts some 10-20 years before the beginning of the clinical symptoms, but not earlier.
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MedicalResearch.com Interview with:Bradley S. Peterson, MD
Director of the Center for Developmental Neuropsychiatry
Director of the Center for Developmental Neuropsychiatry,
New York State Psychiatric Institute
Suzanne Crosby Murphy Professor in Pediatric Neuropsychiatry,
Columbia University, NY
MedicalResearch.com: What are the main findings of the study?Dr. Peterson: We detected the presence of lactate in the brains of 13% of 75 participants who had ASD (Autism Spectrum Disorder), compared with 1% of the brains of 96 typically developing control participants. The presence of lactate was especially more common in adults who have ASD. Lactate is a product of anaerobic metabolism, which generally should not occur in healthy, living brains under normal circumstances. The presence of lactate in the brains of persons with Autism Spectrum Disorder therefore suggests the presence of deficient production of energy stores by a component of brain cells called “mitochondria”. We detected lactate most commonly in the cingulate gyrus, a region that supports the higher-order control of thought, emotion, and behavior, and that has been implicated previously in Autism Spectrum Disorder.
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MedicalResearch.com Interview withUlla Räisänen
Senior Researcher
HERG Health Experiences Research Group
Department of Primary Care Health Sciences
University of Oxford Oxford OX1 2ET
MedicalResearch.com : What are the main findings of the study?Answer: We conducted a qualitative interview study exploring how young men (aged 16-25) recognise eating disorder symptoms and decide to seek help, and to examine their experiences of initial contacts with primary care in the UK.
Our data suggest that the widespread perception of eating disorders as uniquely or predominantly a female problem led to an initial failure by young men to recognise their behaviours as symptoms of an eating disorder. Many presented late in their illness trajectory when eating disorder behaviours and symptoms were entrenched, and some felt that opportunities to recognise their illness had been missed because of others’ lack of awareness of eating disorders in men. In addition, the men discussed the lack of gender-appropriate information and resources for men with eating disorders as an additional impediment to making sense of their experiences, and some felt that health and other professionals had been slow to recognise their symptoms because they were men. (more…)
MedicalResearch.com Interview with Stephen M. Amrock, SM
Department of Pediatrics
New York University School of Medicine
New York, NY 10016
MedicalResearch.com: What are the main findings of the study?Answer: We analyzed data from a nationally representative survey on youth risk behaviors. After adjusting for other risk taking behaviors, we found that high school adolescents who indoor tan were much more likely to also engage in behaviors typically associated with eating disorders. We also noted that the link between indoor tanning and such harmful weight control behaviors was even stronger among males than females.
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MedicalResearch.com Interview with: Prof. Dr. Christa E. Müller
University of Bonn Pharmaceutical Institute Pharmaceutical
Chemistry I An der Immenburg 4 D-53121 Bonn (Endenich) Germany
MedicalResearch.com: What are the main findings of the study?Prof. Dr. Christa E. Müller: Genetically altered mice which show an aggregation of Tau protein and many symptoms of Alzheimer's Disease which progressively worsen with time was used.
Caffeine was given to one group of mice at an early stage, when the symptoms were still moderate.
The caffeine-treated mice showed better memory and less inflammation and brain damages in comparison to the non-treated control mice. This means that caffeine protected the mice to some extent. The side effects were moderate.
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MedicalResearch.com Interview with:Alex Leow, MD PhD
Psychiatric Institute
Chicago, IL 60612 and
Tony J. Simon, PhD
University of California,
Davis MIND Institute Sacramento,
CA 95817
MedicalResearch.com: What are the main findings of the study?Answer: Fragile X syndrome (FXS) is the most common inherited cause of intellectual disabilities and the most prevalent known single-gene cause of autism in males. The fragile X mental retardation 1 gene (FMR1) can be mutated with expanded numbers of CGG trinucleotide repeats in the 5’ untranslated region on the Xq27.3 site of the X chromosome. Normally, unaffected individuals have fewer than 45 CGG repeats in FMR1. When the size of the CGG repeat exceeds 200 FMR1 is silenced and the mutation is categorized as full, generating the FXS phenotype. If the expansion is between 55–200 repeats, then the individual is generally classified as a fragile X premutation carrier (fXPC). An estimated 40% of male and 8-16% of female premutation carriers later develop Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS), which is a late-onset (usually 50-70 years old) neurodegenerative disorder.
We recruited 46 neurologically symptomless young to middle aged carriers of the FMR1 gene mutation. They were age and gender matched with 42 unaffected control individuals without the gene mutation. Both groups were evaluated by cognitive testing as well as novel neuroimaging techniques termed “brain connectomics,” based on diffusion tensor imaging (DTI) whole-brain tractography. A connectome is a comprehensive map, like a wiring diagram, of neural connections in the brain. Our study is the first-ever connectome study to compare fXPCs and controls.
In short, brain connectomics enable scientists for the first time to study the global organizational properties of the human brain by applying cutting edge computational techniques, based on graph theory, to these comprehensive maps of neural connections (i.e., the brain graphs). Our main finding was that, in neurologically symptomless male carriers we detected a correlation between brain graphs’ efficiency in processing information and the number of CGG repeats in the mutated region of FMR1 (we estimated that each additional CGG repeat that in these males represents an effective increase of ~1.5 years of “brain aging”). The correlation may prove to be an effective marker of early brain aging in otherwise neurologically symptomless premutation carriers. The study also further confirmed previous findings of smaller brain stem volumes in male fXPCS than in male controls.
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MedicalResearch.com Interview with: David R. Jacobs Jr, PhD
Divisions of Epidemiology
School of Public Health
University of Minnesota, Minneapolis
MedicalResearch.com: What are the main findings of this study?Dr. Jacobs: Vigorous activity is what is well understood to improve cardiorespiratory fitness. People with high fitness are likely (based on this study) to
a) Lose fitness more slowly as they age and
b) To maintain sharper "thinking skills" into late middle age.
I think the message of this study is primarily for the people in the low to mid range of fitness in young adulthood. Thus, of more importance to the general population, if the people with low to moderate fitness simply do things, be engaged in family, job, community, move around, they would be able to do better on a treadmill test such as we used. Because those who lost less fitness over average age 25 to average age 45 had higher thinking skills at age 50, people who start moving around are likely to reap the benefit of less loss of thinking skills by average age 50.
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MedicalResearch.com Interview with: Rosebud O Roberts, M.B., Ch.B.
Professor of Epidemiology
Professor of Neurology
Mayo Clinic
MedicalResearch.com: What are the main findings of the study?
Dr. Roberts: We found that among persons 70 years and older, people with type 2 diabetes had a reduced glucose uptake (hypometabolism) in brain cells. We also found a similar association for people without type 2 diabetes but who had elevated hemoglobin A1c levels levels at the time of enrollment (HBA1c is a measure of glucose control, and represents the average blood glucose levels over a 3 month period). However, we did not find an association of diabetes with increased brain amyloid accumulation. Our findings were based on an investigation of the association of type 2 diabetes with markers of brain pathology: brain hypometabolism was assessed by 18F-fluorodeoxyglucose positron emission tomography [PET] and amyloid accumulation was assessed by 11-C Pittsburgh Compound B PET imaging.
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MedicalResearch.com Interview Invitation with: Timothy Hughes, PhD, MPH
Roena B. Kulynych Center for Memory & Cognition Research
Department of Internal Medicine
Division of Gerontology and Geriatric Medicine
Wake Forest School of Medicine
Medical Center Boulevard, Winston-Salem, NC 27157-1207
MedicalResearch.com: What are the main findings of the study?Dr. Hughes: This study is a follow-up to our recent paper that showed a novel relationship between arterial stiffness (commonly measured by pulse wave velocity) and the presence and extent of amyloid deposition in the brain, a hallmark of Alzheimer’s disease. For this study, we repeated brain amyloid imaging (using the Pittsburgh Compound B during PET imaging) in order to look for predictors of change in amyloid over two years in n=81 elderly adults aged 80+ and free from dementia. We observed that measures of systemic arterial stiffness (e.g. brachial ankle pulse wave velocity) was strongly associated with the extent of amyloid deposition in the brain at both baseline and follow-up. The change in brain amyloid accumulation over two years resulted in an increase in in the number of participants with Alzheimer’s-like (amyloid-positive) from 45% at baseline to a surprising 75% after just two years. This change in brain amyloid accumulation over two years was strongly related to having greater central stiffness (as measured by carotid femoral pulse wave velocity). These relationships between arterial stiffness and brain amyloid deposition were independent of the effects of age, gender, body mass index, antihypertensive medication use and even current blood pressure.
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MedicalResearch.com Interview with:
Gao-Jun Teng, MD
Chair and Professor, Dept of Radiology
Zhongda Hospital, Southeast University
Nanjing 210009, China
MedicalResearch.com: What are the main findings of the study? Answer: This current study demonstrates that the aberrant resting-state functional connectivity among default mode network (DMN) regions, especially the posterior cingulated cortex (PCC) to right middle temporal gyrus (MTG), is associated with insulin resistance and cognitive performance, which might be the key to understanding the cognitive impairment in type 2 diabetes (T2DM).
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MedicalResearch.com Interview with:
Yvette I. Sheline, M.D.
Professor of Psychiatry, Radiology, Neurology
Director, Center for Neuromodulation in Depression and Stress (CNDS)
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA 19104
MedicalResearch: What are the main findings of this study?
Prof. Sheline: The main findings were that in transgenic mice who are genetically altered to develop Alzheimer's amyloid plaques, citalopram dramatically slowed the growth of plaques but did not cause existing plaques to shrink. In normal young people, it decreased the production of amyloid.
(more…)
