Parkinson's disease (PD) is among the disorders in which the placebo effect can play a significant role. [1][2][3][4] Functional imaging studies have demonstrated that this effect is related to dopamine release in the striatum. 5 This dopamine release appears to be linked to expectation of reward (i.e., clinical benefit), which is in turn mediated by dopamine release in the ventral striatum.Since the initial description of high-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) for the treatment of severe PD in 1995, 6 many centers have reported efficacy and the safety of this procedure. 7-10 Despite its clinical success, the mechanism underlying the effects of STN DBS in PD remains unknown. 11 Only two previous studies have been published describing the role played by expectation in the outcome of movement velocity in parkinsonian patients treated with effective STN DBS. 12,13 The objective of this study is to determine whether the degree to which patients with Parkinson's disease expect therapeutic benefit from STN DBS influences the magnitude of their improved motor response. PATIENTS AND METHODS This study was approved by the University of British Columbia Clinical Research Ethics Board (C98-0404).Ten patients with idiopathic Parkinson's disease who had received bilateral STN DBS were enrolled in the study. Disabling motor fluctuations with severe bradykinesia and dyskinesias secondary to the chronic use of antiparkinsonian medication were the main indications for surgery. There were two women and eight men whose mean age was 61 years (range, 42-78 years). The mean duration of the symptoms before surgery was 14 years (range, 6 -23 years). All underwent microelectrode-guided placement of bilateral deep brain stimulation electrodes (model 3389; Medtronic, Minneapolis, MN) in the subthalamic nuclei, connected to an implantable pulse generator below the left clavicle (Kinetra, model 7428; Medtronic). The stimulation parameters and reduced level of medications were then optimized over several months. At the moment of the study, the mean dose of L-dopa and dopamine agonist in the form of L-dopa equivalents that the patients were receiving was 690 mg (range, 200 -1,300 mg). Patients were then tested for this study after a 12-hour period of no antiparkinsonian medications and no stimulation. Four consecutive Unified Parkinson's Disease Rating Scale (UPDRS) scores were performed in the following conditions: stimulator OFF and patient aware that the stimulation was OFF; stimulator OFF and patient unaware whether the stimulation was ON or OFF; stimulator ON, patient aware; stimulator ON, patient blind. The four conditions were randomly assigned. The stimulator remained OFF or was switched OFF for 10 minutes after each evaluation. The patients were evalu-

Objective: The differentiation between keratocystic odontogenic tumour (KCOT) and other cystic/predominantly cystic odontogenic tumours is difficult on conventional CT and MR sequences as there is overlap in the imaging characteristics of these lesions. The purpose of this study was to evaluate the role of diffusion-weighted imaging (DWI) and to assess the performance of apparent diffusion coefficients (ADCs) in the differential diagnosis of odontogenic cysts and tumours. Methods: 20 patients with odontogenic cysts and tumours of the maxillomandibular region were examined with DWI. Diffusion-weighted images were obtained with a single-shot echoplanar technique with b-values of 0, 500 and 1000 s mm 22. An ADC map was obtained at each slice position. Results: The cystic areas of ameloblastoma (n510) , which yielded 100% sensitivity and 100% specificity. Conclusion: DWI can be used to differentiate KCOT from cystic (or predominantly cystic) odontogenic tumours.

Objective: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in malnutrition treatment centres (MTC). Design: Early detection and treatment of SAM using locally adapted protocols; assessment of programme outcomes, including survival, default, discharge and recovery rates. Setting: All forty-eight MTC in Jharkhand, India. Subjects: Children (n 3595) with SAM admitted to MTC (1 July 2009-30 June 2011). Results: Of children admitted, 55?0 % were girls, 77?7 % were 6-23 months old and 68?6 % belonged to scheduled tribes or castes; 34?4 % had oedema or medical complications. Of the 3418 programme exits, the proportion of children who died was 0?6 % (n 20), the proportion of children who defaulted was 18?4 % (n 628) and the proportion of children discharged was 81?0 % (n 2770). Children's average weight gain was 9?6 (SD 8?4) g/kg body weight per d and their average length of stay was 16?0 (SD 5?7) d. Among the 2770 children who were discharged from the programme, 39?4 % (n 1090) gained 15 % or more of their initial weight while 60?6 % (n 1680) gained less than 15 % of their initial weight. Conclusions: MTC provide live-saving care for children with SAM as demonstrated by high survival rates. However, the protocols and therapeutic foods currently used need to improve to ensure the recovery of all discharged children. MTC should be reserved for children with complicated SAM; children with uncomplicated SAM should be admitted to a community-based programme for the management of SAM, at a lesser risk to children and a lesser cost to families and the health system.

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